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Category: Cutting Edge Literature
09/05/2023

Preventing mental illness in children that experienced maltreatment the efficacy of REThink online therapeutic game

David OA & Fodor LA. Preventing mental illness in children that experienced maltreatment the efficacy of REThink online therapeutic game. npj Digit. Med. 6, 106 (2023). https://doi.org/10.1038/s41746-023-00849-0

This article reports on a randomized controlled trial to test the efficacy of REThink, an online therapeutic game, compared to usual care in preventing mental illness in children who have experienced maltreatment. REThink was developed based on a transdiagnostic cognitive-behavioral therapy and has an action and adventure approach to learning and practicing therapeutic tasks. Each REThink level/session is completed weekly using a mobile device under the supervision of study staff. Children aged 8-12 years with self-reported maltreatment history (N=294) were recruited from schools. Participants completed pre- and post-intervention assessments measuring mental health, emotion regulation, and irrational cognitions. In the REThink group, 65% of the children completed all of the levels/sessions of the game and 18% dropped out from treatment. The REThink intervention arm was found to have a significantly lower level of emotional problems (d=0.42, p=0.001), mental health problems (d=0.35, p=0.007), maladaptive emotion regulation strategies (catastrophizing: d=0.41, p=0.002; self-blame: d=0.26, p=0.017) and irrational cognitions (d=0.54, p<0.001) compared to the control arm post-intervention. Additionally, children with higher maltreatment severity benefitted the most from the REThink game and children with lower parent attachment security benefited the least. Future research is needed to test the long-term efficacy of the REThink game.

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08/28/2023

Long-term participant retention and engagement patterns in an app and wearable-based multinational remote digital depression study

Zhang Y, Pratap A, Folarin AA, Sun S, Cummins N, Matcham F, Vairavan S, Dineley J, Ranjan Y, Rashid Z, Conde P, Stewart C, White KM, Oetzmann C, Ivan A, Lamers F, Siddi S, Rambla CH, Simblett S, Nica R, Mohr DC, Myin-Germeys I, Wykes T, Maria Haro J, Penninx BWJH, Annas P, Narayan VA, Hotopf M, Dobson RJB. (2023). Long-term participant retention and engagement patterns in an app and wearable-based multinational remote digital depression study. NPJ Digital Medicine, 6(1), 25–25. https://doi.org/10.1038/s41746-023-00749-3

This paper reported findings related to long-term participant retention and engagement in a large observational digital study for depression, using survey and passive sensor data collected via smartphones and Fitbit devices. Participants (N=614) were recruited from three sites in the United Kingdom, Spain and Netherlands. Data were collected for up to 2 years by the EU research program RADAR-MDD. The majority of participants (68%) remained engaged in the study after 43 weeks. Smartphone and Fitbit usage data showed 3 distinct engagement subgroups for each data stream (most engaged, medium engaged, and least engaged). The least engaged group tended to have the highest depression severity and took significantly longer to respond to survey notifications. The least engaged were on average 5 years younger than the most engaged group. Roughly 45% of participants who stopped completing surveys after 8 weeks continued to share Fitbit data (average of 42 weeks). Findings could inform the design of future digital health studies to enable equitable and balanced data collection from diverse populations.

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08/21/2023

As soon as I start trusting human beings, they disappoint me, and now I am going to get on an app that someone could hack. I really do not want to take that chance”: barriers and facilitators to digital peer support implementation into community mental health centers.

Fortuna KL, Divatia S, Neupane S, Geiger P and Bohm A (2023) “As soon as I start trusting human beings, they disappoint me, and now I am going to get on an app that someone could hack. I really do not want to take that chance”: barriers and facilitators to digital peer support implementation into community mental health centers. Front. Digit. Health 5:1130095. doi: 10.3389/fdgth.2023.1130095

This study aimed to identify barriers and facilitators to implementation of digital peer support based on perspectives of patients with serious mental illness (SMI) and certified peer support specialists. Semi-structured qualitative interviews were conducted with 27 participants (17 persons with SMI and 10 certified peer support specialists) at an urban community mental health center. Agency staff in a community mental health center shared information about the study with potential participants for recruitment. The interview guide included six broad questions to evaluate feasibility, acceptability, and effectiveness of a digital peer support intervention for patients with SMI. Patient participants were on average 51 years of age, mostly male, white and had varying mental health diagnoses. Peer support specialists were on average 40 years of age, all female and white. Nine barriers were identified: 1) adaptability to the needs of older patients, 2) technology complexity, 3) cost of implementation, 4) compatibility with patients’ real-world environment, 5) quality of communications, 6) availability of resources, 7) access to information, 8) lack of human interaction, and 9) patients’ personality and characteristics. Two facilitators were identified: 1) increased access to health care and 2) relative advantage of implementing digital peer support compared to in-person meetings. Overall, patients with SMI have unique needs regarding training and access to digital peer support. In-person interaction is preferred, but digital peer support can be a helpful augment to clinical treatment.  Identification of implementation barriers and facilitators can inform multilevel strategies to increase uptake of digital peer support in community mental health centers.

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08/07/2023

Identifying Desired Features That Would Be Acceptable and Helpful in a Wrist-Worn Biosensor–Based Alcohol Intervention: Interview Study Among Adults Who Drink Heavily

Richards VL, Rajendran S, Cook RL, Leeman RF, Wang Y, Prins C, Cook C. Identifying Desired Features That Would Be Acceptable and Helpful in a Wrist-Worn Biosensor–Based Alcohol Intervention: Interview Study Among Adults Who Drink Heavily. J Med Internet Res 2023;25:e38713. doi: 10.2196/38713

Researchers identified desired features that could help people reduce their drinking in a wrist-worn biosensor-based alcohol intervention for adults who drink heavily. Wearable alcohol biosensors can passively and continuously measure ethanol excreted through the skin. Participants were at least 40 years old, drank at least twice per week, and were interested in reducing their drinking, and were recruited via an alcohol contingency study, a contact registry, and referrals. In-depth qualitative interviews were conducted on Zoom with 20 participants. Interviews included questions about participants’ thoughts about a wrist-worn biosensor, potential helpfulness to reduce drinking, and what information they would want to receive from the biosensor. Participants reported five major desired feature themes: 1) comfort and look of the biosensor, 2) personalized prompts and feedback, 3) time wearing the biosensor, 4) sharing data with friends, family, and providers, and 5) incorporation of mental health support. In general, participants were open to wearing the biosensor, but were only inclined to engage with the biosensor content if had they were motivation to reduce drinking. Findings also indicated that a mobile app that stores and interprets sensor data for participants to track drinking patterns could be beneficial. Engaging potential end-users to identify desire intervention features can inform and optimize development of interventions that use wrist-worn biosensors to reduce alcohol use.

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07/31/2023

Preliminary Implementation Outcomes of a Free Online Toolkit to Support Exposure Therapy Implementation for Youth

Becker-Haimes EM, Wislocki K, Schriger SH, Kratz HE, Sanchez AL, Clapp D, Frank HE. Preliminary Implementation Outcomes of a Free Online Toolkit to Support Exposure Therapy Implementation for Youth. Child Youth Care Forum (2023). https://doi.org/10.1007/s10566-023-09732-1

Exposure therapy is a cognitive-behavioral treatment tool for youth anxiety but is highly underutilized in routine clinical care. This study assessed usage and clinician perspectives of an online toolkit that supports the use of exposure therapy with anxious youth, called the Resource for Exposure for Anxiety Disordered Youth (READY). READY is hosted on a freely available website and has been disseminated to clinicians. Researchers extracted web analytics from the READY platform and conducted brief, anonymous electronic surveys of site users to assess READY adoption, utility, and the association with exposure therapy use. In its first three years, READY had 13,543 page views across 1731 unique users. READY clinician users (N=49, mean age=34 years, 82.9% female, 71% White) completed the survey. Survey data suggested variability in usage and perceived utility across toolkit components. READY was perceived positively overall by users and was most commonly used to prepare for exposure therapy sessions by reviewing tips or generating exposure ideas. Open-ended responses about perceived challenges in exposure delivery with youth found common barriers to be engagement by patients, difficulties with the family system, and difficulties with generating ideas for exposure practices. Although the study engaged only a small number of READY users (14%) to complete the survey, findings suggest the READY toolkit, a free online implementation resource, could be a promising tool to support clinicians delivering exposure therapy and may augment traditional training and consultation.

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07/24/2023

A Mobile App to Promote Alcohol and Drug SBIRT Skill Translation Among Multi-Disciplinary Health Care Trainees: Results of a Randomized Controlled Trial

Curtis AC, Satre DD, Sarovar V, Wamsley M, Ly K & Satterfield J. (2022). A mobile app to promote alcohol and drug SBIRT skill translation among multi-disciplinary health care trainees: Results of a randomized controlled trial. Substance Abuse, 43(1), 13–22. https://doi.org/10.1080/08897077.2019.1686723

The aim of this study was to evaluate the effectiveness of an alcohol and drug screening, brief intervention, and referral to treatment (SBIRT) mobile app to support healthcare trainees working in various clinical settings. A randomized controlled trial of a new mobile app was conducted among 131 participants who were health profession trainees, had completed SBIRT training in the past year, and had a personal mobile device. The app had three main functions: 1) review of SBIRT skills and substance use disorders, 2) application of SBIRT (including screeners, intervention strategies and tools), and 3) data collection on SBIRT delivery via brief surveys. Participants were randomized to either the SBIRT app or the control condition (no access to the app). Participants completed weekly self-report assessments on SBIRT delivery over the 10-week study duration. Seventy-eight percent of participants assigned to the SBIRT app downloaded it and logged in. There were no statistically significant differences between the groups in the percentage of patients screened, brief interventions delivered, or referrals made to treatment. Additionally, there were no differences between the two arms at baseline nor at the end of the study for attitudes, beliefs, confidence in ability to deliver SBIRT, or behavioral intent to deliver SBIRT. In the group that received the SBIRT app, the average system usability score was 62.00 (SD=12.01), which is considered below average. Participants spent an average of 8.81 minutes in the app. Based on these findings, despite good uptake of the SBIRT app, adherence was low. Authors noted that the effect of the classroom training prior to app access is unknown; it is possible that this training reduced the need for the SBIRT app, leading to non-significant differences between the two arms. The potential for use of digital apps to support the translation of best practices from classroom to clinic is promising; however, additional research is needed to improve engagement and adherence.

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07/17/2023

Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses

Zhao X, Stadnick N, Ceballos-Corro E, Castro Jr J, Mallard-Swanson K, Palomares K, Eikey E, Schneider M, Zheng K, Mukamel D, Schueller S, Sorkin D. Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses. JMIR Form Res 2023;7:e45718. DOI: 10.2196/45718

This article identified barriers, facilitators, and best practices for implementing digital mental health interventions (DMHIs) according to the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. This qualitative interview study is part of a larger state-funded project in which six county behavioral health departments in California explored the use of DMHIs as part of mental health services. Interviews were conducted with clinical staff, peer support specialists and leadership. The interview was structured using the EPIS domains of relevant inner context (i.e., individual and organizational characteristics), outer context (i.e., patient characteristics, policy, fiscal mandates), innovation factors (i.e., fit of the innovation), and bridging factors (i.e., community-academic partnerships). Sixty-nine interviews were included for analysis. Three main themes were identified: readiness of individuals, readiness of innovations, and readiness of organizations and systems. Readiness of individuals included patients’ access to technology and digital literacy to participate in DMHIs. Innovation-level readiness pertained to accessibility, clinical usefulness, safety and fit of DMHIs. On the organization and system level, providers and leaders held positive views about DMHIs. Based on these findings, successful implementation of DHMIs requires readiness at the individual, innovation, and organizational levels. The authors recommend equitable device distribution and digital literacy training at the individual level. Adapting DMHIs to fit clients’ needs, as well as clinical workflow, is also recommended. To improve at the organization level, providers and local behavioral health departments should be supported with appropriate technology and training.

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07/10/2023

Informing the development of the Coaching Online and Community Health (COACH) program: a qualitative study of clubhouse members living with serious mental illness

O’Neill K, Hand R, Diop B, Weiss H, Cruz Pfaeffle A, Maragatham P, Rice K, Naslund JA. Informing the development of the coaching online and community health (COACH) program: a qualitative study of clubhouse members living with serious mental illness. Transl Behav Med. 2023 May 13;13(5):343-353. doi: 10.1093/tbm/ibad001.

Clubhouse organizations for individuals with serious mental illness (SMI) are structured psychosocial rehabilitation communities, some of which have developed virtual service platforms during the COVID-19 pandemic. This qualitative study explored clubhouse members’ experiences engaging with a virtual clubhouse platform during the COVID-19 pandemic; preferences for interest in and access to digital health content was assessed, as well as suggestions for an online peer lifestyle intervention. The study was guided by a community-based participatory action research framework. Ten focus groups were conducted with 33 clubhouse members (ages 28 to 69 years old, 54.3% women). Participants expressed mixed views about use of the virtual clubhouse platform (delivered over Zoom), with some finding that meeting virtually was better for social anxiety, while others reporting it challenging to interact online and pick up on social cues. The virtual platform offered new opportunities to reach individuals with SMI during the pandemic, but participants noted the importance of having staff to help them get online and navigate the virtual platform. Focus group members highlighted that compatibility with the person facilitating the intervention content was necessary for engagement. Another reported motivation for engagement was participation in health and wellness activities that bring joy and access to community resources and involvement. Recommendations from this study will inform a future adaptation of an intervention, called Group Lifestyle Balance, to suit the needs of clubhouse members.

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07/03/2023

Cost-effectiveness of Internet Interventions Compared With Treatment as Usual for People With Mental Disorders: Systematic Review and Meta-analysis of Randomized Controlled Trials

Rohrbach P, Dingemans A, Evers C, Van Furth E, Spinhoven P, Aardoom J, Lähde I, Clemens F, Van den Akker-Van Marle M. Cost-effectiveness of Internet Interventions Compared With Treatment as Usual for People With Mental Disorders: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2023;25:e38204. DOI: 10.2196/38204

A systematic review and meta-analysis were conducted to investigate the cost-effectiveness of internet interventions for mental disorders compared to usual care. Eligibility criteria for included studies were randomized controlled trials with participants who reported any mental health disorder or symptoms, an intervention that was phone- or internet-based, reported outcomes on both quality of life and costs, and published in English. Researchers extracted data to report risk of bias, quality of the economic evaluation, quality-adjusted life years, and costs. The incremental net monetary benefit was calculated and pooled. Thirty-seven studies met eligibility criteria. Overall, the quality of economic evaluations was rated as moderate and the risk of bias as high. Internet interventions were slightly more effective in improving quality of life than usual care (Hedges g=0.052, p=.02) but with similar cost (Hedges g=0.002, p=.96). The pooled incremental net benefit was $255 (95% CI $91 to $419), favoring internet interventions over usual care. This review is a starting point for researchers to further understand the cost-effectiveness of internet interventions for mental disorders. Future work could investigate studies with more homogenous interventions or designs. Additionally, studies from non-Western cultures or low-income countries were not included in this review. To conclude, the cost-effectiveness of internet interventions compared with usual care is likely but not guaranteed.

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