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For: Braun L, Freund J, Thielecke J, Baumeister H, Ebert DD, Titzler I. Barriers to and Facilitators of Engaging With and Adhering to Guided Internet-Based Interventions for Depression Prevention and Reduction of Pain-Related Disability in Green Professions: Mixed Methods Study. JMIR Ment Health 2022;9:e39122. [PMID: 36350684 PMCID: PMC9685507 DOI: 10.2196/39122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 01/02/2023] Open

For:	Braun L, Freund J, Thielecke J, Baumeister H, Ebert DD, Titzler I. Barriers to and Facilitators of Engaging With and Adhering to Guided Internet-Based Interventions for Depression Prevention and Reduction of Pain-Related Disability in Green Professions: Mixed Methods Study. JMIR Ment Health 2022;9:e39122. [PMID: 36350684 PMCID: PMC9685507 DOI: 10.2196/39122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 01/02/2023] Open

Number

Cited by Other Article(s)

Mao Y, Shi RX, Gao LM, Xu AY, Li JN, Wang B, Wu JY. Construction of a nomogram-based risk prediction model for depressive symptoms in middle-aged and young breast cancer patients. World J Clin Oncol 2025;16:102208. [DOI: 10.5306/wjco.v16.i4.102208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Revised: 01/04/2025] [Accepted: 02/14/2025] [Indexed: 03/26/2025] Open

Abstract

BACKGROUND

Breast cancer (BC) is the second most common malignancy globally. Young and middle-aged patients face more pressures from diagnosis, treatment, costs, and psychological issues like self-image concerns, social barriers, and professional challenges. Compared to other age groups, they have higher recurrence rates, lower survival rates, and increased risk of depression. Research is lacking on factors influencing depressive symptoms and predictive models for this age group.

AIM

To analyze factors influencing depressive symptoms in young/middle-aged BC patients and construct a depression risk predictive model.

METHODS

A total of 360 patients undergoing BC treatment at two tertiary hospitals in Jiangsu Province, China from November 2023 to April 2024 were included in the study. Participants were surveyed using a general information questionnaire, the patient health questionnaire depression scale, the visual analog scale for pain, the revised family support scale, and the long form of the international physical activity questionnaire. Univariate and multivariate analyses were conducted to identify the factors affecting depression in middle-aged and young BC patients, and a predictive model for depression risk was developed based on these findings.

RESULTS

Among the 360 middle-aged and young BC patients, the incidence rate of depressive symptoms was 38.61% (139/360). Multivariate analysis revealed that tumor grade, patient’s monthly income, pain score, family support score, and physical activity score were factors influencing depression in this patient group (P < 0.05). The risk prediction model constructed based on these factors yielded an area under the receiver operating characteristic curve of 0.852, with a maximum Youden index of 0.973, sensitivity of 86.80%, specificity of 89.50%, and a diagnostic odds ratio of 0.552. The Hosmer-Lemeshow test for goodness of fit indicated an adequate model fit (χ² = 0.360, P = 0.981).

CONCLUSION

The constructed predictive model demonstrates good predictive performance and can serve as a reference for medical professionals to early identify high-risk patients and implement corresponding preventive measures to decrease the incidence of depressive symptoms in this population.

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Benjet C, Zainal NH, Albor Y, Alvis-Barranco L, Carrasco Tapia N, Contreras-Ibáñez CC, Cortés-Morelos J, Cudris-Torres L, de la Peña FR, González N, Gutierrez-Garcia RA, Vargas-Contreras E, Medina-Mora ME, Patiño P, Gildea SM, Kennedy CJ, Luedtke A, Sampson NA, Petukhova MV, Zubizarreta JR, Cuijpers P, Kazdin AE, Kessler RC. The Effect of Predicted Compliance With a Web-Based Intervention for Anxiety and Depression Among Latin American University Students: Randomized Controlled Trial. JMIR Ment Health 2025;12:e64251. [PMID: 40053727 PMCID: PMC11909483 DOI: 10.2196/64251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 01/10/2025] [Accepted: 01/10/2025] [Indexed: 03/09/2025] Open

Abstract

BACKGROUND

Web-based cognitive behavioral therapy (wb-CBT) is a scalable way to reach distressed university students. Guided wb-CBT is typically superior to self-guided wb-CBT over short follow-up periods, but evidence is less clear over longer periods.

OBJECTIVE

This study aimed to compare short-term (3 months) and longer-term (12 months) aggregate effects of guided and self-guided wb-CBT versus treatment as usual (TAU) in a randomized controlled trial of Colombian and Mexican university students and carry out an initially unplanned secondary analysis of the role of differential predicted compliance in explaining these differences.

METHODS

The 1319 participants, recruited either through email and social media outreach invitations or from waiting lists of campus mental health clinics, were undergraduates (1038/1319, 78.7% female) with clinically significant baseline anxiety (Generalized Anxiety Disorder-7 score≥10) or depression (Patient Health Questionnaire-9 score≥10). The intervention arms comprised guided wb-CBT with weekly asynchronous written human feedback, self-guided wb-CBT with the same content as the guided modality, and TAU as provided at each university. The prespecified primary outcome was joint remission (Generalized Anxiety Disorder-7 score=0-4 and Patient Health Questionnaire-9 score=0-4). The secondary outcome was joint symptom reduction (mean scores on the Patient Health Questionnaire Anxiety and Depression Scale) at 3 and 12 months after randomization.

RESULTS

As reported previously, 3-month outcomes were significantly better with guided wb-CBT than self-guided wb-CBT (P=.02) or TAU (P=.02). However, subsequent follow-up showed that 12-month joint remission (adjusted risk differences=6.0-6.5, SE 0.4-0.5, and P<.001 to P=.007; adjusted mean differences=2.70-2.69, SE 0.7-0.8, and P<.001 to P=.001) was significantly better with self-guided wb-CBT than with the other interventions. Participants randomly assigned to the guided wb-CBT arm spent twice as many minutes logged on as those in the self-guided wb-CBT arm in the first 12 weeks (mean 12.5, SD 36.9 vs 5.9, SD 27.7; χ21=107.1, P<.001), whereas participants in the self-guided wb-CBT arm spent twice as many minutes logged on as those in the guided wb-CBT arm in weeks 13 to 52 (mean 0.4, SD 7.5 vs 0.2, SD 4.4; χ21=10.5, P=.001). Subgroup analysis showed that this longer-term superiority of self-guided wb-CBT was confined to the 40% (528/1319) of participants with high predicted self-guided wb-CBT compliance beyond 3 months based on a counterfactual nested cross-validated machine learning model. The 12-month outcome differences were nonsignificant across arms among other participants (all P>.05).

CONCLUSIONS

The results have important practical implications for precision intervention targeting to maximize longer-term wb-CBT benefits. Future research needs to investigate strategies to increase sustained guided wb-CBT use once guidance ends.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04780542; https://www.clinicaltrials.gov/study/NCT04780542.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-022-06255-3.

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Affiliation(s)

Corina Benjet Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Nur Hani Zainal Department of Health Care Policy, Harvard Medical School, Boston, MA, United States Department of Psychology, Kent Ridge Campus, National University of Singapore, Kent Ridge, Singapore
Yesica Albor Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Libia Alvis-Barranco Department of Psychology, Universidad Popular de Cesar, Valledupar, Colombia
Nayib Carrasco Tapia Department of Psychology, Universidad Cooperativa de Colombia, Medellin, Colombia
Carlos C Contreras-Ibáñez Department of Sociology, Universidad Autónoma Metropolitana, Mexico City, Mexico
Jacqueline Cortés-Morelos Department of Psychiatry and Mental Health, Universidad Nacional Autónoma de México, Mexico City, Mexico
Lorena Cudris-Torres Department of Psychology, Fundación Universitaria del Area Andina, Valledupar, Colombia
Francisco R de la Peña Unit of Research Promotion, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Noé González Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Raúl A Gutierrez-Garcia Department of Psychology, Facultad de Estudios Superiores, Universidad La Salle Bajío, Salamanca, Mexico
Eunice Vargas-Contreras Facultad de Ciencias Administrativas y Sociales, Universidad Autónoma de Baja California, Ensenada, Mexico
Maria Elena Medina-Mora Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico Seminar of Studies on Globality, National Autonomous University of Mexico (UNAM), Mexico City, Mexico Faculty of Psychology, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
Pamela Patiño Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Sarah M Gildea Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
Chris J Kennedy Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
Alex Luedtke Department of Statistics, University of Washington, Seattle, WA, United States Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Nancy A Sampson Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
Maria V Petukhova Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
Jose R Zubizarreta Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
Pim Cuijpers Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Alan E Kazdin Department of Psychology, Yale University, New Haven, CT, United States
Ronald C Kessler Department of Health Care Policy, Harvard Medical School, Boston, MA, United States

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Thielecke J, Buntrock C, Freund J, Braun L, Ebert DD, Berking M, Baumeister H, Titzler I. How to promote usage of telehealth interventions for farmers' mental health? A qualitative study on supporting and hindering aspects for acceptance and satisfaction with a personalized telephone coaching for depression prevention. Internet Interv 2023;34:100671. [PMID: 37772161 PMCID: PMC10523267 DOI: 10.1016/j.invent.2023.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023] Open

Abstract

Low-threshold and remotely delivered preventive interventions, like telephone coaching, are warranted for farmers who experience multiple risk factors for depression, live in underserved areas, and show low help-seeking behavior. Factors facilitating uptake and actual use of effective remote interventions are important to reduce depression disease burden. This study aimed at identifying factors that potentially can influence acceptance of and satisfaction with a telephone coaching in this occupational group.Semi-structured interviews were based on the 'Unified Theory of Acceptance and Use of Technology', the 'Evaluation', and 'Discrepancy' models for satisfaction. Interviews were conducted with 20 of 66 invited participants of a 6-months telephone coaching during an effectiveness or implementation study. Audio-recorded interviews were transcribed and analyzed (deductive-inductive qualitative content analysis). Independent coding by two persons resulted in good agreement (Κ = 0.80). Participants validated results via questionnaire.Overall, 32 supporting (SF) and 14 hindering factors (HF) for acceptance and satisfaction were identified and organized into five dimensions: Coaching result (SF = 9, HF = 3), coach (SF = 9, HF = 1), organization (SF = 5, HF = 2), the telephone as communication medium (SF = 4, HF = 5) and participant characteristics (SF = 5, HF = 3). Most named SFs were 'Flexible appointment arrangement' (n = 19/95 %) and 'low effort' (n = 17/85 %), while most reported HFs were 'lack of visual cues' (n = 12/60 %) and 'social/professional involvement restricts change process' (n = 10/50 %).The perceived changes initiated by coaching, a low effort through telephone conduct, and the indicated personalization were identified as important influencing factors on acceptance and satisfaction based on interviewees' statements. Both may be further enhanced by offering choice and advice for delivery formats (e.g., video-calls) and training of coaches in farm-related issues.

Study registration

German Clinical Trial Registrations: DRKS00017078 and DRKS00015655.

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Toh SHY, Lee SC, Sündermann O. Mobile Behavioral Health Coaching as a Preventive Intervention for Occupational Public Health: Retrospective Longitudinal Study. JMIR Form Res 2023;7:e45678. [PMID: 37862086 PMCID: PMC10625093 DOI: 10.2196/45678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 08/17/2023] [Accepted: 08/31/2023] [Indexed: 10/21/2023] Open

Abstract

BACKGROUND

Researchers have recently proposed that behavioral health coaching (BHC) is effective in promoting proactive care among employees. However, to qualify as a preventive workplace intervention, more research is needed to evaluate whether BHC can further elevate well-being among moderately mentally healthy employees.

OBJECTIVE

Using real-world data, this study evaluates the preliminary effectiveness of app-based BHC against a nonrandomized control group with open access to self-help tools in improving well-being (ie, mood levels and perceived stress). The study also explores the active ingredients of BHC and dose-response associations between the number of BHC sessions and well-being improvements.

METHODS

Employees residing across Asia-Pacific countries (N=1025; mean age 30.85, SD 6.97 y) who reported moderately positive mood and medium levels of perceived stress in their first week of using the mental health app Intellect were included in this study. Users who were given access by their organizations to Intellect's BHC services were assigned to the "Coaching" condition (512/1025, 49.95%; mean age 31.09, SD 6.87 y), whereas other employees remained as "Control" participants (513/1025, 50.05%; mean age 30.61, SD 7.06 y). To evaluate effectiveness, monthly scores from the validated mood and stress sliders were aggregated into a composite well-being score and further examined using repeated-measure conditional growth models. Postcoaching items on "Perceived Usefulness of the BHC session" and "Working Alliance with my Coach" were examined as active ingredients of BHC using 1-1-1 multilevel mediation models. Finally, 2-way repeated-measure mixed ANOVA models were conducted to examine dose-response effects on well-being improvements between groups (coaching and control) across time.

RESULTS

Growth curve analyses revealed significant time by group interaction effects for composite well-being, where "Coaching" users reported significantly greater improvements in well-being than "Control" participants across time (composite well-being: F1,391=6.12; ηp2=0.02; P=.01). Among "Coaching" participants, dependent-sample 2-tailed t tests revealed significant improvements in composite well-being from baseline to 11 months (t512=1.98; Cohen d=0.17; P=.049). Improvements in "Usefulness of the BHC session" (β=.078, 95% Cl .043-.118; P<.001) and "Working Alliance" (β=.070, 95% Cl .037-.107; P<.001) fully mediated within-level well-being enhancements over time. Comparing against baseline or first month scores, significant time by group interactions were observed between the second and sixth months, with the largest effect size observed at the fifth month mark (first month vs fifth month: F1,282=15.0; P<.001; ηp2=0.051).

CONCLUSIONS

We found preliminary evidence that BHC is an effective preventive workplace intervention. Mobile-based coaching may be a convenient, cost-effective, and scalable means for organizations and governments to boost public mental health.

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Freund J, Ebert DD, Thielecke J, Braun L, Baumeister H, Berking M, Titzler I. Using the Consolidated Framework for Implementation Research to evaluate a nationwide depression prevention project (ImplementIT) from the perspective of health care workers and implementers: Results on the implementation of digital interventions for farmers. Front Digit Health 2023;4:1083143. [PMID: 36761450 PMCID: PMC9907445 DOI: 10.3389/fdgth.2022.1083143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/28/2022] [Indexed: 01/24/2023] Open

Abstract

Introduction

Depression has a significant impact on individuals and society, which is why preventive measures are important. Farmers represent an occupational group exposed to many risk factors for depression. The potential of guided, tailored internet-based interventions and a personalized telephone coaching is evaluated in a German project of the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG). While user outcomes are promising, not much is known about actual routine care use and implementation of the two digital health interventions. This study evaluates the implementation from the perspective of social insurance employees to understand determinants influencing the uptake and implementation of digital interventions to prevent depression in farmers.

Methods

The data collection and analysis are based on the Consolidated Framework for Implementation Research (CFIR). Health care workers (n = 86) and implementers (n = 7) completed online surveys and/or participated in focus groups. The surveys consisted of validated questionnaires used in implementation research, adapted items from the CFIR guide or from other CFIR studies. In addition, we used reporting data to map implementation based on selected CFIR constructs.

Results

Within the five CFIR dimensions, many facilitating factors emerged in relation to intervention characteristics (e.g., relative advantage compared to existing services, evidence and quality) and the inner setting of the SVLFG (e.g., tension for change, compatibility with values and existing working processes). In addition, barriers to implementation were identified in relation to the outer setting (patient needs and resources), inner setting (e.g., available resources, access to knowledge and information) and characteristics of individuals (e.g., self-efficacy). With regard to the implementation process, facilitating factors (formal implementation leaders) as well as hindering factors (reflecting and evaluating) were identified.

Discussion

The findings shed light on the implementation of two digital prevention services in an agricultural setting. While both offerings seem to be widely accepted by health care workers, the results also point to revealed barriers and contribute to recommendations for further service implementation. For instance, special attention should be given to "patient needs and resources" by raising awareness of mental health issues among the target population as well as barriers regarding the inner setting.

Clinical Trial Registration

German Clinical Trial Registration: [DRKS00017078]. Registered on 18.04.2019.

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Braun L, Terhorst Y, Titzler I, Freund J, Thielecke J, Ebert DD, Baumeister H. Lessons Learned from an Attempted Pragmatic Randomized Controlled Trial for Improvement of Chronic Pain-Associated Disability in Green Professions: Long-Term Effectiveness of a Guided Online-Based Acceptance and Commitment Therapy  (PACT-A). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022;19:13858. [PMID: 36360738 PMCID: PMC9655679 DOI: 10.3390/ijerph192113858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]

Freund J, Buntrock C, Braun L, Thielecke J, Baumeister H, Berking M, Ebert DD, Titzler I. Digital prevention of depression for farmers? A qualitative study on participants' experiences regarding determinants of acceptance and satisfaction with a tailored guided internet intervention program. Internet Interv 2022;29:100566. [PMID: 36039069 PMCID: PMC9418375 DOI: 10.1016/j.invent.2022.100566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/23/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open

Abstract

Introduction

Farmers, forest workers and gardeners have a higher risk of developing depression compared to other occupational populations. As part of the German pilot project "With us in balance", the potential of six guided internet- and mobile-based interventions (IMIs) to prevent depression among their insurants is examined. The IMI program is tailored to various risk factors of depression, individual symptoms, and needs. Although IMIs have been shown to be effective in reducing depressive symptoms, there is little qualitative research about the acceptance of digital preventive IMIs. The aim of this qualitative study is to gain insights into participants' experiences with the guided IMIs by focusing on determinants for acceptance and satisfaction.

Methods

Semi-structured interviews were conducted with 22/171 (13 %) intervention group (IG) participants of a randomized controlled trial. The interview guide was developed based on theoretical models of user acceptance (Unified Theory of Acceptance and Use of Technology) and patient satisfaction (evaluation model, discrepancy theory). The interviews were evaluated independently by two coders performing a deductive-inductive content analysis and attaining a substantial level of agreement (K = 0.73).

Results

The qualitative analysis revealed 71 determinants for acceptance and satisfaction across ten dimensions: performance expectancy, organisation, e-coach, usability, training content and structure, training usage, training outcome, financing, social influence, and behavioural intention. The most frequently identified drivers for the IMI use include "location independence", "positive relationship to the e-coach" (each n = 19, 86 %), "personal e-coach guidance", "expertise of the e-coach", "target group specific adaptation" (each n = 18, 82 %), "flexibility", "high willingness for renewed participation" (each n = 17, 77 %), "fast and easy availability", "training of health enhancing attitudes and behaviours" and "content with figurative expressions" (each n = 16, 73 %).

Discussion

The qualitative findings predominantly suggest the acceptance of and satisfaction with the IMI program for the prevention of depression in famers and related lines of work. Many identified positive drivers are related to the e-coach guidance, which emphasizes its importance in the preventive setting from the perspective of the participants. Nevertheless, some negative aspects have been identified which help to understand potential weaknesses of the IMI program. Participants indicated different needs in terms of IMI content and usage, which points towards the potential benefit of individualisation. The possibility of being able to use IMIs anonymously, flexibly and independently of location might be highly relevant for this specific target group.

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