Digital Mental Health Interventions (DMHIs) hold significant potential in addressing gaps in mental health treatment, enhancing mental health literacy, and mitigating associated stigma. However, DMHIs have not been systematically evaluated in terms of potential users' attitudes, perceived usefulness, and intentions to use. Thus, this study aims to consolidate evidence to ascertain users' attitudes, perceived usefulness, and intentions to utilize DMHIs.

The meta-analysis reports adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A comprehensive search of databases: Medline, CINHAL, PsycINFO, SCOPUS, and Web of Science, was conducted. As part of the screening process, Covidence database management software was used. Metaprop command was used to calculate the outcome using a random-effects model. Heterogeneity was assessed using Cochrane chi-square (χ2) and the index of heterogeneity (I2 statistics) test. Sensitivity test and subgroup analysis were performed. Publication bias was examined by funnel plots and Egger's test.

In total, 26 studies were analyzed, including data from 13,923 participants. The overall percentage of users' positive attitudes, perceived usefulness, and intentions to use DHMIs was 0.66 (95 % CI; 0.52, 0.79), 0.73 (95 % CI; 0.64, 0.81), and 0.67 (95 % CI; 0.6, 0.74), respectively. Significant heterogeneity was observed; nonetheless, sensitivity analyses indicated that none of the included individual studies exerted undue influence on the overall pooled prevalence. Assessment of funnel plots and Egger's test (p ≤ 0.895) showed no evidence of publication bias.

The results of this meta-analysis indicate that, overall, two-thirds of participants have a positive attitude toward DMHIs, around three-quarters find DMHIs useful, and around two-thirds intend to use them. The findings suggest the need to target users' positive attitudes, perceived utility, and willingness for the improved adoption and sustained use of DMHIs.

College students face significant mental health challenges that were exacerbated by the COVID-19 pandemic. Evidence suggests mental-health burdens are substantial and resources limited. We sought to replicate research supporting a one-time daily ambulatory intervention to facilitate regulation of negative emotion and increase generation of positive emotion. The Daily Coping Toolkit (DCT) was developed at the outset of the pandemic and was effective in boosting mood in front-line medical personnel in an open-trial (Coifman, K. G., et al. [2021]. Occupational and Environmental Medicine, 78(8), 555-557. https://doi.org/10.1136/oemed-2021-107427.

This investigation replicated the DCT against a control condition in college students returning to campus in early 2021. N = 125 college students were randomized to experimental conditions (two-prompt v. one-prompt) or the control condition. Data analysis was preregistered.

Analyses indicated students in experimental groups experienced significant decreases in negative and increases in positive emotion when compared to controls, providing evidence of efficacy. This was notable because a high proportion of participants reported prior mental illness. Although there was no difference by number of prompts (two-prompt v. one-prompt) on emotional reports, there was preliminary evidence the one-prompt condition was associated with greater self-care behaviors (e.g., exercise, social support seeking).

The results suggest the DCT is an efficacious emotion-regulation intervention that can boost mood during stress.

The prevalence of mental health difficulties among young people has risen in recent years, with 75% of mental disorders emerging before the age of 24 years. The identification and treatment of mental health issues earlier in life improves later-life outcomes. The COVID-19 pandemic spurred the growth of digital mental health interventions (DMHIs), which offer accessible support. However, young people of different ethnicities face barriers to DMHIs, such as socioeconomic disadvantage and cultural stigma.

This review aimed to summarize and evaluate the engagement with and effectiveness of DMHIs among young people of different ethnicities.

A systematic search was conducted in MEDLINE, Embase, and PsycINFO for studies published between January 2019 and May 2024, with an update in September 2024. The inclusion criteria were participants aged <25 years using DMHIs from various ethnic backgrounds. Three reviewers independently screened and selected the studies. Data on engagement (eg, use and uptake) and effectiveness (eg, clinical outcomes and symptom improvement) were extracted and synthesized to compare findings. Studies were assessed for quality using the Mixed Methods Appraisal Tool.

The final search yielded 67 studies, of which 7 (10%) met inclusion criteria. There were 1853 participants across the 7 studies, all from high-income countries. Participants were predominantly aged 12 to 25 years, with representation of diverse ethnic identities, including Black, Asian, Hispanic, mixed race, and Aboriginal individuals. Engagement outcomes varied, with culturally relatable, low-cost interventions showing higher retention and user satisfaction. Linguistic barriers and country of origin impeded the effectiveness of some interventions, while near-peer mentorship, coproduction, and tailored content improved the effectiveness of DMHIs. While initial results are promising, small sample sizes, heterogeneity in outcome assessments, and a paucity of longitudinal data impeded robust comparisons and generalizability.

DMHIs show potential as engaging and effective mental health promotional tools for young people of different ethnicities, especially when coproduced and culturally relatable. Initial data suggest that interventions facilitating near-peer mentoring, linguistic adaptation, low cost, and cultural relatability have improved engagement and effectiveness. Future research should focus on developing a consensus definition of DMHIs, exploring DMHIs in children aged <12 years, and conducting detailed qualitative and quantitative research on use factors and treatment efficacy of DMHIs for young people of different ethnicities.

PROSPERO CRD42024544364; https://tinyurl.com/yk5jt8yk.

Background: Arthritis, characterized by joint inflammation, pain, and impaired daily activities, has seen a rapid increase globally. Telehealth has emerged as a transformative approach in managing chronic diseases, including arthritis, by overcoming barriers such as geographic limitations and high costs. Objectives: The primary objectives of this study were to conduct a comprehensive bibliometric analysis of telehealth in arthritis pain management over the past two decades, examine publication trends, citation patterns, and keyword co-occurrences related to telehealth strategies in arthritis management, identify key research areas, influential works, and emerging themes within the field. Methods: A comprehensive search was conducted in the Scopus database for articles related to telehealth in arthritis. A systematic screening process, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was adopted. Bibliometric analysis was used for keyword analysis, citation analysis, and research trends. Results: The bibliometric analysis revealed significant trends in telehealth research for arthritis pain management. A sharp increase in publications was observed from 2020 onwards, coinciding with advancements in digital health technologies and the COVID-19 pandemic. Frequently occurring keywords included "telemedicine," "telehealth," "digital health," "m-health," and "telerehabilitation." The top cited articles primarily explored the efficacy of telerehabilitation in managing postsurgical recovery and chronic knee pain. Emerging themes indicated an increased focus on mobile applications, digital health solutions, and patient-centered care. Conclusion: Telehealth has evolved from a novel concept to a mainstream solution in managing arthritis, driven by technological advancements and the necessity for accessible and cost-effective care.

Young Black men (YBM) disproportionately face the most severe forms and consequences of youth violence (YV) and substance use disorders, but are less likely to access and be retained in services for these high-risk behaviors. Investigating service uptake disparities and the role of barrier-reducing intervention delivery models is essential; so is understanding the service needs and preferences of YBM. This study explores the experiences of violence-involved and substance-disordered YBM and service providers working with them from racially and economically diverse communities, focusing on their service needs and preferences. Additionally, we examine the potential benefits and drawbacks of digital health interventions in addressing crucial structural barriers to service access and promoting equity for Black boys in high-violence environments. Individual interviews were conducted with 16 YBM (selected from a larger pool of 300 participants from a pilot study) and 7 service providers (four females, three males). Data analysis utilized an Interpretive Description (ID) approach guided by the Phenomenological Variant of Ecological Systems Theory (PVEST). Four themes emerged: (1) Revolving Doors and Histories of Violence; (2) Benefits of Violence: "You Do Something to Me, I Do Something to You"; (3) Positive and Negative Perceptions of Violence and Substance Use Prevention Programs; and (4) Need for Equity-Focused and Barrier-Mitigating Digital Health Interventions. Our findings identified avoidance mechanisms utilized by YBM at both individual and community levels and highlighted perceptions of existing community-based programs and digital interventions as crucial tools for mitigating barriers to care. This study also confirms the prevalence of critical service gaps and program uptake issues, even in cities with abundant programs. Thus emphasizing the need for equity-focused interventions co-designed with and for YBM in high-violence and substance use contexts.

Students' mental health has received increased attention in recent years: reports of worsened mental health among higher education students call for new ways to support them in their college years. Educational demands are among the concerns that students report, such as the stress of academic performance, the stress related to examinations and the pressure to succeed. One aspect often present in higher education is group work. Group work can be truly beneficial for learning, but it often causes additional stress to students. The present research contributes to the design of a peer assessment tool to support students during group work. In this tool, each student is asked to rate their teammates on several aspects of group work, and a virtual agent delivers support statements in response to such ratings. For the support statements to be appropriate, the virtual agent should adapt them to the recipient and the group work situation they are experiencing. We investigate the adaptation of emotional support statements to the student's personality trait of Conscientiousness and the score assigned to a teammate on one aspect of teamwork, Productivity. The resulting algorithm is then combined with related work on Emotional Stability, and a final algorithm considering both dimensions is created.

The transition to higher education represents a demanding adaptation process with several socioeconomic factors involved. Mental health problems among university students have been worsening since the beginning of the COVID-19 pandemic. Our objective is to create scientific evidence about the models of mental health-promoting interventions among higher education students applied in academic environments, as well as their effectiveness. We aim to synthesise the scientific evidence on the models of an intervention promoting mental health among university students applied in academic environments as well as their results.

A systematic review of the literature will be conducted. The research will be carried out using the EBSCO databases (CINAHL Complete, MEDLINE Complete, Psychology and Behavioral Sciences Collection), PubMed and Scopus. The research strategy includes the following MeSH or similar terms: Universities [Mesh], Students [Mesh], Education [Mesh], Undergraduate, "Higher Education", Universit*, College, Student*; "Psychosocial intervention" [Mesh], "Non-pharmacological", "Intervention model*", "Mental health promotion program*", Intervention*; "Randomized Controlled Trial", RCT; "Mental health" [Mesh], Depression [Mesh], Anxiety [Mesh], "Stress, psychological" [Mesh], "Quality of life" [Mesh], and "Psychological well-being" [Mesh]. All experimental studies with mental health-promoting interventions for university students that were published between January 2017 and November 2024 in English will be eligible. Two independent reviewers will apply the inclusion and exclusion criteria, analyse the quality of the data and extract it for synthesis. Disagreements will be resolved by a third reviewer. All randomised controlled trial studies with interventions in university students and their efficacy (with means and SD) will be included in the systematic review of the literature. The standardised mean difference will be used as the effect size to standardise individual results. Sensitivity analysis, subgroup analysis and meta-regression will be conducted to explore the causes of heterogeneity and the robustness of the results.

Ethical approval is not required for this study as it is based on the review of previously published data. The results will be disseminated through publication in peer-reviewed journals and presentations at academic conferences, as well as in events organised by student associations.

CRD42022359608.

Artificial intelligence (AI) has emerged as a transformative tool in various professional domains, including counselling, where it offers innovative ways to enhance service delivery and client outcomes. Despite its potential, research on AI in counselling practices often focuses on its technical applications, with limited attention to the interplay between awareness, acceptance, and application. This study analyses how professional counsellors apply artificial intelligence in counselling practices using the nexus between awareness and application through acceptance of AI with gender and professional rank as group.

A total of 5,432 professional counsellors were selected for the study. Data collection was conducted online to ensure a wide reach. The research instruments underwent validity checks, demonstrating high content and factorial validity. Convergent and discriminant validity were confirmed using the Average Variance Extracted (AVE) and Fornel-Larcker criterion.

The findings revealed that professional counsellors exhibited high levels of awareness, acceptability, and application of AI in their counselling practices. Acceptance played a positive mediating role in the relationship between awareness and application. However, male practitioners and professors displayed stronger awareness, acceptance, and application of AI tools compared to their counterparts.

The study highlights the significant role of acceptance in bridging awareness and application of AI in counselling practices. It underscores the importance of addressing gender and professional rank disparities to ensure equitable adoption and utilization of AI tools. The findings offer valuable insights for policymakers in promoting the integration of AI in counselling to enhance professional practices.

Digital mental health interventions (DMHIs) are a potential scalable solution to improve access to psychological support and therapies. DMHIs vary in terms of their features such as delivery systems (Websites or Apps) and function (information, monitoring, decision support or therapy) that are sensitive to the needs and preferences of users. A decision aid is warranted to empower people to make an informed preference-based choice of DMHIs. We conducted a review of features of DMHIs to embed within a patient decision aid to support shared decision-making. DMHIs, with evidence of availability in the United Kingdom (UK) at the time of the review, were identified from interactive meetings with a multi-disciplinary steering group, an online survey and interviews with adults with lived experience of using DMHIs in the UK. Eligible DMHIs targeted users age ≥16 years with a mental health condition(s), delivered through a digital system. A previous classification system for DMHIs was extended to eight dimensions (Target population; System; Function; Time; Facilitation; Duration and Intensity; and Research Evidence) to guide data extraction and synthesis of findings. Twenty four DMHIs were included in the review. More than half (n = 13, 54%) targeted people living with low mood, anxiety or depression and were primarily delivered via systems such as Apps or websites (or both). Most DMHIs offered one-way transmission of information (n = 21, 88%). Ten (42%) also had two-way communication (e.g., with a healthcare provider). Eighteen (75%) had a function of therapy, with seven and five DMHIs providing monitoring and decision support functions respectively. Most DMHIs were capable of being self-guided (n = 18,75%). Cost and access were primarily free, with some free via referral from the UK NHS or through corporate subscription for employees (n = 11). Eight (33%) DMHIs had evidence of effectiveness from randomised controlled trials. Six statements were developed to elicit user preferences on features of DMHIs: Target Population; Function; Time and Facilitation; System; Cost and Access; and Research Evidence. Preference elicitation statements have been embedded into a prototype decision aid for DMHIs, which will be subjected to acceptability and usability testing.

The COVID-19 pandemic contributed to a significant rise in mental health issues, including a 70 % increase in Japan's suicide rate. Prior studies suggest that Thought Field Therapy (TFT) can rapidly alleviate psychological distress.

To evaluate the efficacy of online TFT as a quick intervention for psychological problems.

This study employed the Brief Job Stress Questionnaire, administered to TFT and waitlist (WL) groups before and after the intervention, with the WL group also assessed two weeks prior to the TFT intervention. Follow-up questionnaires were completed by all participants after two additional weeks.

Subjective Unit of Distress Scale (SUDS) scores for targeted psychological issues were collected across participant groups.

Ninety-nine participants were randomly assigned to either the TFT intervention group or the WL group.

Among the 88 participants who completed the TFT intervention, significant reductions were observed in all negative emotions, including stress-induced mental and physical reactions, irritability, fatigue, anxiety, depression, and somatic complaints (p < .01).

SUDS scores for 248 issues, including trauma and anxiety, showed a significant decrease from an average of 7 to 1.5 following the TFT intervention (p < .01) with a large effect size (dz = 2.15).

A brief online TFT intervention during the COVID-19 pandemic significantly reduced psychological stress, with sustained effects observed over two to six weeks. This suggests that TFT is an effective accessible tool for mental health and self-care in the absence of face-to-face therapy.

Objective: The COVID-19 pandemic has simultaneously exacerbated mental health concerns among college students and made it more challenging for many students to access mental health support. However, little is known about the extent of mental health support loss among college students, or which students have lost support. Participants: 415 undergraduate students who reported receiving mental health support prior to the pandemic participated. Methods: Students completed an online questionnaire between March and May of 2020. Researchers examined the extent of support loss and how support loss differed by demographic and mental health variables. Methods pre-registered at https://osf.io/m83hz. Results: 62% of respondents reported loss of mental health support. Loss of support was associated with more severe depressive symptoms (p < .001), more severe anxiety symptoms (p < .001), suicidal ideation (p < .001), and sexual minority identity (p = .017). Conclusions: Loss of support was common, especially among more vulnerable students.

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.

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.

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.

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).

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.

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

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

Digitally native university students face challenges to their well-being and up to a third develop mental health problems. "Whitu: seven ways in seven days" is an app based on positive psychology, cognitive behaviour therapy (CBT) and psychoeducation principles.

Ninety-first year university students (45 per arm) participated in a randomised controlled trial of Whitu against a university self-help website ("Be Well"). Primary outcomes were changes in well-being on the World Health Organisation 5-item well-being index (WHO-5) and the short Warwick-Edinburgh mental well-being scale (SWEMWBS). Secondary outcomes were changes in depression, anxiety, self-compassion, stress, sleep and self-reported acceptability of the app.

At 4 weeks (primary endpoint), participants in the intervention group experienced significantly higher mental well-being (mean difference: 2.53 (95%CI: 0.53, 4.52); p = 0.013) and significantly lower depression (-4.23 (-8.32, -0.15); p = 0.042), compared to controls. Emotional well-being was greater in the intervention group at 3 months (12.23 (3.93, 20.54; p = 0.004). Other outcomes were similar between groups. User feedback was positive, with 88% saying they would recommend the app to a friend.

Whitu is an acceptable, effective, scalable and multi-modal means of improving some aspects of well-being and mental health among university students.

This study was registered with the Australian New Zealand Clinical Trials Network Registry: ACTRN12622000053729.

Digital therapeutics (DTx) are software-driven solutions for prevention, treatment, and management of medical conditions. Despite a pro-DTx momentum in China, global DTx trial assessments overlooked the country. We identified 756 DTx trials in China and analyzed their characteristics and quality parameters. Over 70% were funded by governments, hospitals, and universities, with tertiary hospitals in eastern China leading most trials. 44.8% used automated DTx, with 39.2% DTx-guided. Most trials focused on management (52.5%) and treatment (38.1%), with few on prevention (9.4%). Mental, behavioral, or neurodevelopmental disorders represented the leading condition category of focus. Recent declines in median sample size, median duration, and mean number of sites were noted. Only 18% of trials were at low overall risk of bias. While recognizing the rapid development of DTx trials in China, we call for better trial design and methodological rigor, prioritization of preventive and primary care, wider condition category scope, and higher inclusivity.

Digital mental health (DMH) interventions leveraging digital technologies, such as mobile applications, web-based platforms, artificial intelligence and wearable devices, have emerged as a promising avenue for addressing the mental health needs of young people. This scoping review examines the landscape of primary and secondary preventive DMH interventions for young people aged 10-24 years. Six electronic databases were searched, leading to a final incorporation of 81 studies published between 2010 and 2022. Each of these studies corresponds to a unique DMH intervention. Our findings reveal that research activity in the area of promotive and preventive DMH interventions started gaining ground from 2019 onwards, with the majority of studies conducted in Australia and the USA. 70% of the total studies targeted the prevention of mental health conditions. Randomized controlled trials were the predominant study methodology, while mental well-being, depressive disorders, anxiety disorders, life skills and disorders specifically associated with stress were the most targeted mental health or well-being conditions. Finally, mobile applications and web interfaces were the most studied form of DMH interventions. Most of these applications have integrated advanced AI/ML algorithms to serve the purpose of personalization and real-time monitoring. However, there is a marked need for more emphasis on preventive and, especially, promotive mental health measures, as well as the active inclusion of low- and middle-income countries in future research.

To develop and evaluate the effectiveness of an asynchronously delivered app, InBloom, for postpartum depression (PPD) prevention relative to an evidence-based synchronously delivered in-person intervention, ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) for depression and return on investment via a prospective randomized controlled trial and quasi-experimental cohort analyses.

PPD affects 1 in 7 gestational parents in the US, causing emotional distress, consequences for infant development and child adjustment, disruptions in family relationships, and financial burden. ROSE is an evidence-based intervention administered as four in-person group sessions plus one postpartum booster session. Despite ROSE's demonstrated effectiveness, pragmatic barriers impact disseminating an in-vivo group intervention broadly to people at risk for PPD. If effective, an app may help overcome implementation barriers.

We will develop an app based on the ROSE intervention, recruit 152 pregnant people ≥18 years, 17-32 weeks' gestation, and with risk factors for PPD, and randomize participants either to InBloom or ROSE. Primary outcomes are depression and return on investment (ROI). Hypothesized mechanisms are perceived access, engagement, and satisfaction with the intervention. Control groups include historical control subjects from the largest ROSE trial for depression outcomes and Electronic Health Record (EHR) data on concurrent patients from the same clinics not offered InBloom or ROSE for ROI outcomes.

At the end of the trial, we will know if InBloom is a viable alternative to ROSE, allowing further implementation studies of an easy, low-cost distribution app to reduce risk of PPD.

govRegistration Identifier:NCT05518162.

Courses on well-being are increasingly evaluated to see how they may promote mental health in college. We examined the impact of a course on students' well-being, anxiety, and depression.

Subjects were undergraduates enrolled in the "Science of Happiness," (SOH) (n = 105), and "Child and Adolescent Psychopathology," (CAP) (n = 114). Well-being measures included the PERMA Profiler and Satisfaction with Life Scale (SWLS) at the beginning and conclusion of the semester. The Depression Anxiety and Stress Scale - 21 items (DASS-21) measured psychopathology.

There were significant improvements on the SWLS 1.28 (p = .038; d = .264) in SOH. There was no improvement for the PERMA Profiler in either group, and no differences between groups. There was no significant change on the DASS-21 for SOH subjects.

Undergraduate courses that deliver positive psychology psychoeducation have a small effect size even in non-randomized studies. Future curriculum innovation is needed and better research to validate positive psychology psychoeducation.

Mental health problems in university students are associated with many negative outcomes, yet there is a gap between need and timely access to help. Single-session interventions (SSIs) are designed to be scalable and accessible, delivering core evidence-based intervention components within a one-off encounter.

COMET (Common Elements Toolbox) is an online self-help SSI that includes behavioral activation, cognitive restructuring, gratitude, and self-compassion. COMET has previously been evaluated in India, Kenya, and the United States with promising results. This study tests the acceptability, appropriateness, perceived utility, and efficacy of COMET among UK university students during the peripandemic period.

We conducted a randomized controlled trial evaluating the efficacy of COMET compared with a control group, with 2- and 4-week follow-ups. Outcome variables were subjective well-being, depression severity, anxiety severity, positive affect, negative affect, and perceived stress. We also measured intervention satisfaction immediately after completion of COMET. All UK university students with access to the internet were eligible to participate and were informed of the study online. The data were analyzed using linear mixed models and reported in accordance with the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist.

Of the 831 people screened, 468 participants were randomized to a condition, 407 completed the postintervention survey, 147 returned the 2-week follow-up survey, 118 returned the 4-week follow-up survey, and 89 returned both. Of the 239 randomized, 212 completed COMET. Significant between-group differences in favor of the COMET intervention were observed at 2-week follow-ups for subjective well-being (Warwick-Edinburgh Mental Well-Being Scale; mean difference [MD] 1.39, 95% CI 0.19-2.61; P=.03), depression severity (9-item Patient Health Questionnaire; MD -1.31, 95% CI -2.51 to -0.12; P=.03), and perceived stress (4-item Perceived Stress Scale; MD -1.33, 95% CI -2.10 to -0.57; P<.001). Overall, participants were satisfied with COMET, with the majority endorsing the intervention and its modules as acceptable, appropriate, and exhibiting high utility. The self-compassion module was most often reported as the participants' favorite module and the behavioral activation module was their least favorite. Qualitative analysis revealed that participants found COMET generally accessible, but too long, and experienced immediate and long-term beneficial effects.

This study demonstrated high engagement with the COMET intervention, along with preliminary short-term efficacy. Almost all participants completed the intervention, but study attrition was high. Participant feedback indicated a high level of overall satisfaction with the intervention, with perceived accessibility, immediate benefits, and potential long-term impact being notable findings. These findings support the potential value of COMET as a mental health intervention and highlight important areas for further improvement.

ClinicalTrials.gov NCT05718141; https://clinicaltrials.gov/ct2/show/NCT05718141.

Digital media use disorder (DMUD) is a prevalent problem among young people, which can result in adverse consequences and functional impairments across multiple domains of life due to a persistent inability to regulate one's use, which can lead to the development of psychological problems. In particular, children and adolescents who live in families that are part of the child and youth welfare system and receive support services are considered to be at high risk of developing mental disorders. It is less likely that these families will choose a therapeutic setting for the treatment of DMUD. The objective is to reduce DMUD-related symptoms and improve media use behaviour through the implementation of an app-based training programme.

The efficacy of Res@t digital, initially conceived as an adjunct to child and adolescent psychiatric treatment, is to be evaluated for n= 32 children and adolescents with a media use disorder or at risk of developing this disorder, and their families enrolled in child and youth welfare services. The efficacy of the app will be evaluated in a randomised controlled trial with a waitlist control group. The primary outcome is the reduction of DMUD symptoms over a 20-week period following the onset of app training. Secondary outcomes include EEG measurements and changes in standardised psychopathological variables.

Should the Res@t app prove efficacious when compared to a waitlist control group, it would constitute an evidence-based intervention for the treatment of DMUD in children and adolescents. For high-risk families, the app could serve as a motivational tool to prompt action regarding potential DMUD and facilitates access to therapeutic facilities.

https://drks.de, identifier DRKS00033379.

Background/Objectives: Caregivers of children with chronic illnesses, including chronic pain, experience high levels of distress, which impacts their own mental and physical health as well as child outcomes. Virtual care solutions offer opportunities to provide accessible support, yet most overlook caregivers' needs. We conducted a scoping review to create an interactive Evidence and Gap Map (EGM) of virtual care solutions across a stepped care continuum (i.e., from self-directed to specialized care) for caregivers of youth with chronic illnesses. Methods: The review methodology was co-designed with four caregivers. Data sources were the peer-reviewed scientific literature and a call for innovations. Records were independently coded and assessed for quality. Results: Overall, 73 studies were included. Most virtual care solutions targeted caregivers of children with cancer, neurological disorders, and complex chronic illnesses. Over half were noted at lower levels of stepped care (i.e., self-guided apps and websites), with psychological strategies being predominant (84%). However, very few addressed caregivers' physical health (15%) or provided family counseling (19%) or practical support (1%). Significant gaps were noted in interventions for managing caregiver chronic pain, despite its high prevalence and impact on child outcomes. Conclusions: Evidence and Gap Maps are innovative visual tools for knowledge synthesis, facilitating rapid, evidence-informed decision-making for patients, families, health professionals, and policymakers. This EGM highlighted high-quality virtual care solutions ready for immediate scaling and identified critical evidence gaps requiring prioritization. To address the complexities of pediatric chronic illnesses, including chronic pain, virtual care initiatives must prioritize family-centered, accessible, and equitable approaches. Engaging caregivers as partners is critical to ensure interventions align with their needs and priorities.

The mental health crisis among college students intensified amid the COVID-19 pandemic, suggesting an urgent need for innovative solutions to support them. Previous efforts to address mental health concerns have been constrained, often due to the underuse or shortage of services. Mobile health (mHealth) technology holds significant potential for providing resilience-building support and enhancing access to mental health care.

This study aimed to examine the trends in mental health and well-being outcomes over 3 years among college students, with an exploratory aim to assess the potential impact of the Roadmap mHealth app on these outcomes.

A fully automated longitudinal observational study was conducted remotely from a large public academic institution in the Midwestern United States, evaluating mental health and well-being outcomes among college students using the Roadmap mHealth app over 3 fall semesters from 2020 to 2022. The study enrolled 2164 college students in Year I, with 1128 and 1033 students returning in Years II and III, respectively. Participants completed various self-reported measures, including the Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 for anxiety, and additional metrics for coping, flourishing, and loneliness.

The findings indicated an evolving trajectory in students' mental health. In Year I, depression and anxiety levels were higher compared with levels reported between 2014 and 2019, remaining stable into Year II. However, significant decreases were noted by Year III for both depression (Year I mean 7.78, SD 5.65 vs Year III mean 6.21, SD 4.68; t108=-2.90; P=.01) and anxiety (Year I mean 6.61, SD 4.91 vs Year III mean 5.62, SD 4.58; t116=-2.02; P=.046). Problem-focused coping decreased initially from Year I (mean 2.46, SD 0.58) to Year II (mean 2.36, SD 0.60; t1073=-5.87; P<.001), then increased by Year III (mean 2.40, SD 0.63; t706=2.26; P=.02). Emotion-focused (Year I mean 2.33, SD 0.41 vs Year III mean 2.22, SD 0.47; t994=-7.47; P<.001) and avoidant coping (Year I mean 1.76, SD 0.37 vs Year III mean 1.65, SD 0.38; t997=-8.53; P=.02) consistently decreased. Loneliness significantly decreased from Year I (mean 5.79, SD 1.74) to Year III (mean 5.17, SD 1.78; t1013=-10.74; P<.001), accompanied by an increase in flourishing from Year I (mean 63.78, SD 14.76) to Year III (mean 66.98, SD 15.06; t994=7.22; P<.001). Analysis of app usage indicated that the positive piggy bank and gratitude journal were the favored activities. Greater engagement with the app was positively correlated with enhanced flourishing, even after adjusting for demographic and sociobehavioral factors (β=.04, SE .016; t3974=2.17; P=.03).

In this study, students' mental health and well-being improved, with notable reductions in depression, anxiety, and loneliness, associated with an increase in flourishing. The app did not appear to worsen students' mental health. Based on the usage pattern, it is possible the app enhanced positive psychology-based practices. Future research should explore the efficacy of mHealth interventions through randomized controlled trials to further understand their impact on college students' mental health outcomes.

ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788.

RR2-10.2196/29561.

Telehealth use has significantly increased recently. However, little is known about its use by individuals with depression or anxiety disorders. This study aims to explore the patterns of telehealth use among those individuals.

Data used were from the 2022 Health Information National Trends Survey (HINTS) cycle 6. Weighted logistic regression was performed to test the association between depression/anxiety disorder and telehealth use, and to explore reasons for using/not using telehealth among those with depression/anxiety, compared to those without.

Out of the 4952 study participants, 2887 (weighted percentage: 39.36%) had used telehealth in the past 12 months. Those with depression/anxiety disorder had significantly higher telehealth use, compared to those without (57% vs. 32%; OR = 2.65; 95% CI: (2.04, 3.43)). Factors affecting telehealth use could differ by depression/anxiety disorder status. Among those with depression/anxiety disorder, being woman or married was not associated with telehealth use, whereas they were significant factors among those without depression/anxiety disorder. Among those with depression/anxiety, non-Hispanic Black participants (OR = 0.51; CI: (0.78, 0.94)) were less likely to use telehealth, compared to non-Hispanic White participants; additionally, higher income was associated with telehealth use. Regarding reasons for using telehealth, convenience (OR = 1.80; CI: (1.21, 2.68)) and avoiding COVID infection (OR = 1.40; CI: (1.06, 1.86)) were more likely considered by those with depression/anxiety disorder.

Individuals with depression/anxiety disorder were more likely to use telehealth and to do so for reasons of convenience and avoiding infection. Promoting telehealth to those with depression/anxiety disorder should consider their unique utilization patterns.

This study aimed to systematically review the efficacy of telehealth approaches in alleviating depressive and anxiety symptoms in patients with chronic obstructive pulmonary disease (COPD) using evidence from randomized controlled trials (RCTs).

This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. Databases including PubMed, Embase, Web of Science, and the Cochrane Library were searched for RCTs from database inception to June 2024. All statistical analyses were performed using RevMan 5.3. The standard mean difference (SMD) was used to pool the fixed effects of continuous outcomes.

Seven RCTs comprising 1174 participants were included in this review. The pooled analysis demonstrated that, compared with the control group, telemonitoring significantly affected anxiety among patients with COPD (SMD = -0.12, 95 % confidence interval [CI]: [-0.24, -0.01], p = 0.04), whereas the effect on depression was not significant (SMD = -0.10, 95 % CI: [-0.22, 0.02], p = 0.09).

Telemonitoring effectively reduced anxiety in patients with COPD but had no significant effect on depression. The relatively small number of studies suggests that this area of research is still developing. Additional high-quality, enriched, and more widely distributed intervention studies are needed to further assess the effectiveness of telehealth approaches on mental health among patients with COPD.

Anxiety is highly prevalent among college communities, with significant numbers of students, faculty, and staff experiencing severe anxiety symptoms. Digital mental health interventions (DMHIs), including Cognitive Bias Modification for Interpretation (CBM-I), offer promising solutions to enhance access to mental health care, yet there is a critical need to evaluate user experience and acceptability of DMHIs. CBM-I training targets cognitive biases in threat perception, aiming to increase cognitive flexibility by reducing rigid negative thought patterns and encouraging more benign interpretations of ambiguous situations. This study used questionnaire and interview data to gather feedback from users of a mobile application called "Hoos Think Calmly" (HTC), which offers brief CBM-I training doses in response to stressors commonly experienced by students, faculty, and staff at a large public university. Mixed methods were used for triangulation to enhance the validity of the findings. Qualitative data was collected through semi-structured interviews from a subset of participants (n = 22) and analyzed thematically using an inductive framework, revealing five main themes: Effectiveness of the Training Program; Feedback on Training Sessions; Barriers to Using the App; Use Patterns; and Suggestions for Improvement. Additionally, biweekly user experience questionnaires sent to all participants in the active treatment condition (n = 134) during the parent trial showed the most commonly endorsed response (by 43.30% of participants) was that the program was somewhat helpful in reducing or managing their anxiety or stress. There was overall agreement between the quantitative and qualitative findings, indicating that graduate students found it the most effective and relatable, with results being moderately positive but somewhat more mixed for undergraduate students and staff, and least positive for faculty. Findings point to clear avenues to enhance the relatability and acceptability of DMHIs across diverse demographics through increased customization and personalization, which may help guide development of future DMHIs.

Young people and families endure protracted waits for specialist mental health support in the United Kingdom. Staff shortages and limited resources have led many organizations to develop digital platforms to improve access to support. myHealthE is a digital platform used by families referred to Child and Adolescent Mental Health Services in South London. It was initially designed to improve the collection of routine outcome measures and subsequently the "virtual waiting room" module was added, which includes information about child and adolescent mental health as well as signposting to supportive services. However, little is known about the acceptability or use of digital resources, such as myHealthE, or about sociodemographic inequalities affecting access to these resources.

This study aimed to assess the usability and acceptability of myHealthE as well as investigating whether any digital divides existed among its userbase in terms of sociodemographic characteristics.

A survey was sent to all myHealthE users (N=7337) in May 2023. Caregivers were asked about their usage of myHealthE, their levels of comfort with technology and the internet. They completed the System Usability Scale and gave open-ended feedback on their experiences of using myHealthE.

A total of 680 caregivers responded, of whom 45% (n=306) were from a Black, Asian, or a minority ethnic background. Most (n=666, 98%) used a mobile phone to access myHealthE, and many had not accessed the platform's full functionality, including the new "virtual waiting room" module. Household income was a significant predictor of caregivers' levels of comfort using technology; caregivers were 13% more likely to be comfortable using technology with each increasing income bracket (adjusted odds ratio 1.13, 95% CI 1.00-1.29). Themes generated from caregivers' feedback highlight strengths of digital innovation as well as ideas for improvement, such as making digital platforms more personalized and tailored toward an individual's needs.

Technology can bring many benefits to health care; however, sole reliance on technology may result in many individuals being excluded. To enhance engagement, clinical services must ensure that digital platforms are mobile friendly, personalized, that users are alerted and directed to their full functionality, and that efforts are made to bridge digital divides. Enhancing dissemination practices and improving accessibility to informative resources on the internet is critical to provide fair access to all using Child and Adolescent Mental Health Services.

Digital mental health is a promising paradigm for individualized, patient-driven health care. For example, cognitive bias modification programs that target interpretation biases (cognitive bias modification for interpretation [CBM-I]) can provide practice thinking about ambiguous situations in less threatening ways on the web without requiring a therapist. However, digital mental health interventions, including CBM-I, are often plagued with lack of sustained engagement and high attrition rates. New attrition detection and mitigation strategies are needed to improve these interventions.

This paper aims to identify participants at a high risk of dropout during the early stages of 3 web-based trials of multisession CBM-I and to investigate which self-reported and passively detected feature sets computed from the participants interacting with the intervention and assessments were most informative in making this prediction.

The participants analyzed in this paper were community adults with traits such as anxiety or negative thinking about the future (Study 1: n=252, Study 2: n=326, Study 3: n=699) who had been assigned to CBM-I conditions in 3 efficacy-effectiveness trials on our team's public research website. To identify participants at a high risk of dropout, we created 4 unique feature sets: self-reported baseline user characteristics (eg, demographics), self-reported user context and reactions to the program (eg, state affect), self-reported user clinical functioning (eg, mental health symptoms), and passively detected user behavior on the website (eg, time spent on a web page of CBM-I training exercises, time of day during which the exercises were completed, latency of completing the assessments, and type of device used). Then, we investigated the feature sets as potential predictors of which participants were at high risk of not starting the second training session of a given program using well-known machine learning algorithms.

The extreme gradient boosting algorithm performed the best and identified participants at high risk with macro-F1-scores of .832 (Study 1 with 146 features), .770 (Study 2 with 87 features), and .917 (Study 3 with 127 features). Features involving passive detection of user behavior contributed the most to the prediction relative to other features. The mean Gini importance scores for the passive features were as follows: .033 (95% CI .019-.047) in Study 1; .029 (95% CI .023-.035) in Study 2; and .045 (95% CI .039-.051) in Study 3. However, using all features extracted from a given study led to the best predictive performance.

These results suggest that using passive indicators of user behavior, alongside self-reported measures, can improve the accuracy of prediction of participants at a high risk of dropout early during multisession CBM-I programs. Furthermore, our analyses highlight the challenge of generalizability in digital health intervention studies and the need for more personalized attrition prevention strategies.

Preventing anxiety and depression among college students is a pressing public health need. Recent meta-analyses have examined mobile mindfulness interventions in adult populations; however, college students are in a unique developmental stage and institutional setting.

We conducted a systematic literature review and meta-analysis of published and unpublished studies in English language on the acceptability, usage, and efficacy of mindfulness training apps on mental health among non-clinical samples of college students. Out of 167 reviewed studies, 47 were included in the narrative review. Additionally, we summarized effects from 19 stress, 12 anxiety, 13 depression, and 8 emotional well-being trials (total N = 2974) using robust variance estimation meta-regression and evaluated certainty of evidence with the GRADE approach.

Apps were acceptable, with usage levels varying. They reduced stress by 0.435 standard deviation units, 95 % CI (-0.615,-0.255), and increased emotional well-being by 0.431 (0.162,0.7) approaching medium effect sizes. The apps had small effects on depression (B = -0.219 (-0.374, -0.065)) and anxiety (B = -0.218 (-0.42, -0.016)). Certainty of evidence was moderate for stress, depression, and well-being; and low-to-moderate for anxiety. Distressed participants had larger improvements in all outcomes except depression.

Small sample sizes in the original studies and small numbers of studies limit the precision of our effect estimates. The small number of studies with objective usage data impedes our ability to characterize the optimal dose.

With moderate certainty of evidence, mindfulness training apps may improve student mental health with similar or larger effect sizes than in the general adult population. However, sustained usage may be a challenge, and more research is needed on the optimal implementation strategy, dose, and equity.

Evaluating digital mental health services across racial and ethnic identities is crucial to ensuring health equity. We examined how People of Color (POC) and White adults were using and benefiting from an employer-sponsored digital mental health platform. A sample of 947 adults (42% POC) consented to an observational study and completed surveys on their identities and mental health outcomes at baseline and three-month follow-up. We examined care preferences, utilization, therapeutic alliance with mental health providers, and changes in outcomes among POC and White adults. At baseline, there were no race or ethnicity differences in preferred topics of focus (p = 0.36), rates of depression, anxiety, or loneliness (ps > 0.35), or self-reported well-being or stress (ps > 0.07). POC adults were more likely to prefer one-on-one care than White adults (p = 0.02). After 3 months of care utilization, there were no differences in therapeutic alliance (p = 0.52), use of therapy, coaching, or self-guided digital resources (ps > 0.47), or in the likelihood of improving, recovering, or maintaining clinical symptoms or psychosocial factors (ps > 0.07). Utilization, satisfaction, and clinical effectiveness were similar between POC and White adults, indicating the platform may offer comparable experiences. Evaluating utilization and outcomes among POC communities is necessary to inform consumers and help developers assess if innovations are fostering health equity.

Overweight and obesity are growing public health problems worldwide. Both diet and physical activity have been the primary interventions for weight reduction over the past decade. With increasing rates of overweight and obesity, it is evident that a primary focus on diet and exercise has not resulted in sustained obesity reduction within the global population. There is now a case to explore other weight management strategies such as psychological therapies. However, there is a dearth of literature that has mapped the types of psychological interventions and the characteristics of these interventions as a means of achieving weight reduction.

The key objectives focused on mapping the types and characteristics of psychological interventions versus usual care for weight reduction and sustained weight reduction in adults with overweight or obesity. The study followed the scoping review methodology by Arksey and O'Malley and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

Intervention studies were included if participants were 18 years and over, classified as overweight or obese (body mass index ≥25 kg/m2) and had received a psychological therapy intervention. Studies were excluded if they included a comparison with other active lifestyle interventions (unless classified as usual care), were not available in English, were not full-text articles or were non-peer-reviewed articles.

Six electronic databases were searched from inception to April 2023 to identify relevant articles.

The study employed a systematic charting method and narrative synthesis to organise and synthesise the data.

A total of 31 studies met the eligibility criteria and were included in the review. 13 unique psychological interventions for weight reduction in adults with overweight or obesity were identified, with cognitive-behavioural therapy and motivational interviewing being the most common. Eight types of usual care were identified, which largely included education and training on nutrition and physical activity. Gaps in the current research were also identified.

The findings highlighted several gaps within the existing literature, largely due to a lack of evidence relating to adults with low socioeconomic status, non-white participants, individuals under 40 years of age and the integration of digital health technologies.

Objective: This project examines students' experiences using a mental health mobile application (app) as part of a class assignment developed to support student well-being. Participants: Data was collected from 265 undergraduate students enrolled in a psychology course during the COVID-19 pandemic. Methods: Students developed a self-care goal and used an app to support progress toward it. Thematic analysis was applied to students' written reflections about their experiences using the app and practicing self-care. Results: Students reported using an app for self-care was 1) more helpful than expected for improving focus, productivity, motivation, sleep, and mental health symptoms; 2) challenging due to loss of interest, slow improvement, difficulty integrating into routine, or negative feelings triggered; and 3) influenced by the pandemic and transition to remote learning. Conclusions: A classroom assignment designed to promote self-care using a mental health app shows promise. Future research is needed to better understand engagement and impact.

We evaluated the impact of digital mental health interventions (DMHIs) for college students. We organized findings using the RE-AIM framework to include reach, effectiveness, adoption, implementation, and maintenance.

We conducted a systematic literature review of recent findings from 2019-2024. Our search identified 2,701 articles, of which 95 met inclusion criteria. In the reach domain, student samples were overwhelmingly female and White. In the effectiveness domain, over 80% of DMHIs were effective or partially effective at reducing their primary outcome. In the adoption domain, studies reported modest uptake for DMHIs. In the implementation and maintenance domains, studies reported high adherence rates to DMHI content. While recruitment methods were commonly reported, adaptations and costs of implementation and maintenance were rarely reported. DMHIs for college students are effective for many psychological outcomes. Future work should address diversifying samples and considering implementation in a variety of college settings.

America is experiencing burgeoning mental health needs of their college students. Measuring the impact of mental health challenges for these students and the natural ways they adapt to them might enable smart triage of limited mental health resources. This may, in part, be achieved through a combination of technology-assisted personalized measurement-based care, treatment matching, and peer-support. Helping students self-monitor and organize their personal peer networks can destigmatize and increase accessibility to timely mental health care, especially for students of marginalized identities, who might otherwise be hesitant to receive care or be misdiagnosed. A collaborative effort among students, educators, clinicians, and health technology innovators may provide more tractable solutions for student unmet needs than any single entity or resource alone. Novel resources, tailored through a healthy equity lens that is individualized and culturally-sensitive, may meaningfully meet a student's needs, preferences, and acceptability, and translate to daily use and informed decision-making.

The worldwide Covid19 pandemic caused by the rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represented a unique challenge for patients and healthcare professionals. Patients with chronic rare diseases had to face novel burdens, like the inability to perform regular on-site visits or even difficulties in the supply of medication. Patients with Fabry disease (FD) are affected by a variety of organ manifestations leading to physical but also psychological burden and limitations, which are usually presented in low health-related quality of life (HR-QoL). We sought to examine the impact of the Covid19 pandemic on HR-QoL in patients with FD and their implications for the future care of patients with rare diseases.

This single-center study included patients seen shortly prior to and after the peak of the Covid19 pandemic in 2020 at our study site. All patients had a confirmed genetic diagnosis of FD. Subjects with presumed apathogenic to benigne genetic variants in the GLA gene were excluded. The Short Form (36) Health Survey (SF-36) was used to obtain patients'self-reported outcome. Clinical data and SF-36 scores were collected and analysed for the time period prior to and after the peak of the pandemic.

In total, 60 patients (mean age 47.9 ± 15 years, 53.3 % male) were included. The majority presented with a pathogenic gene variant (63.3 %) associated with classic phenotype. At baseline, 66.7 % were on enzyme replacement therapy (ERT), and 21.7 % on chaperone therapy. Predominant organ manifestations were cardiac (42/60, 70.0 %) and neurological (39/60, 65.0 %). After paired comparison prior and post peak of the pandemic in 2020, all eight items of the SF-36 score showed a numeric decline. Three items presented with a intergroup difference: social functioning (72.5 ± 29.3 vs. 64.8 ± 29.3, p = 0.012), energy/fatigue (56.8 ± 21.7 vs. 48.3 ± 23.9, p < 0.001), and role limitations due to physical health (64.2 ± 42.0 vs. 51.1 ± 45.5, p = 0.007).Subgroup analysis (regarding gender, age, and treatment) revealed that especially male and older (≥50 years) patients with FD showed reductions in multiple categories of HR-QoL. The item "energy/fatigue" presented significant declines among all subgroups.

The worldwide Covid19 pandemic had a persistent negative affect on self-reported HR-QoL in patients with FD, including both mental and physical aspects. It remains unclear to what extend the disease itself and accompanying circumstances including local and governmental actions and restrictions contributed to these deteriorations. Our findings stress the importance for meticulous and constant interdisciplinary care including psychosocial aspects in patients with chronic progressive diseases as well as the need for a change in mindset concerning future medical care including further progress in digitalisation and a strengthening of the remote health care sector by authorities.

Diminished quality of life, inadequate support and social isolation are commonly experienced by individuals living with the chronic pain condition, endometriosis. We aimed to determine the feasibility and acceptability of EndoSMS, a psychologically-focused text message intervention designed to support individuals living with endometriosis.

As part of a two-arm parallel pilot randomised controlled trial with waitlist control, the feasibility and acceptability of a brief (3-month) version of EndoSMS was assessed using a mixed methods approach. Feasibility data (uptake, attrition, text message delivery analytics) and user acceptability (via self-report survey items and written feedback) were assessed. Qualitative data were thematically analysed using the template approach. Primary trial outcomes are not reported in this paper.

Feasibility was indicated by: high conversion rate (99.1 %), low attrition (14.2 %), few opt-outs (0.02 %) and a high message delivery rate (99.8 %). Most intervention participants indicated user acceptability (mean = 4.02/5) across self-report questions. Most rated the length of the program (65.5 %), and the number (80.9 %) and language (94.5 %) of the text messages to be 'just right'. Thematic analysis created four themes: A shared "battle": Feeling less isolated and alone; "Be kind to yourself": A focus on self-care, self-compassion and active coping; Keeping endometriosis at the forefront: Helpful or stressful?; Mixed perceptions surrounding the provision of general endometriosis information; and, Tailoring of text messages.

EndoSMS supportive text message program was feasible and acceptable for individuals with endometriosis. Future developments of the program should consider greater tailoring of content to user needs.

Australian New Zealand Clinical Trials Registry (ACTRN12621001642875).

Impostor syndrome and burnout are highly prevalent among medical students and trainees, significantly impacting their mental health and professional development. The advent of online educational interventions provides a promising solution, offering accessibility and flexibility to tackle these issues. This systematic review aims to evaluate the effectiveness of online educational interventions in alleviating impostor syndrome and burnout among medical learners.

A comprehensive literature search was conducted across PubMed, Cochrane Library, Embase, Scopus and PsycInfo, identifying relevant studies published up to March 2024. Studies focusing on online interventions targeting impostor syndrome and burnout among medical students, residents, and fellows were included, and their quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

Among the screened studies, six met our inclusion criteria, comprising four randomized controlled trials, one qualitative study, and one mixed-methods study. Their mean MERSQI score was 14.67 (SD 1.23), indicating a high methodological quality. The interventions adopted in these studies varied, including group coaching sessions, workshops, and provision of educational resources. Notably, two randomized trials demonstrated significant reductions in impostor syndrome symptoms after online interventions, compared with the control groups. On the other hand, results for burnout outcomes were equivocal, with some studies reporting improved emotional exhaustion scores and decreased burnout risk, while others found no significant differences.

Current evidence suggests that structured online educational interventions, particularly those incorporating coaching and cognitive reframing strategies, can effectively reduce impostor syndrome among medical trainees. However, the impact on burnout remains inconclusive. Further research is needed to optimize online program components and implementation strategies to comprehensively address both impostor syndrome and burnout in this population.

As this is a systematic review rather than a clinical trial, no clinical trial number is applicable. Nonetheless, this systematic review has been prospectively registered with PROSPERO (registration number: CRD42024541034), in line with best practice recommendations for systematic reviews.

Recent studies offer conflicting conclusions about the effectiveness of digital health interventions in changing physical activity behaviors. In addition, research focusing on digital health interventions for college students remains relatively scarce.

This study aims to examine the impact of digital health interventions on physical activity behaviors among college students, using objective measures as outcome indicators.

In accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted across several databases, including MEDLINE (PubMed), Web of Science, Cochrane Library, and EBSCO (CINAHL Plus with full text), to identify relevant intervention studies published up to June 6, 2023. The inclusion criteria specified studies that examined the quantitative relationships between digital health interventions and physical activity among adults aged 18 years to 29 years, focusing on light physical activity (LPA), moderate to vigorous physical activity (MVPA), sedentary time (ST), or steps. Non-randomized controlled trials were excluded. The quality of the studies was assessed using the Cochrane Risk of Bias tool. Results were synthesized both narratively and quantitatively, where applicable. When sufficient homogeneity was found among studies, a random-effects model was used for meta-analysis to account for variability.

In total, 8 studies, encompassing 569 participants, were included in the analysis. The primary outcomes measured were LPA, MVPA, ST, and steps. Among these studies, 3 reported on LPA, 5 on MVPA, 5 on ST, and 3 on steps. The meta-analysis revealed a significant increase in steps for the intervention group compared with the control group (standardized mean difference [SMD] 0.64, 95% CI 0.37-0.92; P<.001). However, no significant differences were observed between the intervention and control groups regarding LPA (SMD -0.08, 95% CI -0.32 to 0.16; P=.51), MVPA (SMD 0.02, 95% CI -0.19 to 0.22; P=.88), and ST (SMD 0.03, 95% CI -0.18 to 0.24; P=.78).

Digital health interventions are effective in increasing steps among college students; however, their effects on LPA, MVPA, and sedentary behavior are limited.

PROSPERO CRD42024533180; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=533180.

Approximately one in five people will experience a death by suicide during their lifetime. Struggling to understand their experiences, people bereaved by suicide often require formal support including support groups, online resources and discussion forums. While previous research has focused on examining experiences of grief, little is known about the implementation of support programs for people bereaved by suicide.

Adhering to PRISMA-ScR guidelines, eight databases were searched for peer-reviewed studies that focused on the strategies or evaluation of the implementation of suicide postvention programs.

Sixteen studies met the eligibility criteria. A narrative synthesis of study findings mapped to the Proctor implementation framework shows that a variety of implementation outcomes have been assessed by different studies; however, there is limited use of formal implementation frameworks to guide analysis.

Recommendations from this review indicate the need for consistent terminology and better utilisation of implementation frameworks to guide postvention research and provide a well-rounded view of implementation. Increasing the use of reliable and validated tools to measure implementation outcomes will also increase the rigour of implementation research in this field.

https://doi.org/10.17605/OSF.IO/4RB92.

Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults.

This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults.

Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements.

The result of this study is a modular intervention web application named RØST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users' motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations.

This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design.

This systematic review aimed to synthesise qualitative evidence on the views and experiences of older adults in using digital mental health interventions (DMHIs) for the prevention or self-management of mental disorders. We searched PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsycINFO, and the first 100 results of Google Scholar for eligible studies and we included 37 papers reporting 35 studies in this Review. Most DMHIs were delivered using mobile apps (n=11), websites (n=6), and video-conferencing tools (n=6). The use of DMHIs in older adults was affected by negative perceptions about ageing and mental health, the digital divide (eg, insufficient digital literacy), personal factors (eg, motivation) and health status, interpersonal influences (eg, guidance and encouragement), intervention features (eg, pace and content), technology-related factors (eg, accessibility), and the perceived benefits and risks of using DMHIs. Future DMHIs for older adults should involve other stakeholders such as health-care professionals, provide content relevant to the needs of older people, be more accessible, and address concerns about privacy and confidentiality.

Incidents of depression, anxiety, and suicidal ideation among adolescents have increased in recent years. Mental health interventions tailored to adolescents and families need to consider mechanisms for increasing enrollment and sustaining program engagement. A telephone-based, health coach intervention for adolescents and families was implemented at a Southeastern US health system with the goals of improving psychiatric appointment attendance, medication adherence, reduction in emergency department visits, and assisting with crisis management ("Youth and Family Engagement" [YFE] program).

This study aims to explore patients' and parents' perceptions of a mental health program and the factors that impact enrollment and sustained engagement.

Semistructured interviews were conducted with adolescent patients (n=9, 56%), parents (n=11, 92%), and clinicians who placed patient referrals (n=6, 100%). Interviews were in English (participants: 19/26, 73%) or Spanish (parents: 7/11, 64%), depending upon participants' preference. Interviews explored perceptions of the YFE program, experiences working with health coaches, suggestions for program changes, and program goals. The data were analyzed using inductive coding methodologies, with thematic analysis used to organize emergent themes. Two qualitatively trained researchers, one bilingual in English and Spanish, facilitated all data collection and collaboratively performed data analysis.

The YFE program's structure was often mentioned as promoting engagement, with telephone appointments and health coaches' ability to accommodate inflexible work or school schedules alleviating participation barriers. Skills learned from health coaches were frequently referenced, with adolescents generally citing internal processes, such as positive thinking and mindfulness. Parents discussed behaviors relative to their children, such as improvements with discipline, setting boundaries, and improved parent-child communication. Many participants discussed the importance of health coaches assisting families in navigating social systems, such as accessing resources (eg, housing) and navigating school processes (eg, individualized educational plans), with clinicians suggesting an increased emphasis on adolescents' nutrition and engagement in primary care. Spanish-speaking parents highlighted numerous advantages of working with bilingual health coaches, emphasizing both enhanced communication and cultural understanding. They specifically noted the coaches' ability to grasp their lived experiences and challenges as immigrants in the United States, which significantly enriched their participation in the program.