mental health app

People are increasingly concerned about their mental health wellness. Scientific studies suggest that online counselling for anxiety and depression is just as effective as in-person treatment. Additionally, journaling interventions have shown promise for individuals dealing with mental and psychological issues. In recent years, a growing number of mobile applications have been developed to improve people’s mental wellness and emotional communication. However, many of these applications are not available in Arabic but are available only in English or the native languages of their users, while other applications have feature limitations. This study presents a prototype of an interactive mental health mobile application, called Dawwen, to assist Arab individuals in freely expressing their feelings through online journaling, receiving recommendations for practices and activities, and locating nearby therapy centers based on their geolocation. Dawwen is augmented with an easy-to-use interface, a natural language processing (NLP) technique for analyzing the user input, and integrated features. The system is implemented using Android Studio and various cloud-based tools, making it adaptable for the integration of more advanced artificial intelligence (AI) technologies in the future. The System Usability Scale (SUS) scored an average of 88.25%, indicating high user satisfaction with the app’s functionality and ease of use. The study highlights Dawwen’s effectiveness in improving mental health support for Arabic-speaking users, filling a critical gap in existing digital mental health resources.

Background Many young children spend at least some time in early care and education programs, where they develop social-emotional skills that prepare them for future success. However, young children may exhibit behavioral challenges in these settings, negatively impacting their social-emotional development. It is critical that the early childhood workforce is prepared to support young children’s burgeoning social-emotional skills to address challenging behaviors in early care and education classrooms. Infant and early childhood mental health consultation is an evidence-informed approach for increasing teachers’ skills for managing young children’s emotions and behaviors. One mechanism to increase teachers’ access and use of the infant and early childhood mental health consultation programs is through on-demand mobile apps. Objective This study aims to investigate 2 primary objectives: to document the development of the Jump Start on the Go (JS Go) app through community-based participatory research (CBPR) methodologies, and to evaluate and refine the app based on early childhood education (ECE) teacher feedback using a mixed methods assessment approach. Methods This study used a community-based participatory research approach to design and evaluate the effectiveness of the JS Go app across 3 phases. In phase 1, a description of how the JS Go app was developed using CBPR principles is provided. In phase 2, teachers (n=12) were interviewed after reviewing mockups of the JS Go app to gather feedback about the interface and usefulness of the app to current and new teachers. Rapid qualitative analysis generated themes to inform phase 3 (n=31) of the study. Results Phase 2 findings suggested that teachers viewed the app as aesthetically pleasing with concise information, but there were design and content features that needed to be refined to improve ease of use for accessing content. Teachers also described the app as beneficial and useful to both current and new ECE teachers and identified it as a tool to support sustainability for the use of JS practices. In phase 3, teachers rated the JS Go app favorably across all mHealth (mobile health) App Usability Questionnaire dimensions, including interface satisfaction (mean 6.12 on a 7-point scale), ease of use (mean 5.56), and usefulness (mean 5.37). Despite positive usability ratings, teachers expressed less certain intentions to adopt the app, scoring near the midpoint on the Technology Acceptance Model Instrument-Fast Form’s predicted future use scale (mean 1.60, –4 to +4-point scale). Implications for how the findings were used to make adaptions to the app are discussed. The next steps for testing the efficacy of the app in a randomized control trial are described. Conclusions ECE teachers have overall positive perceptions about the value of the JS Go app. Future research will need to test the efficacy of the app for increasing and sustaining teacher’s use of JS practices.

Background Although the availability and use of mobile mental health apps has grown exponentially in recent years, little data are available regarding their efficacy. Objective This study aimed to evaluate the effectiveness of an app developed to promote stress management and well-being among working women compared with a control app. Methods Female employees at a private hospital were invited to participate in the study via mailing lists and intranet ads. A total of 653 individuals self-enrolled through the website. Eligible participants were randomized between control (n=240) and intervention (n=250) groups. The well-being mobile app provides an 8-week program with 4 classes per week (including a brief theoretical portion and a 15-min guided practice). The active control app also provided 4 assessments per week that encouraged participants to self-observe how they were feeling for 20 min. We also used the app to conduct Web-based questionnaires (10-item Perceived Stress Scale and 5-item World Health Organization Well-Being Index) and ask specific questions to assess subjective levels of stress and well-being at baseline (t1), midintervention (t4=4 weeks after t1) and postintervention (t8=8 weeks after t1). Both apps were fully automated without any human involvement. Outcomes from the control and intervention conditions at the 3 time points were analyzed using a repeated measures analysis of variance. Results Among the randomized participants (n=490), 185 participants were excluded at the 4-week follow-up and another 79 at the 8-week follow-up because of noncompliance with the experimental protocol. Participants who did not complete t4 and t8 assessments were equally distributed between groups (t4: control group=34.6% [83/240] and intervention group=40.8% [102/250]; P=.16; t8: control group=29.9% [47/157] and intervention group=21.6% [32/148]; P=.10). Both groups showed a significant increase in general well-being as a function of time (F2,426=5.27; P=.006), but only the intervention group presented a significant increase in work-related well-being (F2,426=8.92; P<.001), as well as a significant reduction in work-related and overall stress (F2,426=5.50; P=.004 and F2,426=8.59; P<.001, respectively). Conclusions The well-being mobile app was effective in reducing employee stress and improving well-being. Trial Registration Clinicaltrials.gov NCT02637414; https://clinicaltrials.gov/ct2/show/NCT02637414.

Background Apprenticeships are a common pathway for young people transitioning into the workforce. Apprentices often face many employment-related challenges and have high levels of psychological distress, drug and alcohol use, and suicidal ideation. Little is known about the attitudes of apprentices toward using smartphone apps to support their mental health and the content that would engage them. Objective This study explored (1) apprentices’ interest in using an app to support their mental health and (2) the healthy coping strategies used to manage their mental well-being in the face of workplace challenges, in order to inform future app content. Methods A mixed methods study was conducted with 54 apprentices (50/54 male, 93%) with a mean age of 22.7 (SD 5.7) years. Participants completed a survey on preferred ways of using an app to support mental health. Across 8 focus groups, participants were asked to describe healthy strategies they used to cope with occupational stressors. Results Only 11% (6/54) of participants currently used a well-being app, but there was high interest in using an app to support their friends (47/54 participants, 87%) and develop self-help strategies to manage or prevent mental health issues (42/54 participants, 78%). Four major types of coping behaviors were identified: (1) social connection for disclosure, advice, and socializing; (2) pleasurable activities, such as engaging in hobbies, time-outs, and developing work-life separation; (3) cognitive approaches, including defusing from thoughts and cognitive reframing; and (4) self-care approaches, including exercise, a healthy diet, and getting adequate sleep. Conclusions There is interest among apprentices to use an app with a positive well-being focus that helps them to develop self-management skills and support their friends. Apprentices utilized a range of healthy behaviors to cope with workplace stressors that can be incorporated into mental health apps to improve uptake and engagement. However, many of the preferred coping strategies identified are not those focused on by currently available apps, indicating the need for more targeted digital interventions for this group.

Background Approximately 800 million people, representing 11% of the world’s population, are affected by mental health problems. The COVID-19 pandemic exacerbated problems and triggered a decline in well-being, with drastic increase in the incidence of conditions such as anxiety, depression, and stress. Approximately 20,000 mental health apps are listed in mobile app stores. However, no significant evaluation of mental health apps in French, spoken by approximately 300 million people, has been identified in the literature yet. Objective This study aims to review the mental health mobile apps currently available on the French Apple App Store and Google Play Store and to evaluate their quality using Mobile App Rating Scale–French (MARS-F). Methods Screening of mental health apps was conducted from June 10, 2022, to June 17, 2022, on the French Apple App Store and Google Play Store. A shortlist of 12 apps was identified using the criteria of selection and assessed using MARS-F by 9 mental health professionals. Intraclass correlation was used to evaluate interrater agreement. Mean (SD) scores and their distributions for each section and item were calculated. Results The highest scores for MARS-F quality were obtained by Soutien psy avec Mon Sherpa (mean 3.85, SD 0.48), Evoluno (mean 3.54, SD 0.72), and Teale (mean 3.53, SD 0.87). Mean engagement scores (section A) ranged from 2.33 (SD 0.69) for Reflexe reussite to 3.80 (SD 0.61) for Soutien psy avec Mon Sherpa. Mean aesthetics scores (section C) ranged from 2.52 (SD 0.62) for Mental Booster to 3.89 (SD 0.69) for Soutien psy avec Mon Sherpa. Mean information scores (section D) ranged from 2.00 (SD 0.75) for Mental Booster to 3.46 (SD 0.77) for Soutien psy avec Mon Sherpa. Mean Mobile App Rating Scale subjective quality (section E) score varied from 1.22 (SD 0.26) for VOS – journal de l’humeur to 2.69 (SD 0.84) for Soutien psy avec Mon Sherpa. Mean app specificity (section F) score varied from 1.56 (SD 0.97) for Mental Booster to 3.31 (SD 1.22) for Evoluno. For all the mental health apps studied, except Soutien psy avec Mon Sherpa (11/12, 92%), the subjective quality score was always lower than the app specificity score, which was always lower than the MARS-F quality score, and that was lower than the rating score from the iPhone Operating System or Android app stores. Conclusions Mental health professionals assessed that, despite the lack of scientific evidence, the mental health mobile apps available on the French Apple App Store and Google Play Store were of good quality. However, they are reluctant to use them in their professional practice. Additional investigations are needed to assess their compliance with recommendations and their long-term impact on users.

No abstract available

BACKGROUND Mobile app interventions for mental health conditions (MH apps) are an accessible and effective but underutilized treatment option. Learning which patients are most interested in MH apps is important for informing stakeholders where to position these treatments within the healthcare landscape. This study examined the relationship between patient characteristics and interest in MH apps. METHODS A demographically-balanced sample of 400 patients diagnosed with depression, anxiety and/or post-traumatic stress disorder were identified from VA corporate data warehouse records. These individuals were mailed an information packet explaining the study and the study survey for those who opted to participate. The survey contained questions on demographics, symptom severity and interest in MH apps. 149 participants returned completed surveys. RESULTS Level of interest in MH apps was consistent across race, sex and education level. Patients reporting no interest in MH apps had less severe symptoms and were older than patients reporting some or high interest. LIMITATIONS Participants were Veterans in one geographic region; our sample size was not large enough to evaluate more fine-grained demographic differences; replication would be required to better understand generalizability of findings. CONCLUSIONS Findings suggest interest in MH apps may be more similar across demographic groups than previously thought. This stands in juxtaposition to interest in clinic-based services, for which men and minorities have traditionally reported less interest and show lower utilization. Findings also counter prevailing notions that MH apps will be best received by less symptomatic patients. Implications for integrating MH apps into care are discussed.

The development of internet brings significant changes in human life, including its influence on mental health conditions. As one of the countries with the largest increase in internet users in the world, Indonesia has important potential in utilizing this technology for psychological services. However, various studies show that the use of internet intervention in mental health services, especially by utilizing mobile-based technology, is still limited. This also relates to the conditions for receiving this intervention which are still not clearly known. This study aims to develop a measuring tool to explore the conditions of acceptance of internet interventions with mobile-app-based counseling services. This study involved 174 respondents spread across Indonesia with diverse demographics. Research results show that in general, measuring instruments meet good assessment requirements.

No abstract available

The development of internet technology brings significant changes in human life, including its effects on mental health conditions. As one of the countries with the increase of internet users around the world, Indonesia has the potential to utilize this technology in psychological service. However, various studies show that the use of Internet intervention in mental health services primarily by utilizing mobile-based technology is still limited. It is also related to the conditions of acceptance of this intervention that is not clearly known. This study aims to explore the acceptability condition of Internet-based intervention with mobile-app for mental health service. This preliminary study consisted of 174 respondents spread throughout across Indonesia with diverse demographics. The data findings were analyzed by using network psychometrics analysis and Rasch analysis. The results show that respondents generally accept and open up with mental health services using mobile app, more than half of respondents feel that internet-based services will be more effective, especially for first aid, distance and time constraints could be overcome with mobile app based service technology. The analysis of network psychometrics showed that respondents’ acceptance rate showed in high level and optimism of service success through this technology showed a significant result.

To evaluate a mobile app that delivers mental health support to adults with type 1 diabetes (T1D) living in rural and remote communities using the Reach, Effectiveness, Adoption, Intervention fidelity, Maintenance (RE‐AIM) framework.

Background The rising prevalence of mental health concerns among students is prompting universities to explore innovative solutions to support student well-being. This paper describes the protocol for the development, implementation, and evaluation of a mobile app designed to address the mental health and wellness needs of students. This project employs a student-centered approach, partnering with students from the initial needs analysis through to the final design and implementation stages. Objective The app aims to increase the use of campus resources that address student mental health and wellness by improving the awareness of these resources through user-designated preferences that are established on the initial use of the app and then iteratively refined as it is used. The app is linked to the campus student’s electronic health record so that health and wellness services can be coordinated and enhanced and the student journey to and through care become more seamless. The long-term objective is to leverage data from both the app and electronic health record to improve individual and population health for the entire campus. Methods At the beginning of the project, a comprehensive logic model was created to outline the core inputs, activities, outputs, outcomes, and long-term impacts that were desired for the app. The model emphasized the integration of the app within existing campus mental health and wellness services and its potential to foster a culture of well-being across the university community. An evaluation plan was developed that incorporates both quantitative and qualitative methods through biannual assessments to track trends and app impact across campus in addition to feasibility, acceptability, and usability as well as its reach, effectiveness, and sustainability. Validated measures such as the Patient Health Questionnaire and Generalized Anxiety Disorder scale were selected to track changes in mental health and wellness, while custom surveys and analytics will gauge user engagement and satisfaction. New students, including freshmen, transfers, and first-year medical students, are invited to participate after giving informed consent. They receive compensation for their involvement in both quantitative and qualitative assessments. Results As of March 2025, we have collected over 600 survey responses from freshmen, transfer, and medical students. A second survey round and additional focus groups are planned for April to May 2025. No analyses have been conducted yet. The findings from this project have the potential to inform similar efforts at other institutions and contribute to the broader field of digital mental health innovation and the development of well-being interventions tailored for young people. Conclusions By leveraging digital technology and actively engaging students in supporting their well-being, this initiative represents an innovative user-centered approach to improve mental health and wellness support on university campuses. International Registered Report Identifier (IRRID) DERR1-10.2196/68368

Background Despite the popularity of mental health apps, it is unknown if they are actually used by those with mental illness. This study assessed whether differences in clinic setting may influence the use of mental health apps and which factors influence patient perception of apps. Objective The objective of this study was to gain an understanding of how individuals with mental illness use their mobile phones by exploring their access to mobile phones and their use of mental health apps. Methods A single time point survey study was conducted over a 2-week period in February 2018 at two nearby outpatient psychiatry clinics: one serving largely mood and anxiety disorder patients with private insurance staffed by both faculty and residents and the other serving largely psychotic disorder patients in a state Department of Mental Health (DMH) setting. A total of 25 patients at the state DMH clinic also consented for a single time point observation of apps currently installed on their personal mobile phone. Results A total of 113 patients at the private insurance clinic and 73 at the state DMH clinic completed the survey. Those in the private insurance clinic were more likely to download a mental health app compared to the state DMH clinic, but actual rates of reported current app usage were comparable at each clinic, approximately 10%. Verifying current apps on patients’ mobile phones at the state DMH clinic confirmed that approximately 10% had mental health apps installed. Patients at both clinics were most concerned about privacy of mental health apps, although those at the state DMH clinic viewed cost savings as the greatest benefit while those at the private clinic reported time as the greatest benefit. Conclusions High interest in mental health apps does not automatically translate into high use. Our results of low but similar rates of mental health app use at diverse clinics suggests DMH patients with largely psychotic disorders are as interested and engaged with apps as those in a private insurance clinic treating largely mood and anxiety disorders. Results from our study also highlight the importance of understanding how actual patients are using apps instead of relying on internet-based samples, which often yield higher results due to their likelihood of being selected.

Background Beyond physical health, managing type 1 diabetes (T1D) also encompasses a psychological component, including diabetes distress, that is, the worries, fears, and frustrations associated with meeting self-care demands over the lifetime. While digital health solutions have been increasingly used to address emotional health in diabetes, these technologies may not uniformly meet the unique concerns and technological savvy across all age groups. Objective This study aimed to explore the mental health needs of adolescents with T1D, determine their preferred modalities for app-based mental health support, and identify desirable design features for peer-delivered mental health support modeled on an app designed for adults with T1D. Methods A semistructured qualitative focus group study was conducted with adolescents with T1D and parents of adolescents with T1D. Data were collected through pre–focus group surveys, including sociodemographic background, diabetes status, health care experiences, and focus group sessions, including their opinions on peer support and technology. A thematic analysis following an inductive and iterative process was performed to develop themes and subthemes from the collected information. Results Focus group participants included 10 adolescents (mean 16, SD 1 years; 8/10, 80% female; who had been living with diabetes for an average of 9, SD 5 years) and 10 parents (mean age 51, SD 7 years; 9/10, 90% female). Four core themes emerged: (1) experience: navigating adolescence with T1D, (2) empowerment: support systems that enabled better management of their T1D, (3) obstacles: societal barriers that affect adolescents’ T1D management, and (4) innovation: adolescent-driven preferences for digital peer support platforms. Conclusions App-based peer support offers a promising avenue for addressing the mental health needs of adolescents with T1D. Understanding the unique support needs of these adolescents and using this information to suggest design considerations for a mental health peer support app is an important step toward addressing their complex emotional and social challenges.

Internally displaced persons (IDPs) in Nigeria face a high burden of mental health disorders, with limited access to evidence-based, culturally relevant interventions. Life skills education (LSE) is a promising approach to promote mental health and psychosocial well-being in humanitarian settings. This study aims to evaluate the effectiveness and implementation of a culturally adapted LSE program delivered through in-person and mobile platforms among IDPs in Northern Nigeria. This cluster-randomized hybrid type 2 effectiveness-implementation trial will be conducted in 20 IDP camps or host communities in Maiduguri, Nigeria. Sites will be randomly assigned to receive a 12-week LSE program delivered either through in-person peer support groups or WhatsApp-facilitated mobile groups. The study will recruit 500 participants aged 13 years and older. Intervention effectiveness outcomes include the primary outcome of change in post-traumatic stress disorder (PTSD) symptoms assessed using the PCL-5 scale, and secondary outcomes of depression, anxiety, well-being, and life skills acquisition. Implementation outcomes will be assessed using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Both sets of outcomes will be compared between the in-person and mobile delivery groups. Quantitative data will be analyzed using mixed-effects linear regression models, while qualitative data will be examined through reflexive thematic analysis. The study will be guided by the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework. The RESETTLE-IDPs study addresses key gaps in the evidence base on mental health interventions for conflict-affected populations. It focuses on underserved IDP populations, evaluates the comparative effectiveness of in-person and mobile-delivered LSE, and incorporates implementation science frameworks to assess contextual factors influencing adoption, fidelity, and sustainability. The study employs a community-based participatory approach to enhance cultural relevance, acceptability, and ownership. Findings will inform the development and scale-up of evidence-based, sustainable mental health interventions for IDPs in Nigeria and other humanitarian contexts. Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada. ClinicalTrials.gov, NCT06412679 Registered 15 May 2024.

Background Maternal mental health care is variable and with limited accessibility. Artificial intelligence (AI) conversational agents (CAs) could potentially play an important role in supporting maternal mental health and wellbeing. Our study examined data from real-world users who self-reported a maternal event while engaging with a digital mental health and wellbeing AI-enabled CA app (Wysa) for emotional support. The study evaluated app effectiveness by comparing changes in self-reported depressive symptoms between a higher engaged group of users and a lower engaged group of users and derived qualitative insights into the behaviors exhibited among higher engaged maternal event users based on their conversations with the AI CA. Methods Real-world anonymised data from users who reported going through a maternal event during their conversation with the app was analyzed. For the first objective, users who completed two PHQ-9 self-reported assessments (n = 51) were grouped as either higher engaged users (n = 28) or lower engaged users (n = 23) based on their number of active session-days with the CA between two screenings. A non-parametric Mann–Whitney test (M–W) and non-parametric Common Language effect size was used to evaluate group differences in self-reported depressive symptoms. For the second objective, a Braun and Clarke thematic analysis was used to identify engagement behavior with the CA for the top quartile of higher engaged users (n = 10 of 51). Feedback on the app and demographic information was also explored. Results Results revealed a significant reduction in self-reported depressive symptoms among the higher engaged user group compared to lower engaged user group (M–W p = .004) with a high effect size (CL = 0.736). Furthermore, the top themes that emerged from the qualitative analysis revealed users expressed concerns, hopes, need for support, reframing their thoughts and expressing their victories and gratitude. Conclusion These findings provide preliminary evidence of the effectiveness and engagement and comfort of using this AI-based emotionally intelligent mobile app to support mental health and wellbeing across a range of maternal events and experiences.

Background Co-design is one of the human-centered design approaches that allows end users to significantly and positively impact the design of mental health technologies. It is a promising approach to foster user acceptance and engagement in digital mental health solutions. Surprisingly, there is a lack of understanding of what co-design is in this field. In this paper, co-design is approached as a cocreation process involving persons with a lived experience of mental health problems, health professionals, and design experts who lead and facilitate the overall creative process. Objective This paper describes an initial co-design research protocol for the development of a mobile app that aims to improve access to mental health care. It highlights the characteristics of a co-design approach in e–mental health rooted in human-centered design and led by design experts alongside health experts. The paper focuses on the first steps (phase 1) of the co-design process of the ongoing Mentallys project. Methods This Mentallys project will be located in Montréal (Quebec, Canada). The method approach will be based on the “method stories,” depicting the “making of” this project and reflecting adjustments needed to the protocol throughout the project in specific situations. Phase 1 of the process will focus on the desirability of the app. Targeted participants will include people with a lived experience of mental health problems, peer support workers and clinicians, and 3 facilitators (all design experts or researchers). Web-based sessions will be organized because of the COVID-19 pandemic, using Miro (RealtimeBoard Inc) and Zoom (Zoom Video Communications, Inc). Data collection will be based on the comments, thoughts, and new ideas of participants around the imaginary prototypes. Thematic analysis will be carried out after each session to inform a new version of the prototype. Results We conducted 2 stages in phase 1 of the process. During stage 1, we explored ideas through group co-design workshops (divergent thinking). Six co-design workshops were held: 2 with only clinicians (n=7), 2 with peer support workers (n=5) and people with a lived experience of mental health problems (n=2), and 2 with all of them (n=14). A total of 6 facilitators participated in conducting activities in subgroups. During stage 2, ideas were refined through 10 dyad co-design sessions (convergent thinking). Stage 2 involved 3 participants (n=3) and 1 facilitator. Thematic analysis was performed after stage 1, while analytic questioning is being performed for stage 2. Both stages allowed several iterations of the prototypes. Conclusions The design of the co-design process, the leadership of the design expertise throughout the process, and the different forms of co-design activities are key elements in this project. We highly recommend that health researchers partner with professional designers or design researchers who are familiar with co-design. International Registered Report Identifier (IRRID) DERR1-10.2196/47220

Background In times of increasing mental health problems among young people, strengthening efforts to improve mental health through mental health promotion and prevention becomes increasingly important. Effective measures that support young people in coping with negative thoughts, feelings, and stress are essential, not just for the individual but also for society. Objective The aim of this paper is to provide a description of a cluster randomized controlled trial that will be conducted to examine the effectiveness of Opp, a universal mental health–promoting mobile app for adolescents aged 13 to 19 years that provides information and exercises to better cope with stress, negative thoughts, and negative feelings. The protocol was developed in accordance with the SPIRIT checklist. Methods An effectiveness study will be conducted with 3 measurement points: preintervention (T1), 2 weeks after the intervention (T2), and about 1 month after the intervention (T3). Adolescents will be recruited from middle and high schools in Norway and randomly assigned to the intervention or control groups. Randomization will be conducted on the school level. Opp can be downloaded from the Google Play or App Store but is password protected with a 4-digit code, which will be removed after study completion. Participants in the intervention group will receive a text message with the code to unlock the app. The participants in the intervention group can use Opp without limits on length or time of use. Objective data on how long or how often the participants use the app will not be collected. However, the second and third questionnaires for the intervention group contain app-specific questions on, for example, the use of the app. Results Recruitment and data collection started in August and September 2022. So far, 381 adolescents have answered the first questionnaire. Data collection was expected to end in December 2022 but has had to be prolonged to approximately June 2023. The results of the study will be available in 2023 at the earliest. Conclusions This project will contribute unique knowledge to the field, as there are few studies that have examined the effects of universal health-promoting mobile apps for adolescents. However, several limitations have to be taken into account when interpreting the results, such as randomization on the school level, the short time frame in which the study was conducted, and the lack of objective data to monitor the use of the app. Trial Registration ClinicalTrials.gov NCT05211713; https://www.clinicaltrials.gov/ct2/show/NCT05211713 International Registered Report Identifier (IRRID) PRR1-10.2196/42119

Abstract Abstract This paper describes the development process of a mobile app-based version of the World Health Organization mental health Gap Action Programme Intervention Guide, testing of the app prototypes, and its functionality in the assessment and management of people with mental health conditions in Nepal. Health workers’ perception of feasibility and acceptability of using mobile technology in mental health care was assessed during the inspiration phase (N = 43); the ideation phase involved the creation of prototypes; and prototype testing was conducted over multiple rounds with 15 healthcare providers. The app provides provisional diagnoses and treatment options based on reported symptoms. Participants found the app prototype useful in reminding them of the process of assessment and management of mental disorders. Some challenges were noted, these included a slow app prototype with multiple technical problems, including difficulty in navigating ‘yes’/‘no’ options, and there were challenges reviewing detailed symptoms of a particular disorder using a “more information” icon. The initial feasibility work suggests that if the technical issues are addressed, the e-mhGAP warrants further research to understand if it is a useful method in improving the detection of people with mental health conditions and initiation of evidence-based treatment in primary healthcare facilities.

Background Generation Z (Gen Z) and young millennials (GenZennials) (ages 18-35 years) are unique in that they either have no memory of or were born shortly after the internet “explosion.” They are constantly on the internet, face significant challenges with their mental health and sleep, and are frequent users of digital wellness apps. GenZennials also uniquely identify with and practice spirituality, which has been linked to better mental health and sleep in adult populations. Research has not examined digital approaches to spiritual self-care and its relationship to mental health and sleep in GenZennials. Objective The purpose of this study was to describe a sample of adult GenZennials who use a spiritual self-care app (ie, Skylight), describe how users engage with and perceive the app, and assess the relationship between frequency of using the app with mental health, sleep, and spiritual well-being. Methods Participants were 475 adult Gen Z (ages 18-28 years) and young millennial (ages 29-35 years) Skylight app users who responded to an anonymous survey on the web. The survey asked about demographics, spiritual self-care and practice, and user engagement and perceptions of the app. Outcome measures included 4 validated surveys for mental health (ie, depression, anxiety, and stress) and sleep disturbance, and one validated survey on spiritual well-being. Mean scores were calculated for all measures, and linear regressions were conducted to examine the relationship between the frequency of app use and mental health, sleep, and spiritual well-being outcomes. Results Participants were predominantly White (324/475, 68.2%) and female (255/475, 53.7%), and approximately half Gen Z (260/475, 54.5%) and half young millennials (215/475, 45.3%). Most users engaged in spiritual self-care (399/475, 84%) and said it was important or very important to them (437/475, 92%). Users downloaded the app for spiritual well-being (130/475, 30%) and overall health (125/475, 26.3%). Users had normal, average depressive symptoms (6.9/21), borderline abnormal anxiety levels (7.7/21), slightly elevated stress (6.7/16), and nonclinically significant sleep disturbance (5.3/28). Frequency of app use was significantly associated with lower anxiety (Moderate use: β=–2.01; P=.02; high use: β=–2.58; P<.001). There were no significant relationships between the frequency of app use and mental health, sleep, and spiritual well-being outcomes except for the personal domain of spiritual well-being. Conclusions This is the first study to describe a sample of adult GenZennials who use a spiritual self-care app and examine how the frequency of app use is related to their mental health, sleep, and spiritual well-being. Spiritual self-care apps like Skylight may be useful in addressing anxiety among GenZennials and be a resource to spiritually connect to their personal spiritual well-being. Future research is needed to determine how a spiritual self-care app may benefit mental health, sleep, and spiritual well-being in adult GenZennials.

While peer support research is growing in the Type 1 diabetes (T1D) community, the peer supporter training (PST) process is rarely documented in detail. This study provides a comprehensive description of PST and evaluation for the REACHOUT mental health support intervention, and examines the feasibility and perceived utility of PST.

Background Depression is associated with significant morbidity and human capital costs globally. Early screening for depressive symptoms and timely depressive disorder case identification and intervention may improve health outcomes and cost-effectiveness among affected individuals. China’s public and academic communities have reached a consensus on the need to improve access to early screening, diagnosis, and treatment of depression. Objective This study aims to estimate the screening prevalence and associated factors of subthreshold depressive symptoms among Chinese residents enrolled in the cohort study using a mobile app–based integrated mental health care model and investigate the 12-month incidence rate and related factors of major depressive disorder (MDD) among those with subthreshold depressive symptoms. Methods Data were drawn from the Depression Cohort in China (DCC) study. A total of 4243 community residents aged 18 to 64 years living in Nanshan district, Shenzhen city, in Guangdong province, China, were encouraged to participate in the DCC study when visiting the participating primary health care centers, and 4066 (95.83%) residents who met the DCC study criteria were screened for subthreshold depressive symptoms using the Patient Health Questionnaire-9 at baseline. Of the 4066 screened residents, 3168 (77.91%) with subthreshold depressive symptoms were referred to hospitals to receive a psychiatric diagnosis of MDD within 12 months. Sleep duration, anxiety symptoms, well-being, insomnia symptoms, and resilience were also investigated. The diagnosis of MDD was provided by trained psychiatrists using the Mini-International Neuropsychiatric Interview. Univariate and multivariate logistic regression models were performed to explore the potential factors related to subthreshold depressive symptoms at baseline, and Cox proportional hazards models were performed to explore the potential factors related to incident MDD. Results Anxiety symptoms (adjusted odds ratio [AOR] 1.63, 95% CI 1.42-1.87) and insomnia symptoms (AOR 1.13, 95% CI 1.05-1.22) were associated with an increased risk of subthreshold depressive symptoms, whereas well-being (AOR 0.93, 95% CI 0.87-0.99) was negatively associated with depressive symptoms. During the follow-up period, the 12-month incidence rate of MDD among participants with subthreshold depressive symptoms was 5.97% (189/3168). After incorporating all significant variables from the univariate analyses, the multivariate Cox proportional hazards model reported that a history of comorbidities (adjusted hazard ratio [AHR] 1.49, 95% CI 1.04-2.14) and anxiety symptoms (AHR 1.13, 95% CI 1.09-1.17) were independently associated with an increased risk of incident MDD. The 5-item World Health Organization Well-Being Index was associated with a decreased risk of incident MDD (AHR 0.90, 95% CI 0.86-0.94). Conclusions Elevated anxiety symptoms and unfavorable general well-being were significantly associated with subthreshold depressive symptoms and incident MDD among Chinese residents in Shenzhen. Early screening for subthreshold depressive symptoms and related factors may be helpful for identifying populations at high risk of incident MDD.

Background Although it is well known that adolescents frequently turn to their friends for support around mental health and substance use problems, there are currently no evidence-based digital programs to support them to do this. Objective The aim of this study was to evaluate the efficacy of the Mind your Mate program, a digital peer-support program, in improving mental health symptoms, reducing the uptake of substance use, and increasing help seeking. The Mind your Mate program consists of a 40-minute web-based classroom lesson and a companion smartphone mobile app. The active control group received school-based health education as usual. Methods A cluster randomized controlled trial was conducted with 12 secondary schools and 166 students (mean age 15.3, SD 0.41 years; 72/166, 43.4% female; and 133/166, 80.1% born in Australia). Participants completed self-reported questionnaires assessing symptoms of mental health (depression, anxiety, and psychological distress), substance use (alcohol and other drug use), and help-seeking measures at baseline and at 6-month and 12-month follow-ups. Results Students who received the Mind your Mate program had greater reductions in depressive symptoms over a 12-month period than controls (b=−1.86, 95% CI −3.73 to 0.02; Cohen d=−0.31). Anxiety symptoms decreased among students in the intervention group; however, these reductions did not meet statistical significance thresholds. No differences were observed in relation to psychological distress or help-seeking. Conclusions Small to moderate reductions in depression symptoms were observed among students allocated to receive the Mind your Mate intervention. Although the current results are encouraging, there is a need to continue to refine, develop, and evaluate innovative applied approaches for the prevention of mental disorders in real-world settings. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000753954; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000753954 International Registered Report Identifier (IRRID) RR2-10.2196/26796

Background Over 700,000 people die by suicide annually, making it the fourth leading cause of death among those aged 15-29 years globally. Safety planning is recommended best practice when individuals at risk of suicide present to health services. A safety plan, developed in collaboration with a health care practitioner, details the steps to be taken in an emotional crisis. SafePlan, a safety planning mobile app, was designed to support young people experiencing suicidal thoughts and behaviors and to record their plan in a way that is accessible immediately and in situ. Objective The aim of this study is to assess the feasibility and acceptability of the SafePlan mobile app for patients experiencing suicidal thoughts and behaviors and their clinicians within Irish community mental health services, examine the feasibility of study procedures for both patients and clinicians, and determine if the SafePlan condition yields superior outcomes when compared with the control condition. Methods A total of 80 participants aged 16-35 years accessing Irish mental health services will be randomized (1:1) to receive the SafePlan app plus treatment as usual or treatment as usual plus a paper-based safety plan. The feasibility and acceptability of the SafePlan app and study procedures will be evaluated using both qualitative and quantitative methodologies. The primary outcomes are feasibility outcomes and include the acceptability of the app to participants and clinicians, the feasibility of delivery in this setting, recruitment, retention, and app use. The feasibility and acceptability of the following measures in a full randomized controlled trial will also be assessed: the Beck Scale for Suicide Ideation, Columbia Suicide Severity Rating Scale, Coping Self-Efficacy Scale, Interpersonal Needs Questionnaire, and Client Service Receipt Inventory. A repeated measures design with outcome data collected at baseline, post intervention (8 weeks), and at 6-month follow-up will be used to compare changes in suicidal ideation for the intervention condition relative to the waitlist control condition. A cost-outcome description will also be undertaken. Thematic analyses will be used to analyze the qualitative data gathered through semistructured interviews with patients and clinicians. Results As of January 2023, funding and ethics approval have been acquired, and clinician champions across mental health service sites have been established. Data collection is expected to commence by April 2023. The submission of completed manuscript is expected by April 2025. Conclusions The framework for Decision-making after Pilot and feasibility Trials will inform the decision to progress to a full trial. The results will inform patients, researchers, clinicians, and health services of the feasibility and acceptability of the SafePlan app in community mental health services. The findings will have implications for further research and policy regarding the broader integration of safety planning apps. Trial Registration OSF Registries osf.io/3y54m; https://osf.io/3y54m International Registered Report Identifier (IRRID) PRR1-10.2196/44205

No abstract available

Background College students endorse high rates of mental health problems. While many colleges offer on-campus services, many students who could benefit from mental health services do not receive care. Indeed, nearly half of students who screen positive for depression, for example, do not receive treatment. Digital mental health programs, such as those delivered via mobile apps, may help expand access to mental health care and resources. This mixed-methods study aims to examine the uptake and effectiveness of an implementation of IntelliCare for College Students, a self-guided app-based mental health platform, on two university campuses. Methods Data on counseling center utilization was collected prior to the implementation of the app (pre-implementation phase) and while the app was available on campus (implementation phase). Data on app usage was collected throughout the implementation phase. A subset of participants (n = 20), along with counseling center staff members (n = 10), completed feedback interviews. Results Overall, uptake of the app platform was low. A total of 117 participants downloaded the app and registered their study ID during the implementation phase. Approximately 24% (28/117) of participants used the app only once. The number of days between the first and last day of app use ranged from 0 to 299, with a mean of 35.01 days and a median of 14 days. A relatively small portion of the sample (26.5%; 31/117) downloaded one or more of the IntelliCare interactive apps. In examining counseling center utilization, there were no significant changes in intake appointments, individual therapy sessions, or crisis appointments observed from the pre-implementation phase to the implementation phase of the study. Feedback interviews highlighted the significant level of disruption caused by the COVID-19 pandemic and shift to remote learning, including challenges disseminating information to students and a preference to spend less time with digital devices outside of class time. Conclusions Findings from this study indicate that there is an ongoing need to identify ways to reach college students and support student mental health and wellness for the remainder of the COVID-19 pandemic and beyond.

Background Digital technologies and mobile interventions are possible tools for prevention initiatives to target the substantial social and economic impacts that anxiety, mood, and substance use disorders have on young people. Objective This paper described the design and development of the Mind your Mate program, a smartphone app and introductory classroom lesson enhancing peer support around the topics of anxiety, depression, and substance use for adolescents. Methods The development of Mind your Mate was an iterative process conducted in collaboration with adolescents (n=23), experts, school staff, and software developers. The development process consisted of 3 stages: scoping; end-user consultations, including a web-based survey and 2 focus groups with 23 adolescents (mean age 15.9, SD 0.6 years); and app development and beta-testing. Results This process resulted in a smartphone peer support app and introductory classroom lesson aimed at empowering adolescents to access evidence-based information and tools to better support peers regarding mental health and substance use–related issues. The program contains links to external support services and encourages adolescents to reach out for help if they are concerned about themselves or a friend. Conclusions The Mind your Mate program was developed in collaboration with a number of key stakeholders in youth mental health, including adolescents. The resulting program has the potential to be taken to scale to aid prevention efforts for youth mental health and substance use. The next step is to conduct a randomized controlled trial testing the feasibility, acceptability, and efficacy of the program.

Background While nonprofessional caregivers often experience a sense of fulfillment when they provide care, there is also a significant risk of emotional and physical burnout. Consequently, this can negatively affect both the caregiver and the person being cared for. Intervention programs can help empower nonprofessional caregivers of people with chronic diseases and develop solutions to decrease the physical and psychological consequences resulting from caregiving. However, most clinically tested intervention programs for nonprofessional caregivers require face-to-face training, and many caregivers encounter obstacles that hinder their participation in such programs. Consequently, it is necessary to design internet-based intervention programs for nonprofessional caregivers that address their needs and test the efficacy of the programs. Objective The aim of this study was to evaluate the effectiveness of a smartphone app–based intervention program to increase positive mental health for nonprofessional caregivers. Methods This study was a randomized controlled trial of 3 months’ duration. A total of 152 caregivers over 18 years of age with a minimum of 4 months’ experience as nonprofessional caregivers were recruited from primary health care institutions. Nonprofessional caregivers were randomized into two groups. In the intervention group, each caregiver installed a smartphone app and used it for 28 days. This app offered them daily activities that were based on 10 recommendations to promote positive mental health. The level of positive mental health, measured using the Positive Mental Health Questionnaire (PMHQ), and caregiver burden, measured using the 7-item short-form version of the Zarit Caregiver Burden Interview (ZBI-7), were the primary outcomes. Users’ satisfaction was also measured. Results In all, 113 caregivers completed the study. After the first month of the intervention, only one factor of the PMHQ, F1–Personal satisfaction, showed a significant difference between the groups, but it was not clinically relevant (0.96; P=.03). However, the intervention group obtained a higher mean change for the overall PMHQ score (mean change between groups: 1.40; P=.24). The results after the third month of the intervention showed an increment of PMHQ scores. The mean difference of change in the PMHQ score showed a significant difference between the groups (11.43; P<.001; d=0.82). Significant changes were reported in 5 of the 6 factors, especially F5–Problem solving and self-actualization (5.69; P<.001; d=0.71), F2–Prosocial attitude (2.47; P<.001; d=1.18), and F3–Self-control (0.76; P=.03; d=0.50). The results of the ZBI-7 showed a decrease in caregiver burden in the intervention group, although the results were inconclusive. Approximately 93.9% (46/49) of the app users indicated that they would recommend the app to other caregivers and 56.3% (27/49) agreed that an extension of the program’s duration would be beneficial. Conclusions The app-based intervention program analyzed in this study was effective in promoting positive mental health and decreasing the burden of caregivers and achieved a high range of user satisfaction. This study provides evidence that mobile phone app–based intervention programs may be useful tools for increasing nonprofessional caregivers’ well-being. The assessment of the effectiveness of intervention programs through clinical trials should be a focus to promote internet-based programs in health policies. Trial Registration ISRCTN Registry ISRCTN14818443; http://www.isrctn.com/ISRCTN14818443 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-7264-5

Background The COVID-19 pandemic has been declared an international public health emergency, and it may have long-lasting effects on people’s mental health. There is a need to identify effective health behaviors to mitigate the negative mental health impact of COVID-19. Objective The objectives of this study were to (1) examine the regional differences in mental health and COVID-19–related worry, attention to news, and stress, in light of the state-level prevalence of COVID-19 cases; (2) estimate the associations between mental health and COVID-19–related worry, attention to news, and stress and health behavior engagement (ie, physical activity, mindfulness meditation); and (3) explore the mediating effect of health behavior engagement on the associations between mental health and COVID-19–related worry, attention to news, and stress. Methods A cross-sectional survey was distributed to a sample of US adult paying subscribers to the Calm app (data were collected from April 22 to June 3, 2020). The survey assessed COVID-19–related worry, attention to news, and stress; health behavior engagement; and mental health (ie, perceived stress, posttraumatic stress disorder, and anxiety and depression). Statistical analyses were performed using R software. Differences in COVID-19–related worry, attention to news, and stress and mental health by location were assessed using t tests and chi-square tests. Logistic and ordinary least squares models were used to regress mental health and health behavior on COVID-19–related worry, attention to news, and stress; moreover, causal mediation analysis was used to estimate the significance of the mediation effects. Results The median age of the respondents (N=8392) was 47 years (SD 13.8). Participants in the Mid-Atlantic region (New Jersey, New York, and Pennsylvania) reported higher levels of stress, more severe depression symptoms, greater worry about COVID-19, paying more attention to COVID-19–related news, and more stress related to social distancing recommendations than participants living in other regions. The association between worry about COVID-19 and perceived stress was significantly mediated by changes in physical activity (P<.001), strength of meditation habit (P<.001), and stopping meditation (P=.046). The association between worry about COVID-19 and posttraumatic stress disorder symptoms was significantly mediated by changes in physical activity (P<.001) and strength of meditation habit (P<.001). Conclusions Our findings describe the mental health impact of COVID-19 and outline how continued participation in health behaviors such as physical activity and mindfulness meditation reduce worsening of mental health due to the COVID-19 pandemic. These data have important implications for public health agencies and health organizations to promote the maintenance of health habits to reduce the residual mental health burden of the COVID-19 pandemic.

Background The COVID-19 pandemic has highlighted the importance of health care workers’ mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. Objective RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. Methods The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. Results The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. Conclusions The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. International Registered Report Identifier (IRRID) DERR1-10.2196/26168

Introduction: College students face high rates of depression, anxiety, and suicide. Therefore, the focus of this study was to examine college students' intention to use a mental health app provided by the university, called MySSP, through use of the unified theory of acceptance and use of technology (UTAUT). Materials and Methods: An online survey was developed based on responses to focus groups previously conducted by the authors regarding MySSP. A multiple linear regression was conducted to test the associations between the UTAUT variables and behavioral intention. In addition, moderation analyses were conducted to explore the effects of depression, anxiety, stigma, and quality of life as moderators. Results: Results suggest that performance expectancy (PE) (t = 3.088, p = 0.003) and social influence (SI) (t = −2.163, p = 0.03) were the only significant predictors of behavioral intention. The only significant moderator was stigma in the relationship between effort expectancy and behavioral intention (b = −1.6081, standard error (SE) = 0.7454, confidence interval (CI): −3.0691 to −0.1472) as well as facilitating conditions (FCs) and behavioral intention (b = −2.2292, SE = 0.8580, CI: −3.9110 to −0.5475). Conclusions: This study provides an initial exploration of college students' intentions to use MySSP. The results suggest that successful interventions include features related to PE (usefulness) and SI (norms), which should be focused on when developing and testing apps for mental health. Additionally, the stigma of mental health has significant negative impacts on the adoption of mental health apps and should be considered in implementation of mental health interventions geared toward college students.

Background App-based interventions provide a promising avenue for mitigating the burden on mental health services by complimenting therapist-led treatments for anxiety. However, it remains unclear how specific systems’ use of app features may be associated with changes in mental health outcomes (eg, anxiety and worry). Objective This study was a secondary analysis of engagement data from a stage 1 randomized controlled trial testing the impact of the Unwinding Anxiety mobile app among adults with generalized anxiety disorder. The aims of this study were 2-fold: to investigate whether higher microengagement with the primary intervention feature (ie, educational modules) is associated with positive changes in mental health outcomes at 2 months (ie, anxiety, worry, interoceptive awareness, and emotional reactivity) and to investigate whether the use of adjunctive app features is also associated with changes in mental health outcomes. Methods We analyzed the intervention group during the stage 1 trial of the Unwinding Anxiety mobile app. The total use of specific mobile app features and the use specific to each feature were calculated. We used multivariate linear models with a priori significance of α=.05 to investigate the impact of cumulative app use on anxiety, worry, interoceptive awareness, and emotional regulation at 2 months, controlling for baseline scores, age, and education level in all models. Significant relationships between system use metrics and baseline participant characteristics were assessed for differences in use groupings using between-group testing (ie, 2-tailed t tests for continuous data and chi-square analyses for categorical data). Results The sample was primarily female (25/27, 93%), and the average age was 42.9 (SD 15.6) years. Educational module completion, the central intervention component, averaged 20.2 (SD 11.4) modules out of 32 for the total sample. Multivariate models revealed that completing >75% of the program was associated with an average 22.6-point increase in interoceptive awareness (b=22.6; SE 8.32; P=.01; 95% CI 5.3-39.8) and an 11.6-point decrease in worry (b=−11.6; SE 4.12; P=.01; 95% CI −20.2 to −3.1). In addition, a single log unit change in the total number of meditations was associated with a 0.62-point reduction in the Generalized Anxiety Disorder-7 scale scores (b=0.62; SE 0.27; P=.005; 95% CI −1.2 to −0.6), whereas a single log unit use of the stress meter was associated with an average of a 0.5-point increase in emotional regulation scores (Five Facet Mindfulness Questionnaire; b=0.5; SE 0.21; P=.03; 95% CI 0.1-0.9). Conclusions This study offers a clearer understanding of the impact of engagement with app features on broader engagement with the health outcomes of interest. This study highlights the importance of comprehensive investigations of engagement during the development of evidence-based mobile apps.

Background Undergraduate studies are challenging, and mental health issues can frequently occur in undergraduate students, straining campus resources that are already in demand for somatic problems. Cost-effective measures with ubiquitous devices, such as smartphones, offer the potential to deliver targeted interventions to monitor and affect lifestyle, which may result in improvements to student mental health. However, the avenues by which this can be done are not particularly well understood, especially in the Canadian context. Objective The aim of this study is to deploy an initial version of the Smart Healthy Campus app at Western University, Canada, and to analyze corresponding data for associations between psychosocial factors (measured by a questionnaire) and behaviors associated with lifestyle (measured by smartphone sensors). Methods This preliminary study was conducted as an observational app-based ecological momentary assessment. Undergraduate students were recruited over email, and sampling using a custom 7-item questionnaire occurred on a weekly basis. Results First, the 7-item Smart Healthy Campus questionnaire, derived from fully validated questionnaires—such as the Brief Resilience Scale; General Anxiety Disorder-7; and Depression, Anxiety, and Stress Scale–21—was shown to significantly correlate with the mental health domains of these validated questionnaires, illustrating that it is a viable tool for a momentary assessment of an overview of undergraduate mental health. Second, data collected through the app were analyzed. There were 312 weekly responses and 813 sensor samples from 139 participants from March 2019 to March 2020; data collection concluded when COVID-19 was declared a pandemic. Demographic information was not collected in this preliminary study because of technical limitations. Approximately 69.8% (97/139) of participants only completed one survey, possibly because of the absence of any incentive. Given the limited amount of data, analysis was not conducted with respect to time, so all data were analyzed as a single collection. On the basis of mean rank, students showing more positive mental health through higher questionnaire scores tended to spend more time completing questionnaires, showed more signs of physical activity based on pedometers, and had their devices running less and plugged in charging less when sampled. In addition, based on mean rank, students on campus tended to report more positive mental health through higher questionnaire scores compared with those who were sampled off campus. Some data from students found in or near residences were also briefly examined. Conclusions Given these limited data, participants tended to report a more positive overview of mental health when on campus and when showing signs of higher levels of physical activity. These early findings suggest that device sensors related to physical activity and location are useful for monitoring undergraduate students and designing interventions. However, much more sensor data are needed going forward, especially given the sweeping changes in undergraduate studies due to COVID-19.

Objective This article analyzes the changes in downloads and activity of users of select popular mental health mobile applications (mHealth apps) during coronavirus disease 2019 (COVID-19). Background The outbreak of the COVID-19 crisis has shown a negative impact on public mental health. Mobile health has the potential to help address the psychological needs of existing and new patients during the pandemic and beyond. Method Downloads data of 16 widely used apps were analyzed. The quality of apps was reviewed using the Mobile Application Rating Scale (MARS) framework. Correlation analysis was conducted to investigate the relationship between app quality and app popularity. Results Among the 16 apps, 10 were meditational in nature, 13 showed increased downloads, with 11 apps showing above 10% increase in the downloads after the pandemic started. The popular apps were satisfactory in terms of functionality and esthetics but lacked clinical grounding and evidence base. There exists a gap between app quality and app popularity. Conclusion This study provided evidence for increased downloads of mental mHealth apps (primarily meditation apps) during the COVID-19 pandemic but revealed several gaps and opportunities to address deficiencies in evidence-based design, usability and effective assessment, and integration into current workflows. Application The COVID-19 pandemic is a potential turning point for mHealth applications for mental health care. Whereas the evidence suggests a need for alternative delivery of care, human factors and ergonomics methods should be utilized to ensure these tools are user-centered, easy to use, evidence-based, well-integrated with professional care, and used sustainably.

Purpose We sought to examine whether underage adolescents displaying symptoms for a mental illness (i.e., an eating disorder) would be willing to obtain parental consent to participate in a study to test the efficacy of an evidence-based mobile mental health intervention targeting teens with eating disorders. Methods The participants (n = 366) were 15 to 17 year-old English-speakers who post or follow social media accounts on Instagram that emphasize being thin as important or attractive. The participants were administered a survey through Qualtrics to assess eating disorder pathology, interest in trying an evidence-based mobile mental-health intervention, and comfort level with obtaining parental consent to partake in a research study about such an intervention. Results About 85% of participants met clinical or subclinical criteria for an eating disorder; however, only 12% had received a treatment within the past six months. While 83% of participants were interested in trying a mobile health interventions app, only 35% indicated willingness to obtain parental consent to participate in a research study. The primary reasons presented for unwillingness to obtain consent included importance of retaining privacy and feeling that parents lack awareness or understanding about mental health issues. Conclusions While barriers exist to obtaining treatment for eating disorders, a mobile intervention app may close some of these gaps. Many underage participants indicated interest in obtaining such treatment, yet only a third were willing to obtain parental consent. Future studies should investigate how to reduce these barriers to obtaining parental consent to facilitate teen access to research and mobile mental health treatment.

No abstract available

Background Female chronic pelvic pain disorders (CPPDs) affect 1 in 7 women worldwide and are characterized by psychosocial comorbidities, including a reduced quality of life and 2–10-fold increased risk of depression and anxiety. Despite its prevalence and morbidity, CPPDs are often inadequately managed with few patients experiencing relief from any medical intervention. Characterizing mental health symptom trajectories and lifestyle predictors of mental health is a starting point for enhancing patient self-efficacy in managing symptoms. Here, we investigate the association between mental health, pain, and physical activity (PA) in females with CPPD and demonstrate a method for handling multi-modal mobile health (mHealth) data. Methods The study sample included 4270 person-level days and 799 person-level weeks of data from CPPD participants (N=76). Participants recorded PROMIS global mental health (GMH) and physical functioning and pain weekly for 14 weeks using a research mHealth app, and moderate-to-vigorous PA (MVPA) was passively collected via activity trackers. Data Analysis We used penalized functional regression (PFR) to regress weekly GMH-T (GMH-T) on MVPA and weekly pain outcomes while adjusting for baseline measures, time in study, and the random intercept of the individual. We converted 7-day MVPA data into a single smooth using spline basis functions to model the potential non-linear relationship. Results MVPA was a significant, curvilinear predictor of GMH-T (F=18.989, p<0.001), independent of pain measures and prior psychiatric diagnosis. Physical functioning was positively associated with GMH-T, while pain was negatively associated with GMH-T (B=2.24, B=−1.16, respectively; p<0.05). Conclusion These findings suggest that engaging in MVPA is beneficial to the mental health of females with CPPD. Additionally, this study demonstrates the potential of ambulatory mHealth-based data combined with functional models for delineating inter-individual and temporal variability.

The proliferation of mobile health (mHealth) applications has markedly influenced self-management practices related to obesity and mental well-being. However, the effectiveness of fitness apps in enhancing health outcomes is closely tied to their frequency of usage, a factor that has been insufficiently explored, especially among postpartum populations. This study aimed to propose and empirically test a structural equation modeling (SEM) framework to examine the moderating effects of fitness app usage frequency on the relationships among obesity, lifestyle behaviors, dietary habits, and mental health outcomes among postpartum women. A cross-sectional self-reported online survey was administered to postpartum women in Malaysia within one year after childbirth, collecting 468 valid responses. Participants were categorized into four distinct groups based on their frequency of fitness app usage: daily, weekly, rarely, and never. The SEM analyses highlighted significant variations among the four user groups. The daily-user model exhibited the strongest explanatory power (R² = 0.82), followed by weekly (R² = 0.79), rarely (R² = 0.66), and never-user groups (R² = 0.59). Specifically, in the daily-user group, demographic factors, lifestyle behaviors, dietary intake, and Body Mass Index (BMI) explained 82% of the variance in mental health outcomes. Across all usage categories, BMI consistently demonstrated a significant negative relationship with mental health symptoms, suggesting better mental health among participants with lower BMI. Further, factor loading analyses identified screen time (0.89) and physical activity (0.81) as dominant indicators of lifestyle behaviors. Frequent app users (daily and weekly) displayed healthier dietary choices and lower BMI scores compared to infrequent users. Regular engagement with fitness mHealth applications is associated with better mental health and may support obesity management among postpartum women. This study underscores the critical moderating role of app usage frequency in optimizing health outcomes, providing practical implications for public health strategies and interventions targeting postpartum populations.

ABSTRACT Fathers’ perinatal mental health is a major public health issue, yet few interventions have been developed targeting this group. Fathers face many barriers in accessing perinatal mental health support, including stigma around caregiving and mental health, and thus require careful consideration when designing interventions. This study aimed to examine the feasibility, acceptability, and usability of a mobile app-based intervention for paternal perinatal depression, anxiety, and stress. Following a design science approach, five meta design principles and 15 specific principles were created to guide the intervention design, and a prototype app titled Rover was created. The prototype was evaluated by 43 fathers and 10 mental health clinicians. Participants in both groups rated the app highly for its functionality, clinical content, aesthetics, and digital therapeutic alliance. Qualitative feedback indicated that fathers held particularly favourable views regarding the mood tracking, mindfulness, and goal tracking features. Both groups expressed a preference for more support for the personalisation of content, including more dynamic interactions with the chatbot support feature. To our knowledge, this is the first app-based mental health intervention designed specifically for fathers, with study results providing guidance to the field on developing digital health initiatives for this population.

Background: Adolescent mental health disorders affect 7.3% of Indian youth, yet treatment remains inaccessible for over 80%. While digital interventions show promise, their economic feasibility in resource-constrained settings remains unexplored. This study conducted a micro-costing analysis of AikyaMind, a comprehensive mHealth application for adolescent mental health in Karnataka, India. Methods: Using the activity-based costing-ingredients methodology, we analyzed costs from a provider’s perspective over a one-year implementation period (2023-24). Data collection employed structured micro-costing tools capturing direct development, meeting, and training costs. Capital items were annualized using a 3% discount rate. Per-user costs were calculated across utilization scenarios (100-10,000 users). Fiscal impact was assessed against Karnataka’s District Mental Health Program budget. One-way sensitivity analysis identified cost drivers. Results: Total costs were ₹74,548 (US$896), comprising direct development (65.73%), meetings (26.84%), and training (7.43%). App development represented the largest component (₹30,000). Per-user costs demonstrated substantial economies of scale, decreasing from ₹745.48 (100 users) to ₹7.45 (10,000 users)- a 99% reduction. Implementation required only 0.07% of the state mental health budget. Sensitivity analysis revealed that app development costs were the primary driver, causing a variation of ±₹6,000 with a 20% change. Conclusions: The AikyaMind application demonstrates exceptional economic feasibility for addressing adolescent mental health gaps in LMICs. With a total development cost of less than US$900 and a cost of US$0.09 per user at scale, digital mental health interventions offer financially viable solutions for resource-constrained settings. These findings support the integration of mHealth within existing public health programs to achieve universal health coverage goals.

No abstract available

Background 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. Objective 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. Methods 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. Results 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). Conclusions 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. Trial Registration ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID) RR2-10.2196/29561

Background Mental health care during the postpartum period is notably underexplored within Asian demographics, with barriers such as stigma, privacy concerns, logistical challenges, and a shortage of mental health professionals that limits access to optimal mental healthcare. Previous studies found that mobile health (mHealth) technology has been offering a promising solution to these issues. However, the perspectives of mothers on existing mental health services and their mHealth needs are still not well understood and warrant further exploration. Objective This study aimed to explore the postpartum experiences of Malaysian mothers with postpartum depression (PPD) symptoms and their perspectives on using an mHealth technology to improve mental health care during the postpartum period. Methods We carried out in-depth interviews with six mothers, which were transcribed verbatim and thematically analysed. Collaborative discussions and consensus were employed to enhanced reliability. Findings Five main themes related to mothers’ postpartum experiences and perspectives emerged, namely, the existing circumstances of mothers, psychosociological reactions, maternal needs, innovation of care, and suggestions for pragmatic mHealth elements. These themes emphasized the emotional challenges of meeting societal, cultural, and personal expectations. The essential resources identified to be included in the mHealth technology were education on PPD, professional guided self-care, cognitive restructuring, validation of diverse infant feeding practices, and fostering partner support. Furthermore, interactive mHealth features such as mood trackers, notifications, platforms to share, and motivational tools aimed at elevating maternal well-being were also sought. Conclusions Mothers expressed a desire for mHealth services emphasizing the need for these educational tools to be culturally sensitive, accommodating local language and religious practices, and offering support during confinement, to effectively address the unique needs of postpartum mothers. This study highlights the importance of prioritizing practical mHealth interventions as strategic support services to enhance positive postpartum mental care in resource-stricken countries.

How mHealth and digital innovations are key to transforming mental health care in Ghana, bridging gaps in a system challenged by resource scarcities and a critical shortage of mental health professionals. Key Messages Despite Ghana’s commitment to universal health coverage and the provision of mental health care in public institutions at no direct cost, the mental health system faces an overwhelming demand and logistical challenges, including a critical shortfall of mental health care professionals, geographic limitations, and stigma. This commentary explores the challenges and opportunities within Ghana’s mental health care system, emphasizing the critical role of mobile health (mHealth) and digital innovations in transforming mental health care delivery. We highlight the role of mHealth interventions, including initiatives like the M-Healer smartphone toolkit that equips traditional healers with mental health management techniques, and collaborations with digital communities, such as the West African Digital Mental Health Alliance, in improving mental health services and developing culturally relevant digital mental health solutions. Strategic actions that are essential for further advancing Ghana’s mHealth landscape include establishing dedicated training programs for clinicians to build capacity in digital technologies and integrating digital health solutions into hospital systems.

There is clear scientific evidence that physical activity helps to prevent depression and anxiety. Utilizing mobile health (mHealth) technologies to enable physical activity is promising, but the evidence of the effectiveness of mHealth interventions on physical activity and mental health is inconsistent. We recently developed a native smartphone app to prevent depression and anxiety by promoting physical activity. One of the app's strengths is that it adopts a deep-learning model and automatically estimates psychological distress from users' physical activity patterns. We conducted a single-arm, 1-month feasibility trial to examine the implementation of the app and its effectiveness in promoting physical activity and improving depression and anxiety. As a result, we did not observe any significant improvement in physical activity or psychological distress. For implementation aspects, the participants used the app less. The conclusion of the presentation is that mHealth interventions are promising for the improvement of physical activity and mental health among workers, but, at this stage, their effectiveness is unclear. There are challenges to be addressed, especially in implementation.

Background Mental disorders are complex diseases that affect 28% (about 17.8 million people) of the adult population in Germany annually. Since 2020, certain mobile health (mHealth) apps, so-called digital health applications (DiGA), are reimbursable in the German statutory health insurance system. A total of 27 of the 56 currently available DiGA are approved for the treatment of mental and behavioral diseases. An indicator of existing problems hindering the use of DiGA is the rather hesitant prescribing behavior. Objective This project aims to develop health policy recommendations for the optimal integration of DiGA into outpatient psychotherapeutic care. The project is funded by the Innovation Fund of the Joint Federal Committee (grant 01VSF22029). The current status quo of the use of DiGA will be analyzed. Furthermore, concepts for the integration of mHealth apps, as well as their transfer into the care process will be investigated. In addition, barriers will be identified, and existing expectations of different perspectives captured. Methods The project will be based on a mixed methods approach. A scoping review and a qualitative analysis of focus groups and expert interviews will be carried out. Additionally, an analysis of claims data of the statutory health insurance will be conducted. This will be followed by a written survey of insured persons and health care providers. Finally, health policy recommendations will be derived in cooperation with stakeholders. Results The scoping reviews and qualitative analyses have been completed, and the quantitative surveys are currently being carried out. The target number of responses in the survey of insured persons has already been achieved. Furthermore, the analysis claims data of the statutory health insurance is currently being conducted. Conclusions There is a need for research on how DiGA can be optimally integrated into the care process of patients with mental disorders as evidence regarding the topic is limited and prescribing behavior low. Although the potential of DiGA in mental health care has not yet fully unfolded, Germany serves as a model for other countries regarding reimbursable mHealth apps. This project aims to explore the potentials of DiGA and to describe the organizational, institutional, and procedural steps necessary for them to best support mental health care. International Registered Report Identifier (IRRID) DERR1-10.2196/56205

Background Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. Objective This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. Methods Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ≥3 versus <3 months using χ2 tests. We analyzed interview data using thematic analysis. Results We received 533 surveys (533/2631, for a 20% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65%), make decisions about their treatment (157/262, 60%), and set goals related to their health and health care (156/262, 60%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68% versus 51/98, 52%; P=.009) and rapport (95/164, 58% versus 42/98, 43%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42%), not receiving enough training on the app (73/259, 28%), and not being able to change responses to assessment questions (72/256, 28%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). Conclusions Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA’s Collect-Share-Act model of MBC.

Childhood mental health problems are common, impairing, and can become chronic if left untreated. Children are not reliable reporters of their emotional and behavioral health, and caregivers often unintentionally under- or over-report child symptoms, making assessment challenging. Objective physiological and behavioral measures of emotional and behavioral health are emerging. However, these methods typically require specialized equipment and expertise in data and sensor engineering to administer and analyze. To address this challenge, we have developed the ChAMP (Childhood Assessment and Management of digital Phenotypes) System, which includes a mobile application for collecting movement and audio data during a battery of mood induction tasks and an open-source platform for extracting digital biomarkers. As proof of principle, we present ChAMP System data from 101 children 4–8 years old, with and without diagnosed mental health disorders. Machine learning models trained on these data detect the presence of specific disorders with 70–73% balanced accuracy, with similar results to clinical thresholds on established parent-report measures (63–82% balanced accuracy). Features favored in model architectures are described using Shapley Additive Explanations (SHAP). Canonical Correlation Analysis reveals moderate to strong associations between predictors of each disorder and associated symptom severity (r = .51–.83). The open-source ChAMP System provides clinically-relevant digital biomarkers that may later complement parent-report measures of emotional and behavioral health for detecting kids with underlying mental health conditions and lowers the barrier to entry for researchers interested in exploring digital phenotyping of childhood mental health.

OBJECTIVE This study aimed to compare the costs of two implementation models for the mobile health (mHealth) intervention FOCUS in community mental health settings. The external facilitation (EF) approach uses a hub-and-spoke model, in which a central specialist provides support to clinicians and clients at multiple agencies. With the internal facilitation (IF) approach, frontline clinical staff at each center are trained to serve as their organization's local specialists. METHODS Financial and economic cost data were collected in the context of a hybrid type 3 effectiveness-implementation trial by using a mixed-methods, top-down expenditure analysis with microcosting approaches. The analysis compared the incremental costs of both models and the costs of successfully engaging clients (N=210) at 20 centers. Costs were characterized as start-up or recurrent (personnel, supplies, contracted services, and indirect costs). RESULTS The average annual financial cost per site was $23,517 for EF and $19,118 for IF. EF yielded more FOCUS users at each center, such that the average monthly financial costs were lower for EF ($167 per client [N=129]) than for IF ($177 per client [N=81]). When using a real-world scenario based on economic costs and a lower organizational indirect rate, the average monthly cost per client was $73 for EF and $59 for IF. Both models reflected substantial cost reductions (about 50%) relative to a previous deployment of FOCUS in a clinical trial. CONCLUSIONS Compared with IF, EF yielded more clients who received mHealth at community mental health centers and had comparable or lower costs.

Abstract Objectives This study explored the perceptions of workers regarding mobile health (mHealth) services for physical activity and mental health. Methods Single, online, one-on-one, 60-minute semi-structured interviews were conducted with workers living or working in Tokyo, Japan. The transcribed text corpus of the interviews was used as data to explore their perceptions. The top 200 nouns in the utterances were extracted and modeled using a bag of words (BoW) and embedded into a two-dimensional space. Results The interviews extracted 476 utterances with 1,294 nouns from the 12 workers (7 males and 5 females). A total of 10 themes were estimated from the top 200 nouns. The participants mostly agreed that physical activity was effective in improving their mental health. They needed individualized, attractive, and easy mHealth services. Other estimated themes were: limited effects of non-leisure physical activity on mental health, lower priority on physical activity rather than sleep and rest, reluctance to share the data within the groups, and difficulties in wearing the devices to measure physical activity due to work rules. Conclusion Workers’ perceptions of mHealth services were consistent with previous findings: the need for individualization, attraction, and ease of use. In the working population, mHealth services for physical activity and mental health should consider working conditions and focus on leisure-time physical activity. Social sharing might not be a mandatory technique because of the private topics and variety of associations between physical activity and mental health.

The theme of this work is the validation of a Mhealth mobile technology application, the App ’Mais Um Dia’, for health promotion in the university context. The prevention of mental illness among higher education academics is a subject under increasing discussion and the use of a Mhealth emerges from this context as a psychoeducational intervention tool. The validation of a psychoeducational intervention Mhealth technology in a focus group was carried out through the face-to-face application of two user experience (UX) evaluation questionnaires - the System Usability Scale (SUS) and the Self-Assessment Manikin (SAM). The results show that it is possible to establish the validity of the mobile application ’Mais Um Dia’ in psychoeducational intervention and prevention through digital literacy in mental health.

Abstract Background In West Africa, healers greatly outnumber trained mental health professionals. People with serious mental illness (SMI) are often seen by healers in “prayer camps” where they may also experience human rights abuses. We developed “M&M,” an 8-week-long dual-pronged intervention involving (1) a smartphone-delivered toolkit designed to expose healers to brief psychosocial interventions and encourage them to preserve human rights (M-Healer app), and (2) a visiting nurse who provides medications to their patients (Mobile Nurse). Objective We examined the feasibility, acceptability, safety, and preliminary effectiveness of the M&M intervention in real-world prayer camp settings. Methods We conducted a single-arm field trial of M&M with people with SMI and healers at a prayer camp in Ghana. Healers were provided smartphones with M-Healer installed and were trained by practice facilitators to use the digital toolkit. In parallel, a study nurse visited their prayer camp to administer medications to their patients. Clinical assessors administered study measures to participants with SMI at pretreatment (baseline), midtreatment (4 weeks) and post treatment (8 weeks). Results Seventeen participants were enrolled and most (n=15, 88.3%) were retained. Participants had an average age of 44.3 (SD 13.9) years and 59% (n=10) of them were male. Fourteen (82%) participants had a diagnosis of schizophrenia and 2 (18%) were diagnosed with bipolar disorder. Four healers were trained to use M-Healer. On average, they self-initiated app use 31.9 (SD 28.9) times per week. Healers watched an average of 19.1 (SD 21.2) videos, responded to 1.5 (SD 2.4) prompts, and used the app for 5.3 (SD 2.7) days weekly. Pre-post analyses revealed a significant and clinically meaningful reduction in psychiatric symptom severity (Brief Psychiatric Rating Scale score range 52.3 to 30.9; Brief Symptom Inventory score range 76.4 to 27.9), psychological distress (Talbieh Brief Distress Inventory score range 37.7 to 16.9), shame (Other as Shamer Scale score range 41.9 to 28.5), and stigma (Brief Internalized Stigma of Mental Illness Scale score range 11.8 to 10.3). We recorded a significant reduction in days chained (1.6 to 0.5) and a promising trend for reduction in the days of forced fasting (2.6 to 0.0, P=.06). We did not identify significant pre-post changes in patient-reported working alliance with healers (Working Alliance Inventory), depressive symptom severity (Patient Health Questionnaire-9), quality of life (Lehman Quality of Life Interview for the Mentally Ill), beliefs about medication (Beliefs about Medications Questionnaire–General Harm subscale), or other human rights abuses. No major side effects, health and safety violations, or serious adverse events occurred over the course of the trial. Conclusions The M&M intervention proved to be feasible, acceptable, safe, and clinically promising. Preliminary findings suggest that the M-Healer toolkit may have shifted healers’ behaviors at the prayer camp so that they commit fewer human rights abuses.

Background Mental health problems are common among men who have sex with men (MSM) living with HIV and may negatively affect medication adherence. Psychosocial interventions designed to address these urgent needs are scarce in China. Incorporating behavioral health theories into intervention development strengthens the effectiveness of these interventions. The absence of a robust theoretical basis for interventions may also present challenges to identify active intervention ingredients. Objective This study aims to systematically describe the development of a mobile health–based intervention for MSM recently diagnosed with HIV in China, including the theoretical basis for the content and the considerations for its technological delivery. Methods We used intervention mapping (IM) to guide overall intervention development, a behavioral intervention technology model for technological delivery design, and a human-centered design and cultural adaptation model for intervention tailoring throughout all steps of IM. Results The dialectical behavior therapy (DBT)–informed intervention, Turning to Sunshine, comprised 3 components: app-based individual skills learning, group-based skills training, and on-demand phone coaching. The theoretical basis for the intervention content is based on the DBT model of emotions, which fits our conceptualization of the intervention user’s mental health needs. The intervention aims to help MSM recently diagnosed with HIV (1) survive moments of high emotional intensity and strong action urges, (2) change emotional expression to regulate emotions, and (3) reduce emotional vulnerability, as well as (4) augment community resources for mental health services. Technological delivery considerations included rationale of the medium, complexity, and esthetics of information delivery; data logs; data visualization; notifications; and passive data collection. Conclusions This study laid out the steps for the development of a DBT-informed mobile health intervention that integrated app-based individual learning, group-based skills training, and phone coaching. This intervention, Turning to Sunshine, aims to improve mental health outcomes for MSM newly diagnosed with HIV in China. The IM framework informed by human-centered design principles and cultural adaptation considerations offered a systematic approach to develop the current intervention and tailor it to the target intervention users. The behavioral intervention technology model facilitated the translation of behavioral intervention strategies into technological delivery components. The systematic development and reporting of the current intervention can serve as a guide for similar intervention studies. The content of the current intervention could be adapted for a broader population with similar emotional struggles to improve their mental health outcomes.

New methods of connecting physicians and patients have arisen. Technology is playing a crucial role and the concept of hybrid doctor–patient relationship is considered relevant for the competitive health management system. At the same time, the need for knowledge about implementing policies and best practices into the system is highly demanding. Digital tools, such as eHealth or mHealth can improve the traditional approach to consulting patients without requiring face-to-face interaction. However, due to the discussion surrounding the adoption of these technologies, the authors performed the study with two marketing research methods. The first is qualitative and is related to the opinions, attitudes, and beliefs of Romanian experts on the use of eHealth and mHealth for the prevention, detection, and treatment of mild mental disorders. The second method quantifies the opinions, attitudes, and behaviours of Romanian adults on their openness to adopt new technologies for mental health management. The main findings of the research highlight three factors that can increase the chances of adults using technology for health-related needs: (1) accessibility (2) data security, and (3) content. These are the main aspects that influence the well-being of both young and older adults, who both need support regarding mental health management.

No abstract available

Background Digital health interventions in the form of smartphone apps aim to improve mental health and enable people access to support as and when needed without having to face the stigma they may experience in accessing services. If we are to evaluate mobile health (mHealth) apps and advance scientific understanding, we also need tools to help us understand in what ways mHealth interventions are effective or not. The concept of therapeutic alliance, a measure of the quality of the relationship between a health care provider and a service user, is a key factor in explaining the effects of mental health interventions. The Agnew Relationship Measure (ARM) is a well-validated measure of therapeutic alliance in face-to-face therapy. Objective This study presented the first attempt to (1) explore service users’ views of the concept of relationship within mHealth mental health interventions and (2) adapt a well-validated face-to-face measure of therapeutic alliance, the Agnew Relationship Measure (ARM), for use with mHealth interventions. Methods In stage 1, we interviewed 9 mental health service users about the concept of therapeutic alliance in the context of a digital health intervention and derived key themes from interview transcripts using thematic analysis. In stage 2, we used rating scales and open-ended questions to elicit views from 14 service users and 10 mental health staff about the content and face validity of the scale, which replaced the word “therapist” with the word “app.” In stage 3, we used the findings from stages 1 and 2 to adapt the measure with the support of a decision-making algorithm about which items to drop, retain, or adapt. Results Findings suggested that service users do identify relationship concepts when thinking about mHealth interventions, including forming a bond with an app and the ability to be open with an app. However, there were key differences between relationships with health professionals and relationships with apps. For example, apps were not as tailored and responsive to each person’s unique needs. Furthermore, apps were not capable of portraying uniquely human-like qualities such as friendliness, collaboration, and agreement. We made a number of changes to the ARM that included revising 16 items; removing 4 items due to lack of suitable alternatives; and adding 1 item to capture a key theme derived from stage 1 of the study (“The app is like having a member of my care team in my pocket”). Conclusions This study introduces the mHealth version of the ARM, the mARM, that has good face and content validity. We encourage researchers to include this easy-to-use tool in digital health intervention studies to gather further data about its psychometric properties and advance our understanding of how therapeutic alliance influences the efficacy of mHealth interventions. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 34966555; http://www.isrctn.com/ISRCTN34966555 (Archived by WebCite at http://www.webcitation.org/6ymBVwKif)

Background Treating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined. Objective This study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns. Methods Adolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality. Results Participants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language. Conclusions The novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes.

Adolescents are slowly being recognized as a generation, worldwide, that may require different policy approaches to improve staggering statistics on their failing well-being, including mental health. By providing the support to allow the next generation to achieve better mental health outcomes, they are going to be more economically successful and the future economic growth of nations can be better assured. Adoption of mobile-based health interventions (e.g., mHealth) has garnered a lot of attention toward this end. While mHealth interventions are growing in popularity, many researchers/policy-makers appear to have neglected assessing potential (indirect) costs/negative consequences from their use. Evidence from the developed world shows strong associations between extensive cell phone use and negative mental health outcomes, but similar research is minimal in developing world contexts. Additionally, the bulk of work on the outcomes of mobile phone use is studied using a unidirectional approach with blinders to front-end motivations. Using primary data from a large-scale, school-based survey of older adolescents in southwestern Nepal (N = 539), this work investigates such a tension between mobile/smartphone usage as a true mobile health (mHealth) opportunity in Nepal or as a potential problem, introducing additional deleterious well-being effects from over-use. Founded in Basic Psychological Needs Theory (BPNT), robust results of analyses using full structural modeling approaches (and traditional regression-based sensitivity analyses) indicate support for the BPNT framework in explaining statistically significant positive associations between bullying and anxiety, as well as, negative associations between bullying and grit, including evidence to support the mediating role of problematic mobile phone use in these relationships. More than 56% of the sample showed indicators of mild to moderate anxiety and over 10% claim experiences of bullying, coupled with over 75% of the sample scoring above the midline of a problematic mobile phone use scale, all of which motivates the relevance of our findings. Potential policy implications of these findings, and mention of other intriguing avenues for future work are further discussed.

The study is focused into the field of tele-mental health with youth. It has three polarities. The first polarity consists on the analysis of the state of art of the guide-lines and reports the recent situation depicted by the American Telemedicine Association and the American Psychiatric Association. The second polarity faces the recent evolution related to the tools available in mHealth to activate remote psychological rehabilitation processes. These tools are today also based on a wearable cyberspace comprehending virtual (VR) and augmented reality (AR). The third polarity concludes the study by opening and submitting basic questions on the related activity of the stake-holders, scholars, regulation bodies and workgroups and showing some example of this activity.

Background One in five Canadians experience mental health issues with those in the age range of 15 to 24 years being most at risk of a mood disorder. University students have shown significantly higher rates of mental health problems than the general public. Current university support services are limited by factors such as available staff and finances, and social stigma has frequently been identified as an additional barrier that prevents students from accessing these resources. Mobile health (mHealth) apps are one form of alternative health support that is discrete and accessible to students, and although they are recognized as a promising alternative, there is limited research demonstrating their efficacy. Objective The aim of this study was to evaluate a mindfulness-based app’s (“DeStressify”) efficacy on stress, anxiety, depressive symptomology, sleep behavior, work or class absenteeism, work or school productivity, and quality of life (QoL) among university students. Methods Full-time undergraduate students at a Canadian university with smartphones and Internet access were recruited through in-class announcements and on-campus posters. Participants randomized into an experimental condition were given and instructed to use the DeStressify app 5 days a week for 4 weeks. Control condition participants were wait-listed. All participants completed pre- and postintervention Web-based surveys to self-assess stress, anxiety, depressive symptomatology, sleep quality, and health-related QoL. Results A total of 206 responses were collected at baseline, with 163 participants completing the study (86 control, 77 experimental). Using DeStressify was shown to reduce trait anxiety (P=.01) and improve general health (P=.001), energy (P=.01), and emotional well-being (P=.01) in university students, and more participants in the experimental condition believed their productivity improved between baseline and postintervention measurements than the number of participants expected to believe so randomly by chance (P=.01). The app did not significantly improve stress, state anxiety, physical and social functioning, and role limitations because of physical or emotional health problems or pain (P>.05). Conclusions Mindfulness-based apps may provide an effective alternative support for university students’ mental health. Universities and other institutions may benefit from promoting the use of DeStressify or other mindfulness-based mHealth apps among students who are interested in methods of anxiety management or mindfulness-based self-driven health support. Future steps include examining DeStressify and similar mHealth apps over a longer period and in university staff and faculty.

With a shortage of mental health specialists and a significant rural population in Pakistan, leveraging community-based healthcare workers becomes crucial to address mental health needs. Equipping the healthcare workers with digital tools such as mobile applications have the potential to increase access to mental health support in low-resource areas. This study examines the acceptability, appropriateness, barriers, and facilitators to implementing a technology-assisted mental health intervention (mPareshan) delivered by Lady Health Workers (LHWs) in rural Pakistan. This is a qualitative study embedded within a larger implementation research trial assessing the feasibility of an mHealth intervention aimed at improving anxiety and depression. 8 focus group discussions and 18 in-depth interviews were conducted. Perceptions were sought before and after intervention from stakeholders comprising of policymakers, LHWs, Lady Health Supervisors (LHSs), and community participants. Data underwent thematic analysis using the RE-AIM framework. Six main themes emerged from the data. All participants had realization of rising burden of mental illnesses and identified key determinants for mental ill-health. Delivery of mental health counselling by LHWs through a technology-assisted intervention was deemed acceptable and appropriate. LHWs were considered capable and trustworthy by the community to deliver a home-based mHealth intervention, given their easy accessibility as residents of the same community. The technology demonstrated potential for easy adoption as these frontline health workers were already familiar with smartphone technology. Some barriers identified during implementation roll-out included heavy workload of LHWs and difficulty in internet connectivity. Use of videos for counselling, and supportive supervision by LHSs emerged as key facilitators for implementation. This study highlights that a technology-focused mental health intervention is feasible, acceptable, and appropriate to be implemented by community frontline workers in resource-constrained rural Pakistani settings. The mPareshan intervention can be easily adopted within the LHW-P. Further research should investigate how implementation barriers can be addressed for successful delivery.

Background Clinical trials are the gold standard of evidence-based practice. Still many papers inadequately report methodology in randomized controlled trials (RCTs), particularly for mHealth interventions for people with serious mental health problems. To ensure robust enough evidence, it is important to understand which study phases are the most vulnerable in the field of mental health care. Objective We mapped the recruitment and the trial follow-up periods of participants to provide a picture of the dropout predictors from a mHealth-based trial. As an example, we used a mHealth-based multicenter RCT, titled “Mobile.Net,” targeted at people with serious mental health problems. Methods Recruitment and follow-up processes of the Mobile.Net trial were monitored and analyzed. Recruitment outcomes were recorded as screened, eligible, consent not asked, refused, and enrolled. Patient engagement was recorded as follow-up outcomes: (1) attrition during short message service (SMS) text message intervention and (2) attrition during the 12-month follow-up period. Multiple regression analysis was used to identify which demographic factors were related to recruitment and retention. Results We recruited 1139 patients during a 15-month period. Of 11,530 people screened, 36.31% (n=4186) were eligible. This eligible group tended to be significantly younger (mean 39.2, SD 13.2 years, P<.001) and more often women (2103/4181, 50.30%) than those who were not eligible (age: mean 43.7, SD 14.6 years; women: 3633/6514, 55.78%). At the point when potential participants were asked to give consent, a further 2278 refused. Those who refused were a little older (mean 40.2, SD 13.9 years) than those who agreed to participate (mean 38.3, SD 12.5 years; t1842=3.2, P<.001). We measured the outcomes after 12 months of the SMS text message intervention. Attrition from the SMS text message intervention was 4.8% (27/563). The patient dropout rate after 12 months was 0.36% (4/1123), as discovered from the register data. In all, 3.12% (35/1123) of the participants withdrew from the trial. However, dropout rates from the patient survey (either by paper or telephone interview) were 52.45% (589/1123) and 27.8% (155/558), respectively. Almost all participants (536/563, 95.2%) tolerated the intervention, but those who discontinued were more often women (21/27, 78%; P=.009). Finally, participants’ age (P<.001), gender (P<.001), vocational education (P=.04), and employment status (P<.001) seemed to predict their risk of dropping out from the postal survey. Conclusions Patient recruitment and engagement in the 12-month follow-up conducted with a postal survey were the most vulnerable phases in the SMS text message-based trial. People with serious mental health problems may need extra support during the recruitment process and in engaging them in SMS text message-based trials to ensure robust enough evidence for mental health care. ClinicalTrial International Standard Randomized Controlled Trial Number (ISRCTN): 27704027; http://www.isrctn.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/6oHcU2SFp)

Abstract Objective This mixed-methods study examined attitudes, barriers, and preferences for mobile mental health interventions among first-year college students. Participants 351 students (64% women; 51% non-Hispanic White; 66% Heterosexual) from two campuses completed self-report assessments and 10 completed individual semi-structured interviews. Methods Paired t-tests compared attitudes for various mHealth applications and logistic regressions examined sociodemographic and clinical characteristics of mental health app users. Themes, topics, and quotes from interviews were derived through rapid qualitative analysis. Results Mental health applications were less used and perceived to be less helpful than other mHealth applications. Past mental health app use was best predicted by past use of formal mental health care. Conclusions Mobile health interventions have significant potential to diversify mental health services for students. Despite limited engagement with these resources, openness to digital interventions among students is quite high. Improving intervention features and increasing problem-recognition to facilitate help-seeking may result in greater uptake.

With the rise in the occurrence of mental health issues among youths, especially students, an urgent need might have arisen for intervention strategies that respect cultural intricacies. Digital Therapeutic (DTx) quite interestingly serves as a frontier wherein technology is used to give evidence-based support for mental health. In an unfortunate case of neglect, however, there has been a lack of adaptation of these platforms for the considered needs of Muslim users in terms of accommodating Islamic principles and understanding. This paper took a huge jump forward in filling this gap by offering an innovative and thorough User Experience (UX) evaluation framework that holistically integrates Islamic design architecture featuring geometric patterns, calligraphy, and content imbued with spiritual significance. It also offers places for gateways into Islamic teachings, reminders to pray, and guided meditation. The framework looks very closely at and gives guidelines on important elements for Turkish developer to create DTx solutions within an Islamic framework such as usability, accessibility, engagement, and user satisfaction. Having developed through an exhaustive literature review and established frameworks, this model acts as a basic tool for appraising and thereby improving systematically the user experience of digital therapeutics within Islamic contexts. This research contribution attempts to improve the mental health outcomes for Muslim youth through digital health technologies alongside cultural inclusivity to suggest the importance of culturally attuned mental health interventions in today's digital realm.

Mental health difficulties, including anxiety, depression and stress, are prevalent among Muslim university students and are often intensified by academic demands and societal stigma that discourage help-seeking. Existing mental health services frequently lack cultural and religious sensitivity, limiting their relevance and effectiveness for this population. Furthermore, although numerous Islamic-themed mobile applications exist globally, a comprehensive literature review reveals a notable absence of digital platforms specifically designed to address the distinct mental health challenges faced by Muslim students, particularly those offering live access to therapists and experts. This study seeks to address this critical gap by developing and evaluating a digital therapeutic application rooted in Islamic principles to enhance the psychological well-being of Muslim university students aged 18 to 30. The application combines evidence-based psychological interventions with Islamic spiritual practices such as Dhikr, Dua, and faith-based coping mechanisms. It delivers structured daily spiritual exercises, personalised support, and direct access to culturally competent clinicians, thereby providing a culturally congruent approach to mental healthcare. A total of 308 Muslim university students participated in a quantitative evaluation involving surveys, interviews and app usage data to assess the intervention’s impact on emotional resilience, stress reduction and engagement with spiritual practice. Statistical analysis revealed significant improvements in emotional regulation (p < 0.01) and coping strategies (p < 0.05) following app utilisation. While awareness of digital therapeutic apps (p = 0.497) and perceived helpfulness of Islamic-themed apps (p = 0.424) were not significant predictors, the model demonstrated strong explanatory capacity with adjusted R² values of 0.768 and 0.816 for mental health outcomes and age-related variance, respectively. These findings highlight the potential efficacy of integrating digital mental health interventions with Islamic values to overcome culturally specific barriers faced by Muslim students. The study emphasises the importance of culturally sensitive digital therapeutics and recommends further longitudinal research to evaluate their long-term impact within diverse religious populations.

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

Abstract Background While the number of digital therapeutics (DTx) has proliferated, there is little real-world research on the characteristics of providers recommending DTx, their recommendation behaviors, or the characteristics of patients receiving recommendations in the clinical setting. Objective The aim of this study was to characterize the clinical and demographic characteristics of patients receiving DTx recommendations and describe provider characteristics and behaviors regarding DTx. Methods This retrospective cohort study used electronic health record data from a large, integrated health care delivery system. Demographic and clinical characteristics of adult patients recommended versus not recommended DTx by a mental health provider between May 2020 and December 2021 were examined. A cross-sectional survey of mental health providers providing these recommendations was conducted in December 2022 to assess the characteristics of providers and recommendation behaviors related to DTx. Parametric and nonparametric tests were used to examine statistical significance between groups. Results Of 335,250 patients with a mental health appointment, 53,546 (16%) received a DTx recommendation. Patients recommended to DTx were younger, were of Asian or Hispanic race or ethnicity, were female, were without medical comorbidities, and had commercial insurance compared to those without a DTx recommendation (P<.001). More patients receiving a DTx recommendation had anxiety or adjustment disorder diagnoses, but less had depression, bipolar, or psychotic disorder diagnoses (P<.001) versus matched controls not recommended to DTx. Overall, depression and anxiety symptom scores were lower in patients recommended to DTx compared to matched controls not receiving a recommendation, although female patients had a higher proportion of severe depression and anxiety scores compared to male patients. Provider survey results indicated a higher proportion of nonprescribers recommended DTx to patients compared to prescribers (P=.008). Of all providers, 29.4% (45/153) reported using the suggested internal electronic health record–based tools (eg, smart text) to recommend DTx, and of providers recommending DTx resources to patients, 64.1% (98/153) reported they follow up with patients to inquire on DTx benefits. Only 38.4% (58/151) of respondents report recommending specific DTx modules, and of those, 58.6% (34/58) report following up on the impact of these specific modules. Conclusions DTx use in mental health was modest and varied by patient and provider characteristics. Providers do not appear to actively engage with these tools and integrate them into treatment plans. Providers, while expressing interest in potential benefits from DTx, may view DTx as a passive strategy to augment traditional treatment for select patients.

No abstract available

This research study evaluates the effectiveness, usability, and limitations of digital mental health interventions, particularly mobile applications and online platforms, in managing anxiety and depression. As digital therapeutics gain traction as innovative tools in mental health care, their potential for accessibility, scalability, and personalization positions them as valuable complements to traditional therapeutic approaches. The study utilized a cross-sectional design and meta-analysis of quantitative data from clinical trials, peer-reviewed studies, and user feedback. Key findings revealed that digital interventions significantly reduce symptoms of anxiety and depression, with paired t-tests confirming notable symptom relief post-intervention (p < 0.01). Regression analysis highlighted user engagement and personalized content as critical factors, with higher engagement correlating with improved mental health outcomes. Demographic analysis indicated that older participants experienced the most pronounced benefits, underscoring the importance of tailored approaches for different age groups. Limitations included short-term follow-up periods and potential sample selection bias, pointing to the need for more diverse, long-term research. The study concludes that digital therapeutics hold significant promise for enhancing mental health care, recommending future integration with traditional services and the adoption of emerging technologies like artificial intelligence to optimize user engagement and outcomes.

Prescription Digital Therapeutics (PDTs) are emerging as promising tools for treating and managing mental and brain health conditions within the context of daily life. This commentary distinguishes PDTs from other Software as Medical Devices (SaMD) and explores their integration into mental and brain health treatments. We focus on research programs and support from the National Institutes of Health (NIH), discussing PDT research supported by the NIH’s National Institute on Child Health and Development (NICHD), National Institute of Mental Health (NIMH), and National Institute on Aging (NIA). We present a hierarchical natural language processing topic analysis of NIH-funded digital therapeutics research projects. We delineate the PDT landscape across different mental and brain health disorders while highlighting opportunities and challenges. Additionally, we discuss the research foundation for PDTs, the unique therapeutic approaches they employ, and potential strategies to improve their validity, reliability, safety, and effectiveness. Finally, we address the research and collaborations necessary to propel the field forward, ultimately enhancing patient care through innovative digital health solutions.

This study focuses on the development and evaluation of an AI-based digital therapeutic prototype for adolescent mental health management and disaster response. The system integrates real-time monitoring, AI-driven conversation analysis, personalized psychological treatment programs, and multimodal data analysis. An algorithm was developed to detect gaslighting and verbal abuse using a BERT-based classification model, achieving 85% accuracy in gaslighting detection and 87% accuracy in verbal abuse detection. Additionally, a psychological disaster-recovery support module was included, which demonstrated a 30% improvement in users’ stress reduction rates during simulated disaster scenarios. This study demonstrates that digital therapeutic approaches can significantly contribute to early intervention in adolescent mental health issues. Additionally, these approaches provide effective support during disasters. The developed prototype demonstrates the potential of AI and digital technology to innovate mental health management and disaster response strategies.

Digit therapeutics are novel software devices that clinicians may utilize in delivering quality mental health care and ensuring positive outcomes. However, uptake of digital therapeutics and clinically tested software-based programs remains low. This article presents possible reasons for attrition and low engagement in clinical studies investigating digital therapeutics, analyses of studies in which engagement was high, and design constructs that may encourage user engagement. The aim is to shed light on the importance of real-world attrition data of digital therapeutics, and important characteristics of medical devices that have positively influenced user engagement. The findings presented in this article will be useful to relevant stakeholders and medical device experts tasked with addressing the gap between software medical design and user engagement present in digital therapeutic clinical trials.

As psychological diseases become more prevalent and are identified as the leading cause of acquired disability, it is essential to assist people in improving their mental health. Digital therapeutics (DTx) has been widely studied to treat psychological diseases with the advantage of cost savings. Among the techniques of DTx, a conversational agent can interact with patients through natural language dialog and has become the most promising one. However, conversational agents' ability to accurately show emotional support (ES) limits their role in DTx solutions, especially in mental health support. One of the main reasons is that the prediction of emotional support systems does not extract effective information from historical dialog data and only depends on the data derived from one single-turn interaction with users. To address this issue, we propose a novel emotional support conversation agent called the STEF agent that generates more supportive responses based on a thorough view of past emotions. The proposed STEF agent consists of the emotional fusion mechanism and strategy tendency encoder. The emotional fusion mechanism focuses on capturing the subtle emotional changes throughout a conversation. The strategy tendency encoder aims at foreseeing strategy evolution through multi-source interactions and extracting latent strategy semantic embedding. Experimental results on the benchmark dataset ESConv demonstrate the effectiveness of the STEF agent compared with competitive baselines.

BACKGROUND Poor engagement has hindered the dissemination of self-guided digital therapeutics for mental health. Evidence on the efficacy of technology-supported strategies designed for increasing engagement with these interventions is currently inconclusive. Few studies have examined user perceptions of such strategies, which could yield key insights for enhancing their effectiveness. METHODS Two hundred and eleven participants completed a cross-sectional online survey. All participants were aged 18 years and above, living in Australia, fluent in English, and self-reported prior use of digital therapeutics for mental health needs. Survey items elicited participants' views on factor(s) contributing to their engagement/disengagement with digital therapeutics, and perceptions of engagement strategies, including: automated electronic reminders, fun facts, quizzes, and social media platforms. χ2 tests of independence were used to analyse nominal data. Inductive thematic analysis was used to analyse free-text data. RESULTS Factors facilitating engagement included digestible content, assurance of confidentiality, and esthetically appealing design. Factors hindering engagement included lack of time, forgetfulness, and lack of perceived intervention efficacy. Participants had mixed views over the feasibility and acceptability of the strategies explored toward promoting engagement. CONCLUSIONS Regardless of strategy type, succinct and easily applicable content was identified as an important feature for promoting engagement. Conversely, content that could trigger psychological distress among intervention users should be avoided. Overall, the diverse range of user perspectives highlighted that engagement strategies for any specific digital intervention should be co-designed with individuals with lived experience of mental health difficulties.

Objective We aimed to elucidate public mental health problems and associated factors during the coronavirus disease-2019 (COVID-19). Furthermore, we evaluated people’s attitudes toward digital therapeutics during the pandemic. Methods Data was collected online from participants, aged between 20–50 without any history of mental illness, from June 1st to June 30th 2021. The survey consisted of questions regarding demographics, changes during pandemic and attitude towards digital therapeutics, and mental health measures. Results Among the total of 445 participants, 49.2% reported significant level of stress and 13.5% and 7.0% met the screening criteria for major depressive disorder and generalized anxiety disorder, respectively. Significant predictive factors for mental health problems were-younger age group, female sex, currently being treated for medical or surgical disease, change in the amount of time spent on mobile device or computer after pandemic, change in household income, and change in work environment due to pandemic. Furthermore, 35.1% of participants, considered psychiatric consultation, at least slightly, but were hesitant to receive it due to the fear of contacting COVID-19 at the clinics. Instead, 54.4% of them preferred using digital therapeutics as an alternative to visiting offline clinics. Conclusion We demonstrated that COVID-19 increased mental health problems along with access problems and identified their predictive factors. Digital therapeutics emerged as a viable solution to mental health problems and it was well-received by those in need of psychiatric consultation. Therefore, development and implementation of digital therapeutics should be considered to improve the mental health of people.

No abstract available

With so many promising digital therapeutics for anxiety and obsessive-compulsive (OC) spectrum problems, there is an urgent need to consider how evolving regulatory oversight of digital therapeutics is poised to shift how these tools are developed, evaluated, reimbursed, and delivered. In this commentary, we discuss both opportunities and potential pitfalls associated with emerging government regulations of digital therapeutics for mental health, and we consider how applying the traditional 'prescription-based' medical approval paradigm to digital therapeutics for mental health could ultimately undermine and limit the broad accessibility of these software-based innovations that have been explicitly designed to expand the accessibility of care. For example, the vast majority of behavioural and mental health providers do not have 'prescription privileges' (a term originally rooted in pharmacologic practices), and as a result, under current regulations in the U.S. would not be authorized to make FDA-cleared digital therapeutics available to their patients. This is particularly concerning given that most digital therapeutics for mental health are directly rooted in psychological and behavioural science, yet psychologists would not be authorized to incorporate these innovations into their practice. We consider how synchronizing regulatory standards across countries may prove useful, and we conclude by arguing that multidisciplinary teams making regulatory decisions concerning digital therapeutics for mental health must include representation from the discipline and practice of psychology. PRACTITIONER POINTS: Emerging government regulations of digital therapeutics for mental health present both opportunities and potential pitfalls Applying the traditional 'prescription-based' medical approval paradigm to digital therapeutics for mental health could ultimately undermine the broad accessibility of these software-based innovations. Synchronizing regulatory standards across countries may prove useful. Multidisciplinary teams making regulatory decisions concerning digital therapeutics for mental health must include representation from the field of psychology.

In the last years, Information and Communication Technology has increasingly offered solutions in the field of psychology and mental health. Internet-based psychological interventions, apps, solutions based on social media have been suggested as tools to be used with the usual psychotherapy interventions, or in some cases, in substitution to them. Many of these are based on cognitive behavioral therapy (which by its nature is easily transferable into digital format) and fall into the category of digital therapeutics. On the other hand, tele-psychiatry, an area in strong expansion (also justified by the need to continue providing care to patients in this period of covid-19 which has prevented, or severely limited, face-to-face meetings), seems to improve the access to specialized mental health care, reduce delays in care, reduce stigma and promote greater patient attention. There is evidence that comes from randomized clinical trials, systematic reviews and meta-analysis and that demonstrates the efficacy of these tools in managing and preventing episodes of depression, anxiety and addictions. For other mental health disorders further confirmation is needed. In this context, it is therefore necessary to make greater use of randomized clinical trials with an adequate number of patients recruited, with a sufficient observation period and with easily measurable endpoints.

Attention Deficit Hyperactivity Disorder (ADHD) child patients face difficulty in maintaining focus of and completing daily tasks due to their impaired executive function. Failure in such aspects leads to the formation of negative self-images as well as sub-optimal relationships with parents. This investigative research presents a voice-bot and conversational agent design intervention supporting both the ADHD child patients and their parents in dealing with daily tasks. We conducted patient's parent interviews, created voice-bot scenario designs and conducted prototyping. Potential therapeutic benefits and assistive technology user experience perspectives are discussed in this paper.

Introduction Prescription Digital Therapeutics (PDTs) hold unique potential to improve mental health in underserved rural areas. However, potential users' perceptions towards PDTs and community-specific differences in barriers to care are not well-understood. Methods We conducted an online survey of 351 U.S. adults with ≥1 mental health condition and care-seeking behaviors. Descriptive statistics and non-parametric tests were used to evaluate rural and non-rural differences in demographics, social determinants of health, current barriers to mental health treatment, and the perceived value of PDTs. Key limitations of this approach include self-reported rurality and digital access bias associated with online survey distribution. Results Barriers to mental healthcare impacted 60% of all rural respondents, and rurality was associated with unique challenges like lower incomes, lower education levels, substantial Medicaid enrollment, and further distances from care. Rural respondents were also more likely to be completely unfamiliar with digital apps for mental health treatment. 89% of all respondents thought PDTs could address at least one barrier to care and about 97% of respondents were likely to use a PDT recommended by their provider. Discussion Existing gaps in care and positive perceptions towards PDTs demonstrate unique promise for these modalities to address unmet mental health needs. However, lower PDT familiarity among rural respondents suggests a need for provider intervention and policy reforms.

No abstract available

No abstract available

BACKGROUND Generative artificial intelligence (Gen-AI) chatbots hold promise for building highly personalized, effective mental health treatments at scale, while also addressing user engagement and retention issues common among digital therapeutics. We present a randomized controlled trial (RCT) testing an expert–fine-tuned Gen-AI–powered chatbot, Therabot, for mental health treatment. METHODS We conducted a national, randomized controlled trial of adults (N=210) with clinically significant symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), or at clinically high risk for feeding and eating disorders (CHR-FED). Participants were randomly assigned to a 4-week Therabot intervention (N=106) or waitlist control (WLC; N=104). WLC participants received no app access during the study period but gained access after its conclusion (8 weeks). Participants were stratified into one of three groups based on mental health screening results: those with clinically significant symptoms of MDD, GAD, or CHR-FED. Primary outcomes were symptom changes from baseline to postintervention (4 weeks) and to follow-up (8 weeks). Secondary outcomes included user engagement, acceptability, and therapeutic alliance (i.e., the collaborative patient and therapist relationship). Cumulative-link mixed models examined differential changes. Cohen’s d effect sizes were unbounded and calculated based on the log-odds ratio, representing differential change between groups.

The concerning prevalence of mental disorders underscores the need for innovative solutions in outpatient care, including prescription digital therapeutics (DTx) designed as regulated software-based medical products for treatment and disease management. In Germany, approved DTx are called DiGAs (referring to “Digitale Gesundheitsanwendungen”) and can be prescribed since 2020 at the expense of statutory health insurance. However, DiGAs remain underutilized by general practitioners (GPs) in primary care. Although prior research indicated individual barriers to prescription among healthcare professionals, little is known on how acceptance-facilitating strategies could be tailored to GPs’ needs. This study therefore explores GPs’ perspectives on DiGAs in general and for mental health, focusing on their needs and wishes regarding information strategies. A qualitative descriptive exploratory study using semi-structured interviews with GPs was conducted within a mixed-methods study in fall 2024. Participants were recruited via GP networks, social media, and fax using a purposive sampling approach. Data was analyzed using qualitative content analysis with deductive-inductive category development. Thirteen GPs between 27 and 66 years (median: 54 years, female: n = 3; 23%) were interviewed. Twelve participants (92%) had prescribed DiGAs at least once, mostly based on patients’ requests for dealing with depression, insomnia or obesity. Analysis revealed varying levels of perceived knowledge and differing attitudes toward digitalization. Independent information sources, particularly from governmental and regulatory institutions, medical associations, and colleagues were mentioned, while ambivalent views on health insurances were reported. GPs favored information content on the evidence base, indications, usability, and cost effectiveness of DiGAs. In terms of delivery modes, online formats, in-person events, and traditional print media were named. GPs showed high engagement with DiGA prescriptions despite persistent knowledge gaps and ambivalent attitudes. They expressed expectations regarding information provision, emphasizing concise content from trusted, neutral sources, about central structural aspects (e.g., budgetary impact), delivered through familiar formats such as journals, lectures, and digital platforms. Information strategies should account for limited time resources in primary care and align with established routines. Strengthening institutional support and integrating digital health into medical training may further facilitate the adoption of DiGAs in primary care.

Mental health clinicians are increasingly engaging with a range of innovative, technology-driven approaches to care, from telehealth to digital therapeutics, given their potential to significantly increase access to care among patients with diagnoses of varying clinical severity. However, the continued integration of digital mental health interventions into mental health service delivery requires ongoing attention to their effectiveness, cultural and linguistic responsiveness, equitable accessibility, privacy and security, and safety. Ensuring these factors are addressed requires efforts from multiple entities, with mental health clinicians playing a particularly pivotal role. This article describes approaches mental health clinicians can take to advocate for effective, equitable, accessible, and safe digital mental health services. Recommendations include selecting digital interventions with demonstrated effectiveness and providing expertise to further the evidence base, collaborating with patients to provide culturally responsive care, advocating for expanded delivery and coverage of digital interventions, and openly discussing safety and privacy considerations with patients.

As digital mental health research and technology continue to grow, a systematic approach to quickly and safely translating digital innovation into Child and Adolescent Mental Health Services (CAMHS) is needed. Here, we provide an overview of the CAMHS Digital Lab, a service in London, United Kingdom, which integrates operational, clinical and research expertise to support digital discovery and translate research into practice. The service is organized into four workstreams: Population and clinical analytics; Data science and discovery; Digital therapeutics and assessment; and Education, outreach and training. This service provides a model for integrating digital innovation into mental health services which could be adopted elsewhere.

Engagement is a multifaceted construct and a likely mechanism by which digital interventions achieve clinical improvements. To date, clinical research on digital mental health interventions (DMHIs) has overwhelmingly defined engagement and assessed its association with clinical outcomes through the objective/behavioral metrics of use of or interactions with a DMHI, such as number of log-ins or time spent using the technology. However, engagement also entails users' subjective experience. Research is largely lacking that tests the relationship between subjective metrics of engagement and clinical outcomes. The purpose of this study is to present a proof-of-concept exploratory evaluation of the association between subjective engagement measures of a mobile DMHI with changes in depression and anxiety. Adult primary care patients (N = 146) who screened positive for depression or anxiety were randomized to receive a DMHI, IntelliCare, immediately or following an 8-week waitlist. Subjective engagement was measured via the Usefulness, Satisfaction, and Ease of Use (USE) Questionnaire. Across both conditions, results showed that individuals who perceived a mobile intervention as more useful, easy to use and learn, and satisfying had greater improvements in depression and anxiety over eight weeks. Findings support our proposed experimental therapeutics framework that hypothesizes objective/behavioral and subjective engagement metrics as mechanisms that lead to changes in clinical outcomes, as well as support directing intervention design efforts for DMHIs to target the user experience.

The efficacy of digital mental health (DMH) services is well established. DMH services are comprised of the technology, service protocol, and ideally, implementation plan to support delivery. Like their traditional in-person treatment counterparts, DMH services have been developed and are being studied to target the behavioral, cognitive, and/or affective mechanisms that impact functioning (e.g., decreasing avoidance via a digital anxiety intervention). However, when DMH services move from controlled research settings to deployment in real-world healthcare settings, engagement is an acute problem. 1 Implementation attempts often show low rates of service use and retention among patients (i.e., failure for individual-level engagement), and DMH services fail to be integrated successfully within their targeted systems of care (i.e., failure for systems-level engagement among providers/organizations). For example, a large-scale attempt to implement commercially-available and free-to-use digital depression services in primary care failed. 2 Several factors impede successful implementation of evidence-based interventions into care, such as organizational, sociopolitical, and economic policies (e.g., reimbursement challenges) and failed understanding of mechanisms by which implementation strategies improve outcomes. Another critical factor impacting low engagement is the failure to adequately incorporate end-users (e.g., patients, providers, and care systems) in the design of DMH services. To rectify these failures, our field needs methods to study and improve treatment design and delivery for DMH. The National Institute of Mental Health’s (NIMH) National Advisory Mental Health Council report on developing information technologies recommended research on “the design and evaluation of interventions in real-world environments with input from end-users (consumers, clinicians, administrators).” 3 We propose here the integration of user-centered design (UCD) methods to improve engagement by patients and providers, along with adaptation of NIMH’s Research Domain Criteria (RDoC) framework 4 to study these

Background In Germany, patients often have to wait several months for psychotherapeutic treatment. Digital therapeutics (DTx) offer a promising approach for timely mental health support, but their use remains limited. Digital navigators (DNs) are specially trained medical assistants who support other health care professionals (HCPs) in selecting and using DTx. This can improve digital health literacy, increase engagement, and reduce the burden on HCPs. Objective The DigiNavi study is the first pilot study that aims to test the feasibility of implementing DNs in general practice and outpatient psychiatric care in Germany. Methods This mixed methods study took place at six study sites (three psychiatric outpatient clinics, three general practices) in Germany. In the prestudy, patients and HCPs participated in semistructured interviews and focus groups concerning their acceptance and expectations of DNs (phase I). The Harvard Digital Navigator Training (HDNT) was adapted, and medical assistants were trained as DNs (phase II). During the intervention, 8 patients per site (N=48) diagnosed with a mental disorder were recruited via convenience sampling and supported by DNs in using DTx for mental health for 12 weeks (phase III). Patients’ (N=48) and HCPs’ (N=18) digital health literacy, digital and technical literacy, readiness and ability to change, and clinical symptom severity were assessed before and after 12 weeks of DTx prescription and support by DNs. Patient engagement with the DiGAs (usage duration and intensity) was measured after the intervention. Quantitative data were analyzed using a pre-post design. Finally, qualitative interviews were conducted with HCPs, patients, and DNs to explore their experiences with DNs, including perceived implementation barriers. Results The study received funding in July 2024. The prestudy including 35 participants was conducted from August to October 2024. HDNT adaptation and DN training were conducted from October to December 2024. Recruitment and quantitative baseline data collection started in December 2024, and 48 participants were enrolled by the end of March 2025. The intervention study ended in June 2025. Result dissemination and the development of strategies for the long-term implementation of DNs into the German health care system are planned until September 2025. We hypothesize that the provision of support by DNs will enhance patients’ and HCP’ digital and technical literacy, patient engagement with DiGAs, and readiness and ability to change. In addition, patients’ mental health is expected to improve after the end of the intervention. Conclusions This is the first study to examine the feasibility and effects of DNs in German health care. The study will provide significant insights into the acceptability and feasibility of human-facilitated competency development for mental health apps in multiprofessional health care teams and their patients. The successful implementation of DNs can promote the use of DTx in Germany and thus enhance access to and the provision of health care for individuals affected by a mental disorder. Trial Registration German Clinical Trial Register DRKS00034327; https://drks.de/search/en/trial/DRKS00034327; ClinicalTrials.gov NCT06575582; https://clinicaltrials.gov/study/NCT06575582 International Registered Report Identifier (IRRID) DERR1-10.2196/67655

With an increasing societal need for digital therapy solutions for poor mental health, we face a corresponding rise in demand for scientifically validated digital contents. In this study we aimed to lay a sound scientific foundation for the development of brain-based digital therapeutics to assess and monitor cognitive effects of social and emotional bias across diverse populations and age-ranges. First, we developed three computerized cognitive tasks using animated graphics: 1) an emotional flanker task designed to test attentional bias, 2) an emotional go-no-go task to measure bias in memory and executive function, and 3) an emotional social evaluation task to measure sensitivity to social judgments. Then, we confirmed the generalizability of our results in a wide range of samples (children (N = 50), young adults (N = 172), older adults (N = 39), online young adults (N=93), and depression patients (N = 41)) using touchscreen and online computer-based tasks, and devised a spontaneous thought generation task that was strongly associated with, and therefore could potentially serve as an alternative to, self-report scales. Using PCA, we extracted five components that represented different aspects of cognitive-affective function (emotional bias, emotional sensitivity, general accuracy, and general/social attention). Next, a gamified version of the above tasks was developed to test the feasibility of digital cognitive training over a 2-week period. A pilot training study utilizing this application showed decreases in emotional bias in the training group (that were not observed in the control group), which was correlated with a reduction in anxiety symptoms. Using a 2-channel wearable EEG system, we found that frontal alpha and gamma power were associated with both emotional bias and its reduction across the 2-week training period.

Mental health, as critical as physical well-being, has gained significant importance during the COVID19 pandemic. Moreover, pandemic-induced lockdowns have exacerbated mental health issues, including suicides, spousal violence, and domestic bullying. Consequently, the demand for digital therapeutics has surged, manifesting as mobile and web applications and facilitating remote access to support. However, children have been underserved in this category despite their vulnerability to the emotional consequences of school closures and caregiver distress. This study's objectives and methodology encompassed developing a child centric digital therapy mobile application, conducting usability testing for optimal user-friendliness, creating content compliant with industry standards, gathering user feedback for improvements and providing ongoing maintenance for the application's effectiveness. The resulting 'Calm & Care' prototype empowers parents to authorise counselling sessions and motivational content for their children at home. Ten families participated in user testing, yielding positive feedback praising the vibrant interface, child-friendly visuals, and simplified language for an enhanced user experience. 'Calm & Care' can enable local clinics to accept mental health patients with lower infection risks and increase treatment success. This research underscores the pivotal role of digital solutions in addressing children's mental well-being during the pandemic.

Background Digital therapeutics (DTx) for children and adolescents with mental health problems have been developed in the health care industry. Despite reports of side effects from DTx for children and adolescents, there have been no guidelines to address the prevention of DTx overdependence among young users. Objective This study aimed to identify the requirements for guidelines to prevent DTx overdependence in children and adolescents and to develop and evaluate these guidelines. Methods We conducted 2 phases. This study first involved a phase I survey to develop guidelines, including assessments of smartphone usage and mental health conditions. The second phase evaluated the guidelines’ effectiveness, reliability, necessity, and satisfaction using a visual analog scale through a randomized controlled trial. Participants—45 children and adolescents aged 9-16 years and 42 caregivers—were randomly assigned to the experimental and control groups. Results Phase I revealed that blocking mobile applications and notifications (mean 8.5, SD 1.8) and parental monitoring (mean 8.5, SD 2.1) were effective preventive features. Caregivers, children, and adolescents expressed concerns about the side effects and overdependence of DTx and decreased effects due to nonindividualized guidelines in subjective responses to the phase I survey. Based on these insights, personalized guidelines for phase II were developed, in which overall mean visual analog scale scores for guideline evaluation were higher in the experimental group, except for necessity among caregivers (mean 8.5, SD 1.3 versus mean 8.7, SD 1.2). Conclusions Both caregivers and children and adolescents demonstrated the need for guidelines to prevent overdependence on DTx distinct from smartphone usage. Tailored guidelines may be acceptable for use in real-world therapeutic protocols. Guidelines to prevent overdependence on DTx in children and adolescents and to achieve a balance between their benefits and risks need to be established. Trial Registration Clinical Research Information Service (CRiS) of the Republic of Korea KCT0008893; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25609

Abstract Background PTSD remains a challenge in high-stress environments such as conflict zones and among military personnel and veterans. Traditional mental health care systems often struggle to provide timely and effective care due to logistical barriers, stigma, and the complex nature of PTSD. However, advances in digital therapeutics and AI are transforming mental health care by offering solutions that can adapt to rapidly changing and resource-constrained settings. These innovations provide new opportunities to capitalize on Golden Periods — critical windows of neuroplasticity and emotional processing where targeted interventions may have enhanced effectiveness. Aims & Objectives This presentation explores how digital platforms are enhancing resilience and preventing PTSD in high-stress settings. Platforms like MARTA in Ukraine demonstrate that combining self-assessment tools, psychoeducation, and real-time support improves emotional regulation, reduces stigma, and increases access to care. MARTA’s tailored approach reflects the importance of adapting interventions to the specific needs of veterans and service members. Similarly, the United Nations’ Mind Companion — designed for peacekeepers and uniformed personnel — integrates psychoeducation, real-time self-monitoring, and coping strategies, reinforcing the value of proactive mental health care in operational settings. Method At the more complex end of the spectrum, treatment-resistant PTSD cases highlight the need for personalized interventions. Novel approaches like 3MDR and the use of psychedelics are showing promise in modifying deep emotional processing pathways and promoting cognitive flexibility. These therapies reflect the growing shift toward highly individualized, immersive treatments that target complex symptom networks and emotional processing deficits. Results A central theme in this presentation is backward translation — adapting insights from effective treatment models to improve prevention strategies. AI-driven models and digital phenotyping — allow for early identification of stress dysregulation and PTSD trajectories, enabling more timely and targeted interventions. By combining personalized care with AI’s predictive power, these approaches aim to stabilize symptoms before they develop into a self-sustaining disorder. Discussion & Conclusions Digital therapeutics, AI, and personalized immersive approaches represent a shift in PTSD prevention and treatment. Leveraging Golden Periods allows for the development of more responsive and adaptive mental health solutions towards resilience and healing. This framework allows a personalized model for enhancing resilience and improving mental health outcomes in complex situations.

Background There is certain evidence on the efficacy of smartphone-based mental health interventions. However, the mechanisms of action remain unclear. Placebo effects contribute to the efficacy of face-to-face mental health interventions and may also be a potential mechanism of action in smartphone-based interventions. Objective This study aimed to investigate whether different types of efficacy expectancies as potential factors underlying placebo effects could be successfully induced in a smartphone-based digital placebo mental health intervention, ostensibly targeting mood and stress. Methods We conducted a randomized, controlled, single-blinded, superiority trial with a multi-arm parallel design. Participants underwent an Android smartphone-based digital placebo mental health intervention for 20 days. We induced prospective efficacy expectancies via initial instructions on the purpose of the intervention and retrospective efficacy expectancies via feedback on the success of the intervention at days 1, 4, 7, 10, and 13. A total of 132 healthy participants were randomized to a prospective expectancy–only condition (n=33), a retrospective expectancy–only condition (n=33), a combined expectancy condition (n=34), or a control condition (n=32). As the endpoint, we assessed changes in efficacy expectancies with the Credibility Expectancy Questionnaire, before the intervention and on days 1, 7, 14, and 20. For statistical analyses, we used a random effects model for the intention-to-treat sample, with intervention day as time variable and condition as two factors: prospective expectancy (yes vs no) and retrospective expectancy (yes vs no), allowed to vary over participant and intervention day. Results Credibility (β=−1.63; 95% CI −2.37 to −0.89; P<.001) and expectancy (β=−0.77; 95% CI −1.49 to −0.05; P=.04) decreased across the intervention days. For credibility and expectancy, we found significant three-way interactions: intervention day×prospective expectancy×retrospective expectancy (credibility: β=2.05; 95% CI 0.60-3.50; P=.006; expectancy: β=1.55; 95% CI 0.14-2.95; P=.03), suggesting that efficacy expectancies decreased least in the combined expectancy condition and the control condition. Conclusions To our knowledge, this is the first empirical study investigating whether efficacy expectancies can be successfully induced in a specifically designed placebo smartphone-based mental health intervention. Our findings may pave the way to diminish or exploit digital placebo effects and help to improve the efficacy of digital mental health interventions. Trial Registration Clinicaltrials.gov NCT02365220; https://clinicaltrials.gov/ct2/show/NCT02365220.

Background Worldwide, the COVID-19 pandemic contributed to further gaps in mental health care, particularly in low- and middle-income countries such as Vietnam, where care is inaccessible for 90% of those who need it. There has subsequently been a considerable increase in the use of digital mental health interventions such as smartphone apps. Presently, the evidence for such interventions is limited, especially in cases in which the interventions have been adapted from evidence-based in-person formats. Implementation science aims to promote the incorporation of scientific findings into practice. A key determinant of implementation success is an intervention’s usability. Hurdles to usability include an intervention being too confusing or time-intensive to use. Facilitators include incorporating a greater number of engagement features and integrating human support. Objective The aim of this implementation science feasibility study was to describe the challenges and mitigation strategies used in the development, usability testing, and implementation of a digital depression intervention (VMood smartphone app) developed in Vietnam. VMood was adapted from an evidence-based in-person intervention originally developed in Canada that is grounded in principles of cognitive behavioral therapy with supportive coaching by a lay health or social services worker. The research team is currently testing the effectiveness and cost-effectiveness of VMood in a randomized controlled trial across 8 provinces in Vietnam informed by the results of this feasibility assessment. Methods This mixed methods feasibility study was organized using an implementation outcome framework focused on acceptability, adoption, appropriateness, and feasibility. This study involved three data collection components: (1) usability testing (interviews and focus groups with app user and provider participants who tested VMood in 1 Vietnamese province), (2) app metrics (from the early phase of the randomized controlled trial in the same province but from different municipalities), and (3) discourse data (notes from various team meetings, communications, and reports on VMood’s development and implementation). Qualitative data were analyzed using thematic content analysis. App use data were analyzed using basic descriptive statistics. Results The findings of the 3 data components showed that there were seven main challenges: (1) challenges with recruitment and uptake of the app, (2) challenges with use and engagement, (3) screening challenges, (4) digital divide, (5) limitations to digital applications for mental health, (6) technological challenges, and (7) funding and policy constraints. Various solutions to help mitigate the challenges were used by the team. Conclusions The findings contribute important evidence on the challenges to the development and feasibility assessment of a digital depression app adapted from an in-person intervention in Vietnam. The findings have applicability for others looking to develop and implement digital interventions in similar contexts, serving as a unique opportunity to share the lessons learned regarding the development and testing process.

Background Perinatal depression is a predominant and serious condition that adversely affects prenatal and postpartum women and their children. Prenatal depression is a notable predictor of postpartum depression, highlighting the need for mental health care during pregnancy. Therefore, we developed an innovative smartphone application based on interpersonal psychotherapy (IPT) to improve depressive symptoms in women in the perinatal period (i.e., from pregnancy through the first year postpartum). Here, we present a randomized controlled trial (RCT) protocol to investigate the potential of this intervention for prenatal women. Methods This study is an 8-week, open-label, parallel-group, stratified block RCT. In total, 350 primiparous women were randomly assigned to the intervention group—combining the smartphone application for mental health care based on IPT and care as usual—and the control group, with only care as usual. The women assigned to the intervention were encouraged to use the application for approximately 5–10 min daily. The primary outcomes included the proportion of participants with moderate-to-high satisfaction (scoring ≥17 on the 8-item Client Satisfaction Questionnaire) and changes in depressive symptoms measured by the Patient Health Questionnaire-9 from baseline to the end of the 8-week intervention. Discussion To our knowledge, this RCT is the first to investigate the acceptability and efficacy of an IPT-based smartphone application for reducing depressive symptoms in prenatal women. If successful, the findings will contribute to the growing evidence supporting digital mental health interventions during pregnancy, offering a scalable and accessible solution for prenatal mental health care.

Abstract Background The rising burden of disease associated with mental disorders calls for evidence-based psychological interventions that can be swiftly scaled up. Blending smartphone-based mental health apps (MHapps) for delivering ecological momentary interventions (EMIs) with traditional in-person interventions may have the benefits of improving treatment adherence, facilitating the application of learned techniques into everyday life, and, in turn, enhancing clinical response. However, previous work has shown that most existing MHapps were developed for specific research studies or for profit, thereby making them difficult to adapt, particularly in time-limited and resource-constrained settings. Objective This study aimed to demonstrate how a person-centered and theory-informed MHapp could be developed in a timely and low-cost manner for use as part of blended care, using a phased approach. Given the scarcity of digital mental health interventions for older adults, we adopted a participatory research approach to co-design the blended intervention with 2 groups of older adults. Methods In Phase 1, we reviewed existing MHapps with consideration of whether they could be adapted by individual researchers or clinicians, their key functions, and whether their efficacy had been tested. “No-code” app builders were additionally reviewed, which may be alternatives if no MHapp can be used. In Phase 2, following the IDEAS (Integrate, Design, Assess, and Share) framework, we built a prototype according to users’ needs, with its content informed by theories of cognitive behavioral therapy (CBT) and the Health Action Process Approach. The prototype was then tested and refined over 2 rounds of 3-session co-design workshops with peer supporters (n=8) and service users (n=5) from a stepped-care intervention for older adults with depressive symptoms. Usability testing was conducted with both stakeholder groups in Phase 3. Results Of the 149 MHapps identified, only 43 (28.9%) can be publicly downloaded. Four (8.3%) of them can be partially adapted, although no new content can be directly added. We therefore developed the MHapp using m-Path (a spin-off from KU Leuven's Faculty of Psychology), which was the only existing no-code app development platform designed for mental health interventions. A prototype incorporating CBT-based homework and behavior change techniques informed by the Health Action Process Approach was built, with its refined version rated as highly easy to use and acceptable by both stakeholder groups. Conclusions By integrating CBT with EMI, we demonstrated the feasibility and acceptability of a novel blended care model for reference in future work. Preliminary findings suggest high usability and clinical relevance, highlighting the potential of leveraging no-code platforms to facilitate scalable, theory-driven interventions that extend mental health support beyond traditional settings. Grounding the blended intervention in evidence-based psychological and health behavior change theories, coupled with user involvement throughout the design process, may improve clinical efficacy and reduce implementation barriers, which are areas for further investigation in future work.

TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry ACTRN12622001410741.

Objective To prevent the exacerbation of mental health burdens, a growing body of research has recommended a balanced approach that emphasizes both the delivery of mental health treatments to individuals with common mental disorders (CMDs) and the strengthening of protective factors for CMDs among nonclinical populations. This randomized controlled trial (RCT) evaluated the efficacy of a smartphone-delivered multicomponent lifestyle medicine (LM) intervention, Lifestyle Hub, for improving mental health among a nonclinical population of Chinese adults. Methods A total of 106 participants with Patient Health Questionnaire-9 total score < 10 and Generalized Anxiety Disorder 7-Item Scale <8 were randomly assigned to either the Lifestyle Hub intervention group (LH, n = 53) or the waitlist control group (WL, n = 53). Lifestyle Hub is an 8-week smartphone-delivered multicomponent LM intervention developed based on the transtheoretical model. The intervention components included lifestyle psychoeducation, physical activity, diet and nutrition, stress management, sleep management, and motivation and goal-setting techniques. Assessments were conducted at baseline, immediate post-intervention, and 1-month follow-up (LH only). Results The linear mixed effect model based on the intention-to-treat principle indicated that Lifestyle Hub significantly improved overall mental health, depressive symptoms, anxiety symptoms, stress, insomnia severity, overall health-promoting behaviors, dietary quality, and stress management compared to the WL group at immediate post-intervention (d = 0.13–0.56). No significant between-group differences were observed in terms of functional impairment, health-related quality of life, health responsibility, physical activity level, spiritual growth, and interpersonal relations. The intervention gains in the LH group were maintained at 1-month follow-up. The LH participants indicated that Lifestyle Hub was an acceptable intervention for improving mental health, although a significantly higher level of study attrition was observed in the LH group (20.8%) relative to the WL group (5.7%). Conclusion Lifestyle Hub may serve as an efficacious and acceptable intervention for improving mental health in nonclinical adult populations. To extend the benefits of LM interventions at the population level, future studies are warranted to examine a stepped-care approach to delivering LM interventions. Trial registration: This randomized controlled trial was pre-registered with ClinicalTrials.gov (NCT04295369).

Background: Adolescents are particularly vulnerable to mental disorders, with over 75% of cases manifesting before the age of 25. Research indicates that only 18 to 34% of young people experiencing high levels of depression or anxiety symptoms seek support. Digital tools leveraging smartphones offer scalable and early intervention opportunities. Objective: Using a novel machine learning framework, this study evaluated the feasibility of integrating active and passive smartphone data to predict mental disorders in non-clinical adolescents. Specifically, we investigated the utility of the Mindcraft app in predicting risks for internalising and externalising disorders, eating disorders, insomnia and suicidal ideation. Methods: Participants (N=103; mean age 16.1 years) were recruited from three London schools. Participants completed the Strengths and Difficulties Questionnaire, the Eating Disorders-15 Questionnaire, Sleep Condition Indicator Questionnaire and indicated the presence/absence of suicidal ideation. They used the Mindcraft app for 14 days, contributing active data via self-reports and passive data from smartphone sensors. A contrastive pretraining phase was applied to enhance user-specific feature stability, followed by supervised fine-tuning. The model evaluation employed leave-one-subject-out cross-validation using balanced accuracy as the primary metric. Results: The integration of active and passive data achieved superior performance compared to individual data sources, with mean balanced accuracies of 0.71 for SDQ-High risk, 0.67 for insomnia, 0.77 for suicidal ideation and 0.70 for eating disorders. The contrastive learning framework stabilised daily behavioural representations, enhancing predictive robustness. This study demonstrates the potential of integrating active and passive smartphone data with advanced machine-learning techniques for predicting mental health risks.

Abstract Background Accessible ecological momentary interventions deliver brief, real-time support integrated into daily routines. Interpersonal dynamics and maladaptive coping mechanisms can contribute to an individual’s anxiety and depression. Both mindfulness and mentalization represent psychological constructs with the potential to mitigate the negative impact of interpersonal stressors. Objective This study aims to assess the feasibility and acceptability of an automated mindfulness- and mentalization-based ecological momentary intervention for common mental health problems as delivered via a mobile phone app. Methods The design was a parallel-group pilot randomized controlled trial with 1:1 allocation ratio and exploratory framework. Recruitment of participants experiencing common mental health issues was internet-based from a university setting. Eligible participants were randomly allocated to fully automated mindfulness- or mentalization-based ecological momentary interventions via computer-generated randomization. Participants were blind to the alternative intervention options. Outcomes were self-assessed through questionnaires after 4 weeks. Primary outcomes were feasibility (recruitment, retention, and adherence) and acceptability (satisfaction ratings and qualitative feedback). Secondary outcomes included changes in depression (Patient Health Questionnaire-9 [PHQ-9]) and anxiety (Generalized Anxiety Disorder Questionnaire-7 [GAD-7]) scores. Results A total of 84 participants were randomized (42 to each group). The interventions demonstrated good feasibility with an 89.2% retention rate and a mean adherence of 87.69% (SD 11.3%) across both groups. Acceptability ratings were positive, with favorable scores for ease of engagement (mean 5.20, SD 1.6), overall enjoyment (mean 5.15, SD 1.2), and likelihood of recommending the app (mean 5.11, SD 1.6) on a 7-point scale. For primary outcomes, both groups showed significant within-group reductions in PHQ-9 and GAD-7 scores, with moderate to large effect sizes (Cohen d=−0.68 to −0.81), with no significant difference between groups. Both treatments demonstrated clinically significant change, with 33 (44%) participants in both groups no longer meeting caseness criteria for anxiety and depression. Mindfulness performed better on improving assertiveness and perceived support compared to mentalization in the ecological momentary assessment data. One unintended harm was reported in the mindfulness arm, whereas none was reported in the mentalization arm. Conclusions This pilot trial suggests that both mindfulness- and mentalization-based ecological momentary interventions are feasible and acceptable for individuals with common mental health problems and warrant further evaluation.

Background While the importance of mental health is well-recognized in the field of occupational health, implementation of effective strategies in the workplace has been limited by gaps in infrastructure, program comprehensiveness, coverage, and adherence. The authors developed a Screening, Brief Intervention, and Referral to Treatment (SBIRT) model based occupational mental health intervention, and implemented in a web-based format with a smartphone application. Methods The SBIRT-based intervention was developed by a multidisciplinary team, including occupational health physicians, nurses, psychiatrists, and software developers. The following mental health areas were included, based on outcomes of an epidemiological survey conducted: insomnia, depression, anxiety, problematic alcohol use, and suicidal risk. The viability of the two-step evaluation process utilizing a combination of the brief version and the full-length version of the questionnaire was examined using responses from the survey. The intervention was adjusted according to the survey results and expert opinions. Results The epidemiological survey included 346 employees who completed the long-form version of mental health scales. These data were the used to confirm the diagnostic value of using a combination of short-form and long-form version of the scales for screening in the SBIRT model. The model uses a smartphone application for screening, provision of psychoeducation, and for surveillance. The universal methods of the model ensure it can be implemented by all occupational managers, regardless of their specialization in mental health. In addition to the two-step screening procedure to identify employees at-risk for mental health problems, the model includes a stepped care approach, based on risk stratification, to promote mental health education, management, and follow-up for continuous care. Conclusion The SBIRT model-based intervention provides an easy-to-implement approach for the management of mental health in the workplace. Further studies are required to examine the effectiveness and feasibility of the model.

Background Family caregivers of people with dementia are critical to the quality of life of care recipients and the sustainability of health care systems but face an increased risk of emotional distress and negative physical and mental health outcomes. Objective The purpose of this study was to examine the usability, acceptability, and preliminary effectiveness of a technology-based and caregiver-delivered peer support program, the Caregiver Remote Education and Support (CARES) smartphone or tablet app. Methods A total of 9 adult family caregivers of people with dementia received the CARES intervention, and 3 former family caregivers of people with dementia were trained to deliver it. Quantitative data were collected at baseline and at the end of the 2-week field usability study. Qualitative data were also collected at the end of the 2-week field usability study. Results The field usability study demonstrated that a 2-week peer-delivered and technology-supported mental health intervention designed to improve burden, stress, and strain levels was experienced by former and current family caregivers of people with dementia as acceptable. Current family caregivers rated CARES as above average in usability, whereas the caregiver peer supporters rated CARES as marginally usable. CARES was associated with non–statistically significant improvements in burden, stress, and strain levels. Conclusions This field usability study demonstrated that it is possible to train former family caregivers of people with dementia to use technology to deliver a mental health intervention to current family caregivers of people with dementia. Future studies would benefit from a longer trial; a larger sample size; a randomized controlled design; and a control of covariables such as stages of dementia, years providing care, and severity of dementia symptoms.

Objective Despite steady increases in the prevalence of depression and anxiety, many adolescents remain undertreated. Digital mental health interventions (DMHI) may address some barriers to care. This study is the first to examine the prospective noninferiority of a smartphone-based, self-guided relational agent (W-GenZD) DMHI to address adolescent depressive symptoms compared to group-based telehealth cognitive-behavioral therapy (CBT). Method Adolescents 13 to 17 years of age who were seeking treatment for depression and/or anxiety at a children’s hospital outpatient mental health program and who met study inclusion criteria were randomized to either W-GenZD (n = 71) or CBT Group (n = 70). The primary aim was to examine feasibility and acceptability. The secondary aim was to test the noninferiority of W-GenZD compared to CBT Group on the 8-item Patient Health Questionnaire (PHQ-8) at 4 weeks (end of treatment [EOT]). The study also examined the trajectory of working alliance, anxiety, general mood, and safety in each intervention group. Results W-GenZD was noninferior to CBT Group in reducing depressive symptoms, with a mean between-group PHQ-8 EOT score difference of −0.67, 95% CI = − 2.30, 0.82 in intent-to-treat analysis (N = 141) using multiple imputation for missing values. Four different sensitivity analyses confirmed noninferiority, including per protocol analysis (−1.38, −3.61, 0.86, n = 82). Feasibility, acceptability, and tertiary aims were similar in both groups, and data support the safety of W-GenZD in a mental health outpatient setting. Conclusion Results suggest that W-GenZD is a feasible and efficacious intervention for adolescents presenting with depression and/or anxiety in a real-world setting. W-GenZD could help expand the capacity of mental health clinicians to support the many youth and families in need of mental health care. Clinical trial registration information Feasibility and Acceptability of W-GenZD vs CBT-light Teletherapy for Adolescents Seeking Mental Health Services; https://clinicaltrials.gov/study/NCT05372913

Abstract Trials of digital mental health interventions (DMHIs) often exclude individuals with suicide-related thoughts and behaviors precluding an understanding of whether DMHIs for affective disorders are safe for, and perform similarly within, this high-risk group. We explore the safety and performance of a DMHI for depression in participants with and without suicidal ideation (SI) at baseline. Three hundred and one participants were included in this secondary data analysis from a trial of an 8-week DMHI comprising 14 smartphone apps. We found that SI decreased across the study among participants with baseline SI and that baseline SI status did not attenuate depression treatment effects. Through a case study of the IntelliCare platform, we find that DMHIs for general affective disorders can be safe.

Background Mental health problems among workers cause enormous losses to companies in Japan. However, workers have been considered to have limited access to psychological support because of time constraints, which makes it difficult for them to engage in face-to-face psychological support interventions. Objective This study aimed to present an intervention protocol that describes a randomized controlled trial to examine whether brief guided mindfulness meditation (MM) or self-compassion meditation (SCM) provided by a smartphone app is effective for mental health and work-related outcomes among workers. Methods This is an open-label, 3-arm randomized controlled trial. The participants will be recruited through an open call on relevant websites with the following inclusion criteria: (1) employees who are working more than 20 hours per week, (2) between the ages of 18 and 54 years, (3) not on a leave of absence, (4) not business owners or students, and (5) not currently diagnosed with a mental disorder and have a Kessler Psychological Distress Scale-6 score below 13 points. We will include 200 participants and randomly assign them to an SCM course (n=67), an MM course (n=67), and a waitlist group (n=66). The intervention groups (SCM and MM) will be instructed to engage in daily guided self-help, self-compassion, and MMs lasting 6-12 minutes per day over 4 weeks. Primary outcomes will include psychological distress and job performance, and secondary outcomes will include somatic symptoms, cognitive flexibility, self-esteem, self-compassion, perceived stress, well-being, emotion regulation, work engagement, anger, psychological safety, and creativity. All procedures were approved by the ethics committee of the University of Tokyo (22-326). All participants will be informed of the study via the websites, and written informed consent will be collected via web-based forms. Results The recruitment of participants began in December 2022, and the intervention began in January 2023. As of September 2023, a total of 375 participants have been enrolled. The intervention and data collection were completed in late October 2023. Conclusions This study will contribute to the development of effective self-care intervention content that will improve mental health, work performance, and related outcomes and promote mindful and self-compassionate attitudes when faced with distress. Trial Registration University Hospital Medical Information Network Clinical Trials Registry UMIN000049466; https://tinyurl.com/23x8m8nf International Registered Report Identifier (IRRID) DERR1-10.2196/53541

Background: The mental health challenges faced by police of fi cers due to high-stress work environments necessitate effective interventions. Cognitive-behavioral therapy (CBT) has shown promise in addressing mental health issues, and this study aims to evaluate the ef fi cacy of smartphone-based cognitive-behavioral therapy (SCBT) in improving mental health outcomes among police of fi cers. This intervention could provide a reference for enhancing mental health literacy and resilience in this population. Methods: A randomized controlled trial (RCT) design was employed, involving 291 police of fi cers who were randomly assigned to either the SCBT intervention group (n = 145) or the control group (n = 146). Participants completed pre-and post-intervention assessments using the Symptom Checklist-90 (SCL-90), which measures multiple psychological symptoms including somatization, obsessive-compulsiveness, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. Statistical analyses were conducted to examine group differences in symptom severity and effect sizes. Results: Post-intervention results indicated signi fi cant reductions in somatization, obsessive-compulsiveness, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism, with large effect sizes observed in the intervention group. Notably, the intervention group showed signi fi cantly greater improvements compared to the control group, particularly in overall psychological distress as measured by the total SCL-90 score. However, signi fi cant reductions in interpersonal sensitivity and paranoid ideation were also observed in the control group, suggesting external factors may have in fl uenced these dimensions. Conclusion: SCBT demonstrated ef fi cacy in reducing psychological distress among police of fi cers, offering a fl exible and accessible mental health intervention. However, challenges such as high dropout rates and the complex, dynamic nature of mental health warrant further investigation. Future studies should explore targeted interventions for speci fi c behavioral issues and consider SCBT as a supplementary tool alongside traditional psychotherapy.

Background Perinatal mental health problems, such as anxiety, stress, and depression, warrant particularly close monitoring and intervention, but they are often unaddressed in both obstetric and psychiatric clinics, with limited accessibility and treatment resources. Mobile health interventions may provide an effective and more accessible solution for addressing perinatal mental health. Development and evaluation of a mobile mental health intervention specifically for pregnant women are warranted. Objective This study aimed to evaluate the effectiveness of a 4-week, self-administered mobile mindfulness intervention in reducing anxiety, depression, and stress, and improving emotional well-being, maternal-fetal attachment, and mindfulness skills in a general population of pregnant women. Methods Pregnant women were recruited and randomized to an intervention or a wait-list control group. The intervention group participated in a self-administered 4-week smartphone-based mindfulness program. Anxiety, depression, and stress were assessed as primary outcomes at baseline and postintervention. Secondary outcomes were mental health well-being, maternal-fetal attachment, and skills of mindfulness. The usability of the mobile intervention was also evaluated. Results A total of 133 pregnant women were randomly assigned to the intervention (n=66) or the control group (n=67). The overall dropout rate was 30% (39/133). Anxiety scores of the intervention group significantly decreased from baseline to postintervention (P=.03, Wilcoxon Signed-Rank test), whereas no significant changes were observed in the control group. Depression and stress scores showed no significant changes. Emotional well-being significantly improved in the intervention group (P=.01). Improvements were observed in maternal-fetal attachment, particularly in attributing characteristics to the fetus (P=.003) and in differentiating the self from the fetus (P=.006). Mindfulness awareness also showed significant improvement (P=.008). Significant between-group effects were identified for mindfulness awareness (P=.006) and attributing characteristics to the fetus (P=.002). After applying the false discovery rate corrections, within-group improvements in emotional well-being, maternal-fetal attachment, and mindfulness awareness remained significant, while between-group differences for emotional well-being and differentiation were not significant. Conclusions A mobile mindfulness program effectively reduced anxiety and improved emotional well-being, maternal-fetal attachment, and mindfulness awareness in the general population of pregnant women. Mobile interventions may offer a cost-effective and feasible method for promoting perinatal mental health. Trial Registration Clinical Research Information Service KCT0007166; https://tinyurl.com/458vfc4r

Mobile health (mHealth) interventions for mental health and well-being have increased exponentially in recent years. In this digital era, mHealth interventions are proving to be a useful tool in the promotion of mental health for university students. This mixed-methods study explored the feasibility, practicality, and acceptability of a mental health application (app) designed to address mental health challenges among university students. Overall, a total of 1100 participants completed an online survey, and data were analysed using statistical analytics software. Most of the participants were female (72.73%) within the 18–20 age group (64.64%) and in their first year of study (46.18%). The results show that at least 98.7% of the participants owned a smartphone, 80.8% had access to mobile data, 66.9% used Android software, 20.09% had historically been diagnosed with a mental health challenge, and 26.6% had used an online health app. Sixty-two participants were enrolled across 16 focus group discussions. Qualitative data were analysed using thematic analysis, which revealed four facilitators of app acceptability (exposure to mental health apps, convenience, accessibility, and confidentiality) and three barriers to app acceptability (preference for face-to-face therapy, overreliance on app, and fear of misdiagnosis). The findings suggest that an app that is convenient, accessible, confidential, and nonpathologising can be a feasible and acceptable intervention to address mental health challenges.

Background Taking advantage of the rapidly increasing access to digital technology in low- and middle-income countries, the World Health Organization has launched an electronic version of the mental health Gap Action Programme intervention guide (emhGAP-IG). This is suitable for use on smartphones or tablets by non-specialist primary healthcare providers (PHCWs) to deliver evidence-based intervention for priority mental, neurological and substance use disorders. We assessed the perceptions of PHCWs on the feasibility, acceptability, and benefits of using smartphone-based clinical guidance and the emhGAP-IG in the management of people with mental health conditions in Nigeria.  Methods Exploration of the views of PHCWs from 12 rural and urban primary health clinics (PHCs) in South-Western Nigeria were carried out using 34 in-depth key informant qualitative interviews with nurses ( n  = 10), community health officers ( n  = 13) and community health extension workers ( n  = 11). An additional two focus group discussions, each comprising eight participants drawn from across the range of characteristics of PHCWs, were also conducted. Thematic analysis was conducted using a three-staged constant comparison technique to refine and categorise the data. Results Three overall themes were identified around the use of clinical guidance and mobile applications (apps) in PHCs. Apps were deployed for purposes other than clinical consultation and decision making. Although paper-based guidance was the expected practice, its utilization is not fully embedded in routine care. An app-based decision-making tool was preferred to paper by PHCWs. Future usage of the emhGAP-IG would be facilitated by training and supporting of staff, helpful design features, and obtaining patients’ buy-in. Conclusion Our findings suggest that the emhGAP-IG could be a viable way to embed clinical guidance and decision-making tools in the management of people with mental health conditions in Nigerian PHCs.

Mental health symptoms are commonly discovered in primary care. Yet, these settings are not set up to provide psychological treatment. Digital interventions can play a crucial role in stepped care management of patients’ symptoms where patients are offered a low intensity intervention, and treatment evolves to incorporate providers if needed. Though digital interventions often use smartphone and wearable sensor data, little is known about patients’ desires to use these data to manage mental health symptoms. In 10 interviews with patients with symptoms of depression and anxiety, we explored their: symptom self-management, current and desired use of sensor data, and comfort sharing such data with providers. Findings support the use digital interventions to manage mental health, yet they also highlight a misalignment in patient needs and current efforts to use sensors. We outline considerations for future research, including extending design thinking to wraparound services that may be necessary to truly reduce healthcare burden.

ABSTRACT Objective Multimorbidity or the co-occurrence of multiple health conditions is increasing globally and is associated with significant psychological complications. It is unclear whether digital mental health (DMH) interventions for patients experiencing multimorbidity are effective, particularly given that this patient population faces more treatment resistance. The goal of the current study was to examine the impact of smartphone-delivered DMH interventions for patients presenting with elevated internalizing symptoms that have reported multiple lifetime medical conditions. Methods This preregistered (see https://osf.io/vh2et/) retrospective cohort intent-to-treat study with 2819 patients enrolled in a therapist-supported DMH intervention examined the associations between medical multimorbidity (MMB) and mental health outcomes. Results Results indicated that more MMB was significantly associated with greater presenting mental health symptom severity. MMB did not have a deleterious influence on depressive symptom trajectories across treatment, although having one medical condition was associated with a steeper decrease in anxiety symptoms compared to patients with no medical conditions. Finally, MMB was not associated with time to dropout, but was associated with higher dropout and was differentially associated with fewer beneficial treatment outcomes, although this is likely attributable to higher presenting symptom severity, rather than lesser symptom reductions during treatment. Conclusions Overall, the Meru Health Program was associated with large effect size decreases in depressive and anxiety symptoms regardless of the number of MMB. Future DMH treatments and research might investigate tailored barrier reduction and extended treatment lengths for patients experiencing MMB to allow for greater treatment dose to reduce symptoms below clinical outcome thresholds.

Introduction: Digital technology platforms offer unparalleled opportunities to reach vulnerable adolescents at scale and overcome many barriers that exist around conventional service provision. This paper describes the design and development of POD Adventures, a blended problem-solving game-based intervention for adolescents with or at risk of anxiety, depression and conduct difficulties in India. This intervention was developed as part of the PRemIum for ADolEscents (PRIDE) research programme, which aims to establish a suite of transdiagnostic psychological interventions organized around a stepped care system in Indian secondary schools. Methods and Materials: Intervention development followed a person-centered approach consisting of four iterative activities: (i) review of recent context-specific evidence on mental health needs and preferences for the target population of school-going Indian adolescents, including a multiple stakeholder analysis of school counseling priorities and pilot studies of a brief problem-solving intervention; (ii) new focus group discussions with N = 46 student participants and N = 8 service providers; (iii) co-design workshops with N = 22 student participants and N = 8 service providers; and (iv) user-testing with N = 50 student participants. Participants were aged 12–17 years and recruited from local schools in New Delhi and Goa, including a subgroup with self-identified mental health needs (N = 6). Results: Formative data from existing primary sources, new focus groups and co-design workshops supported a blended format for delivering a brief problem-solving intervention, with counselors supporting use of a game-based app on “offline” smartphones. User-testing with prototypes identified a need for simplification of language, use of concrete examples of concepts and practice elements to enhance engagement. There were also indications that participants most valued relatability and interactivity within real-world stories with judicious support from an in-app guide. The final prototype comprised a set of interactive and gamified vignettes and a structured set of problem-solving questions to consolidate and generalize learning while encouraging real-world application. Discussion: Findings shaped the design of POD Adventures and its delivery as an open-access blended intervention for secondary school students with a felt need for psychological support, consistent with an early intervention paradigm. A randomized controlled trial is planned to evaluate processes and impacts of POD Adventures when delivered for help-seeking students in low-resource school settings.

Introduction: Despite the increasing number of mental health professionals in Malaysia, many have yet to receive adequate treatment for common mental illnesses such as depression and anxiety. Coupled with the increasing number of mobile phone users globally, smartphone-based intervention can be a promising mental health intervention. Thus, this study aims to investigate the efficacy of using a smartphone-based mental health application in addition to treatment-as-usual (TAU) in outpatients with depressive and/or anxiety symptoms. Methods: Psychiatric outpatients that fulfill the selection criteria were recruited and randomized into two groups, the intervention group (n = 24) and the control group (n = 24). Those in the intervention group received MoodMission in addition to TAU, while those in the control group received TAU. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores were assessed at baseline and after four weeks. Results: A total of 48 participants were recruited, randomized, and completed the study. Baseline characteristics for both groups were comparable. There is no significant mean difference between-group comparison of PHQ-9 (1.31, 95% CI -1.35, 3.98) and GAD-7 (0.02, 95% CI -2.01, 2.05) scores at four weeks. However, for the intervention group, there was a significant improvement in the PHQ-9 score at four weeks [mean difference 2.58 (95% CI 1.16, 4.01), P = 0.001)]. Conclusion: This study showed no significant improvement in anxiety symptoms after four weeks. Use of smartphone-based mental health applications led to significant reduction of depressive symptoms.

Background Non-communicable diseases (NCDs) and common mental disorders (CMDs) are the leading causes of death and disability worldwide. Lifestyle interventions via mobile apps and conversational agents present themselves as low-cost, scalable solutions to prevent these conditions. This paper describes the rationale for, and development of, “LvL UP 1.0″, a smartphone-based lifestyle intervention aimed at preventing NCDs and CMDs. Materials and Methods A multidisciplinary team led the intervention design process of LvL UP 1.0, involving four phases: (i) preliminary research (stakeholder consultations, systematic market reviews), (ii) selecting intervention components and developing the conceptual model, (iii) whiteboarding and prototype design, and (iv) testing and refinement. The Multiphase Optimization Strategy and the UK Medical Research Council framework for developing and evaluating complex interventions were used to guide the intervention development. Results Preliminary research highlighted the importance of targeting holistic wellbeing (i.e., both physical and mental health). Accordingly, the first version of LvL UP features a scalable, smartphone-based, and conversational agent-delivered holistic lifestyle intervention built around three pillars: Move More (physical activity), Eat Well (nutrition and healthy eating), and Stress Less (emotional regulation and wellbeing). Intervention components include health literacy and psychoeducational coaching sessions, daily “Life Hacks” (healthy activity suggestions), breathing exercises, and journaling. In addition to the intervention components, formative research also stressed the need to introduce engagement-specific components to maximise uptake and long-term use. LvL UP includes a motivational interviewing and storytelling approach to deliver the coaching sessions, as well as progress feedback and gamification. Offline materials are also offered to allow users access to essential intervention content without needing a mobile device. Conclusions The development process of LvL UP 1.0 led to an evidence-based and user-informed smartphone-based intervention aimed at preventing NCDs and CMDs. LvL UP is designed to be a scalable, engaging, prevention-oriented, holistic intervention for adults at risk of NCDs and CMDs. A feasibility study, and subsequent optimisation and randomised-controlled trials are planned to further refine the intervention and establish effectiveness. The development process described here may prove helpful to other intervention developers.

No abstract available

Problematic smartphone use negatively affects physical and mental health. Despite the wide range of prior research, existing persuasive techniques are not flexible enough to provide dynamic persuasion content based on users’ physical contexts and mental states. We first conducted a Wizard-of-Oz study (N=12) and an interview study (N=10) to summarize the mental states behind problematic smartphone use: boredom, stress, and inertia. This informs our design of four persuasion strategies: understanding, comforting, evoking, and scaffolding habits. We leveraged large language models (LLMs) to enable the automatic and dynamic generation of effective persuasion content. We developed MindShift, a novel LLM-powered problematic smartphone use intervention technique. MindShift takes users’ in-the-moment app usage behaviors, physical contexts, mental states, goals & habits as input, and generates personalized and dynamic persuasive content with appropriate persuasion strategies. We conducted a 5-week field experiment (N=25) to compare MindShift with its simplified version (remove mental states) and baseline techniques (fixed reminder). The results show that MindShift improves intervention acceptance rates by 4.7-22.5% and reduces smartphone usage duration by 7.4-9.8%. Moreover, users have a significant drop in smartphone addiction scale scores and a rise in self-efficacy scale scores. Our study sheds light on the potential of leveraging LLMs for context-aware persuasion in other behavior change domains.

BACKGROUND Post-intensive care syndrome-family (PICS-F) is a constellation of adverse psychological symptoms experienced by family members of critically ill patients during and after acute illness. Cognitive behavioral therapy delivered using smartphone technology is a novel approach for PICS-F symptom self-management. OBJECTIVE To determine the efficacy of smartphone delivery of cognitive behavioral therapy in reducing the prevalence and severity of PICS-F symptoms in family members of critically ill patients. METHODS The study had a randomized controlled longitudinal design with control and intervention groups composed of family members of patients admitted to 2 adult intensive care units. The intervention consisted of a mental health app loaded on participants' personal smartphones. The study time points were upon enrollment (within 5 days of intensive care unit admission; time 1), 30 days after enrollment (time 2), and 60 days after enrollment (time 3). Study measures included demographic data, PICS-F symptoms, mental health self-efficacy, health-related quality of life, and app use. RESULTS The study sample consisted of 60 predominantly White (72%) and female (78%) family members (30 intervention, 30 control). Anxiety and depression symptom severity decreased significantly over time in the intervention group but not in the control group. Family members logged in to the app a mean of 11.4 times (range, 1-53 times) and spent a mean of 50.16 minutes (range, 1.87-245.92 minutes) using the app. CONCLUSIONS Delivery of cognitive behavioral therapy to family members of critically ill patients via a smartphone app shows some efficacy in reducing PICS-F symptoms.

No abstract available

Background The Feeling Good App is an automated stand-alone digital mobile mental health tool currently undergoing beta testing with the goal of providing evidence-informed self-help lessons and exercises to help individuals reduce depressive symptoms without guidance from a mental health provider. Users work through intensive basic training (IBT) and ongoing training models that provide education regarding cognitive behavioral therapy principles from a smartphone. Objective The key objective of this study was to perform a nonsponsored third-party academic assessment of an industry-generated data set; this data set focused on the safety, feasibility, and accessibility of a commercial automated digital mobile mental health app that was developed to reduce feelings associated with depression. Methods The Feeling Good App development team created a waitlist cohort crossover design and measured symptoms of depression and anxiety using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and an app-specific measure of negative feelings called the 7 Dimension Emotion Slider (7-DES). The waitlist cohort crossover design divided the participants into 2 groups, where 48.6% (141/290) of the participants were given immediate access to the apps, while 51.4% (149/290) were placed on a 2-week waitlist before being given access to the app. Data collected by the Feeling Good App development team were deidentified and provided to the authors of this paper for analysis through a nonsponsored university data use agreement. All quantitative data were analyzed using SPSS Statistics (version 28.0; IBM Corp). Descriptive statistics were calculated for demographic variables. Feasibility and acceptability were descriptively assessed. All participants included in the quantitative data were given access to the Feeling Good App; this study did not include a control group. Results In terms of safety, there was no statistically significant change in suicidality from preintervention to postintervention time points (t288=0.0; P>.99), and there was a statistically significant decrease in hopelessness from preintervention to postintervention time points (F289=30.16; P<.01). In terms of acceptability, 72.2% (166/230) of the users who started the initial 2-day IBT went on to complete it, while 34.8% (80/230) of the users who started IBT completed the entirety of the apps’ 4-week protocol (150/230, 65.22% dropout rate over 4 weeks). Conclusions This study is the first reported proof-of-concept evaluation of the Feeling Good App in terms of safety, feasibility, and statistical trends within the data set. It demonstrates a feasible and novel approach to industry and academic collaboration in the process of developing a digital mental health technology translated from an existing evidence-informed treatment. The results support the prototype app as safe for a select nonclinical population. The app had acceptable levels of engagement and dropouts throughout the intervention. Those who stay engaged showed reductions in symptom severity of depression warranting further investigation of the app’s efficacy.

No abstract available

BACKGROUND Paternal perinatal mental health significantly impacts family outcomes, yet fathers are often overlooked and underserved in mental health services. This study evaluates the efficacy of a mindfulness-based cognitive behaviour therapy intervention delivered via mobile app to address paternal perinatal depression, anxiety, and stress symptoms. METHOD A randomised controlled trial was conducted with perinatal fathers experiencing moderate depression, anxiety, or stress symptoms. Participants were assigned to either the Rover app mindfulness-based CBT intervention (n = 81) or an active control app, moodmonitor (n = 75). Primary outcomes were depression (EPDS), anxiety, and stress (DASS21); secondary outcomes included social support, parenting self-efficacy, and couple relationship quality. Post-test analysis occurred at four weeks, with an additional eight-week follow-up for the intervention group. RESULTS Contrary to hypotheses, no differences were found between groups for depression, anxiety, and stress symptoms. Both groups showed significant reductions in anxiety (intervention d = -1.7, control d = -1.94) and stress (intervention d = -2.9, control d = -2.8) and improved couple relationship quality. Rover users maintained improvements at 8-week follow-up. Fathers with severe baseline depression experienced greater reductions in depression using the Rover app (b = 5.36, p < 0.01). LIMITATIONS Low adherence to the intervention and moderate attrition over the study duration. CONCLUSIONS Although the intervention was acceptable to fathers, treatment adherence was low, highlighting the need for more engaging content. App-based interventions show potential benefits for paternal mental health, but user engagement must be improved. This study contributes to the growing literature on digital interventions for fathers' mental health and emphasizes the importance of including fathers in perinatal mental health research. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12621000275864.

: Cognitive distortions—irrational thought patterns contributing to emotional distress—are central to cognitive behavioral therapy (CBT), but early detection often depends on clinical assessments, limiting opportunities for timely self-reflection. Cognify is a cross-platform mobile application designed to help users detect and understand these distortions by analyzing daily journal entries using a fine-tuned NLP model that classifies entries into 14 cognitive distortion types. The app offers real-time feedback, weekly summaries highlighting recurring patterns, and an intuitive interface that promotes ongoing engagement. This paper presents Cognify’s system architecture, AI model integration, and results from a pilot study, which demonstrated improved user awareness of cognitive patterns, high user satisfaction, and increased journaling consistency over time. The app’s modular design also allows for optional integration of privacy-preserving features, ensuring flexibility to address evolving user needs. By combining AI-driven distortion detection with an adaptable journaling experience, Cognify offers a practical and engaging tool for enhancing cognitive awareness and supporting personal growth.

Background War conditions can severely impact sleep and mental health at the population level, especially in the conflicts of such tremendous scale as in Ukraine. The aim of this research was to study whether a mobile, unguided Cognitive Behavioral Therapy-based Intervention for sleep problems, Sleep2, is feasible, acceptable, and potentially able to reduce mental health/sleep problems symptoms. Methods A single-arm, open-label, uncontrolled pre-post evaluation study was conducted with 487 registered participants: 283 started, 160 (56.55%) finished, out of which 95 completed without an ambulatory heart rate (HR) sensor and 65 with. Assessments were conducted through online questionnaires and objective measurements via HR sensors. Besides feasibility and acceptability, outcome measures included symptoms in several mental health domains alongside self-reported and objectively reported sleep parameter. Results Engagement with the Sleep2 app was high, achieving an 80.72% compliance rate, alongside high levels of feasibility and acceptance. Participants reported significant pre-post reductions in the severity of symptoms, with sleep problems decreasing by 22.60% (Cohen’s d = 0.53), insomnia by 35.08% (d = 0.69), fear of sleep by 32.43% (d = 0.25), anxiety by 27.72% (d = 0.48), depression by 28.67% (d = 0.52), PTSD by 32.41% (d = 0.51), somatic symptoms by 24.52% (d = 0.51), and perceived stress by 17.90% (d = 0.39). Objective sleep measurements showed a significant reduction in sleep onset latency only. Conclusion The ‘Sleep2Ukraine’ program demonstrated high feasibility and acceptance, with significant improvements in subjective sleep and mental health measures among participants. However, given the study’s uncontrolled design and reliance on self-selected participants, these findings should be considered preliminary. Randomized controlled trials are needed to establish efficacy. Nonetheless, the results highlight the potential of culturally adapted, scalable, mobile-based CBT-I interventions to address sleep and mental health needs in war-affected populations.

While there is no cure for tinnitus, research has shown that cognitive behavioral therapy (CBT) is effective in managing clinical sequelae. Although traditional CBT is labor-intensive and costly, new online consultations may improve accessibility. Moreover, there is promise in an engaging conversational agent, or a “chatbot,” delivering CBT in a conversation-like manner and allowing users to work through complex situations with the guidance of a virtual coach. Currently, there is little research examining a possible hybrid model using iCBT and tele consultation with a psychologist.A randomized, 2 parallel-group trial was conducted to compare the clinical effectiveness of (1) iCBT delivered through a chatbot mobile app (i.e., Tinnibot only group) (2) Tinnibot combined with telepsychology (i.e., hybrid-intervention group). A total of 30 eligible adults with tinnitus were included. After an 8-week intervention period, participants were followed up for 2 months. The primary outcome measure, the Tinnitus Functional Index (TFI), and the secondary outcome measures, Hyperacusis Questionnaire (HQ), Generalized Anxiety Disorder 7-item (GAD-7), and Patient Health Questionnaire (PHQ-9), were assessed before treatment, post-treatment, and at follow-up.The TFI decreased significantly over time in both groups, with a trend for a larger improvement in the group that received telepsychology. At post-treatment, a clinically significant improvement was observed in 42% of the Tinnibot-only group and 64% of the hybrid-intervention group. At follow-up, this was 64% for both groups. The secondary outcome measures, PHQ-9 and GAD-7 improved significantly over time, but the HQ did not.Internet-based delivery of CBT is effective in decreasing tinnitus distress, and levels of anxiety and depression, which is more relevant today than ever in the context of a global pandemic that has challenged the delivery of face-to-face intervention. The addition of telepsychology might be beneficial, but not essential for the effectiveness of treatment. There is a need for further research to determine whether there is any relationship between the characteristics of tinnitus patients and the success of the different modes of delivery of therapy.

OBJECTIVE Anorexia nervosa (AN) is often treated in the acute setting, but relapse after treatment is common. Cognitive-behavioral therapy (CBT) is useful in the post-acute period, but access to trained providers is limited. Social support is also critical during this period. This study utilized a user-centered design approach to develop and evaluate the usability of a CBT-based mobile app and social networking component for post-acute AN support. METHOD Participants (N = 19) were recently discharged from acute treatment for AN. Usability testing of the intervention was conducted over three cycles; assessments included the System Usability Scale (SUS), the Usefulness, Satisfaction, and Ease of Use Questionnaire (USE), the Mobile Application Rating Scale (MARS), a social media questionnaire, and a semi-structured interview. RESULTS Interview feedback detailed aspects of the app that participants enjoyed and those needing improvement. Feedback converged on three themes: Logistical App Feedback, boosting recovery, and Real-World App/Social Media Use. USE and MARS scores were above average and SUS scores were "good" to "excellent" across cycles. CONCLUSION This study provides evidence of feasibility and acceptability of an app and social networking feature for post-acute care of AN. The intervention has potential for offering scalable support for individuals with AN in the high-risk period following discharge from acute care.

During adolescence, individuals are particularly vulnerable to developing eating disorders (EDs). To address the dysfunctional beliefs linked to these disorders, a new mobile app has been developed. This app, called GG eating disorders-Adolescents (GGED-AD), was created based on CBT to help adolescents work on their self-dialogue related to the core beliefs of eating disorders. The objective is to present the protocol for a randomized controlled trial to explore the efficacy of GGED-AD. Methods The study will be carried out in adolescents aged 13 to 16 from an educational center in the Valencian Community. The participants will be randomized into two groups: the experimental group will use the GGED-AD app during 14 consecutive days for approximately 5 min each day; and the control group will use a neutral app (GGNEUTRAL) during the same time. Both groups will complete instruments that assess dysfunctional beliefs related to eating disorders, eating symptoms, symptoms of depression and anxiety, body satisfaction and self-esteem before and after the intervention. A follow-up will be conducted one month later. Results A decrease in the degree of ascription to dysfunctional beliefs associated with eating disorders and eating symptomatology is expected, as well as an increase in body satisfaction and the self-esteem of the participants of the experimental group. Discussion The app in this study could help tackle and prevent ED-related symptoms in adolescents. Trial registration NCT06039514.

Abstract Background In Japan, the prevalence of anxiety and depressive symptoms within the working population has risen. This has been accentuated by the economic repercussions of the COVID-19 pandemic and the social isolation resulting from remote work setups. Mobile health apps, particularly those incorporating cognitive behavioral therapy (CBT) features, have shown potential in addressing these symptoms. These self-guided CBT interventions hold promise in alleviating the heightened depressive and anxiety symptoms often observed among Japanese employees. Objective Using a randomized controlled trial, we compared the efficacy of the “INTELLECT” app against a no-treatment control group in improving depressive symptoms and CBT skills among Japanese full-time employees at postintervention and 2-month follow-up. Method A total of 123 full-time Japanese employees were randomly allocated to either the intervention group (INTELLECT), where they engaged with self-help CBT features, or to a control group receiving no treatment. Intervention participants were required to engage with these features for at least 20 minutes per week over a span of 4 weeks. Weekly self-reported assessments were collected from all participants starting from baseline and continuing until the end of the 4-week intervention period. Subsequent assessments were conducted at 1-month and 2-month follow-up intervals. Linear mixed models were used to evaluate any effects of the self-guided intervention on depressive symptoms, as measured by the Patient Health Questionnaire-4, and cognitive behavioral skills, as measured by the Cognitive Behavioral Therapy Skills Scale. The app’s feasibility, usability, and acceptability ratings were also examined using the Implementation Outcome Scales for Digital Mental Health (iOSDMH). Results The final sample (n=73) consisted of 46 (63%) participants who were female, 23 (32%) participants who were male, and 4 (6%) participants who identified as other genders, with a mean age of 40.4 (SD 10.7) years. Significant time × group interactions were found at postintervention and 2-month follow-up, with the intervention group (n=34) reporting significantly lower depressive symptoms than the control group (n=38) at postintervention (t364.7426=−2.243; P=.03; Cohen d=−0.57, 95% CI −1.07 to −0.06) and 2-month follow-up (t364.6948=−3.284; P<.001; Cohen d=−0.85, 95% CI −1.38 to −0.32). In addition, intervention participants reported significantly greater improvements in self-monitoring cognitive skills than control participants at postintervention (t120.7526=2.672; P=.01; Cohen d=0.68, 95% CI 0.17 to 1.18) but not follow-up (t121.5475=1.947; P=.05; Cohen d=0.50, 95% CI −0.01 to 1.02). Conclusions This study provides evidence that CBT features on the INTELLECT app are effective in improving depressive symptoms and self-monitoring cognitive skills.

This study aimed to evaluate the effectiveness of a mobile-based mental health application in reducing anxiety symptoms and cognitive distortions among young adult users. A randomized controlled trial was conducted with 30 participants (15 in the experimental group and 15 in the control group) recruited from Iran. The intervention consisted of a mobile application delivering 12 CBT-based sessions over six weeks. Standardized tools—the Beck Anxiety Inventory (BAI) and the Cognitive Distortions Scale (CDS)—were used to assess outcomes at pre-test, post-test, and five-month follow-up. Data were analyzed using repeated measures ANOVA and Bonferroni post-hoc tests via SPSS-27. The repeated measures ANOVA revealed significant main effects of time (F = 44.52, p < .001, η² = .614 for anxiety; F = 39.73, p < .001, η² = .595 for cognitive distortions), group (F = 35.45, p < .001 for anxiety; F = 41.68, p < .001 for cognitive distortions), and time × group interactions (F = 42.53, p < .001 for anxiety; F = 37.21, p < .001 for cognitive distortions). Bonferroni post-hoc tests confirmed that the experimental group experienced significant reductions in both anxiety and cognitive distortions from pre-test to post-test (p < .001) and from pre-test to follow-up (p < .001), with no significant relapse over time (p > .05). The findings support the effectiveness of a structured mobile-based mental health application in reducing anxiety and maladaptive thinking patterns. The sustained improvements at five-month follow-up suggest that such digital interventions can offer accessible and durable mental health support.

Background Generalized anxiety disorder (GAD) is common among university students due to academic pressure and financial uncertainty, among other challenges. Despite the need, the receipt of available psychological services is often low. Objective This study investigates the feasibility of a digital unguided cognitive behavioral therapy (CBT)–based mobile app, Cerina, and examines the likely effects of this intervention in reducing GAD symptoms compared to the waitlist control group. Methods Eligible students (n=158) with mild to moderate GAD symptoms were self-assessed through web-based questionnaires and were randomly allocated to the intervention group (n=79) or to the waitlist control group (n=79) following their informed consent. The intervention group had direct access to Cerina and followed CBT-based interactive sessions for 6 weeks. The waitlist control group participants had access to optional on-campus well-being services, and they were given access to Cerina 6 weeks after their randomization. Participants completed assessments on anxiety, depression, worry, and usability at three time points. Additionally, upon completing the intervention, they were invited to a web-based interview to understand the implementation of the intervention in more depth. Results On average, 13% (10/79) intervention group participants dropped out, 61% (36/69) completed the core clinical content (2 sessions), and 12% (7/69) completed the desired number of sessions (6 or 7 sessions). Analyses of the completers (2 or more sessions) revealed significant group differences in GAD (mean 8.4, SD 3.7; t42=–2.25; P=.03; d=–0.7) and worry symptoms (mean 42.3, SD 10.8; t42=–2.50; P=.02; d=–0.8), as well as functional impairment (mean 16.7, SD 2.44; t42=–2.12; P=.04; d=–0.6) in favor of the intervention group at posttest with medium to large effect sizes. The intention-to-treat analyses confirmed significant group differences in GAD (mean 8.47, SD 2.7; t156=–2.23; P=.03; d=–0.4), and there were marginally nonsignificant group differences in worry symptoms (mean 41.5, SD 8.40; t156=–1.94; P=.05; d=–0.3) in favor of the intervention group at posttest with medium effect sizes. These results suggest that the intervention had a meaningful impact on reducing GAD symptoms and a modest impact on reducing worry symptoms among participants. Conclusions The Cerina app showed promising results in reducing GAD symptoms among students. This result supports findings from other randomized controlled trials showing that digital CBT-based interventions are effective and feasible for a wide range of age groups and populations experiencing GAD symptoms. The low number of participants completing the recommended number of sessions suggests a usability issue. To address this, the intervention could be refined through an iterative design process informed by user feedback, and the long-term impact of specific engagement features in improving usability and retention could be assessed through extended evaluations. Trial Registration ClinicalTrials.gov NCT06146530; https://clinicaltrials.gov/study/NCT06146530 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2023-083554

No abstract available

No abstract available

This paper describes the development and test of a smartphone application to quit smoking using cognitive behavioral therapy (CBT). The tool includes recommendations from US Clinical Practice Guidelines (USCPG), drawing on the potential of smartphones and complying with the health App (mHealth) assessment standards. The mHealth created, called NoFumo+, is structured by 4 weeks treatment, implements the USCPG 5A recommendations (ask, advise, assess, assist, and arrange) and incorporates a CBT. It also includes complementary information, monitoring of the smoking behavior, social support for users, proposals for alternative activities to smoking, and innovative gamification to encourage and reward adherence. To technical development, a multidisciplinary team was formed (healthcare, research, and software engineers) that made theoretical decisions on both technical issues and the incorporation of therapeutic techniques. The validation was carried out in two phases; the first in the laboratory by a group of experts in information and communication technologies and CBTs (n = 15) and the second, a field study with smokers (n = 10). The standards for the development of mHealth recommended by the Andalusian Healthcare Quality Agency and the App quality evaluation guidelines of the Catalonian ICT Foundation for Social Health were used as assessment protocols by the experts' panel and the smokers' group, respectively. Experts' assessment results were satisfactory and some improving changes were suggested, such as to add more gamification elements. The group of smokers rated the mHealth as 100% easy to use and effective for quit smoking and understandable by the 83.3%. They also found No Fumo + quite useful to have the information available at all times. The obtained evidence after a complete two-phased validation study, with experts and potential users, shows a mHealth with high quality and easy to use. Finally, investigation project registered in ClinicalTrials.gov with reference to this trial is registered with NCT045402004.

BACKGROUND Based on evidence that mental health is more than an absence of mental disorders, there have been calls to find ways to promote flourishing at a population level, especially in young people, which requires effective and scalable interventions. Despite their potential for scalability, few mental wellbeing apps have been rigorously tested in high-powered trials, derived from models of healthy emotional functioning, or tailored to individual profiles. We aimed to test a personalised emotional competence self-help app versus a cognitive behavioural therapy (CBT) self-help app versus a self-monitoring app to promote mental wellbeing in healthy young people. METHODS This international, multicentre, parallel, open-label, randomised controlled trial within a cohort multiple randomised trial (including a parallel trial of depression prevention) was done at four university trial sites in four countries (the UK, Germany, Spain, and Belgium). Participants were recruited from schools and universities and via social media from the four respective countries. Eligible participants were aged 16-22 years with well adjusted emotional competence profiles and no current or past diagnosis of major depression. Participants were randomised (1:1:1) to usual practice plus either the emotional competence app, the CBT app or the self-monitoring app, by an independent computerised system, minimised by country, age, and self-reported gender, and followed up for 12 months post-randomisation. The primary outcome was mental wellbeing (indexed by the Warwick-Edinburgh Mental Well Being Scale [WEMWBS]) at 3-month follow-up, analysed in participants who completed the 3-month follow-up assessment. Outcome assessors were masked to group allocation. The study is registered with ClinicalTrials.gov, NCT04148508, and is closed. FINDINGS Between Oct 15, 2020, and Aug 3, 2021, 2532 participants were enrolled, and 847 were randomly assigned to the emotional competence app, 841 to the CBT app, and 844 to the self-monitoring app. Mean age was 19·2 years (SD 1·8). Of 2532 participants self-reporting gender, 1896 (74·9%) were female, 613 (24·2%) were male, 16 (0·6%) were neither, and seven (0·3%) were both. 425 participants in the emotional competence app group, 443 in the CT app group, and 447 in the self-monitoring app group completed the follow-up assessment at 3 months. There was no difference in mental wellbeing between the groups at 3 months (global p=0·47). The emotional competence app did not differ from the CBT app (mean difference in WEMWBS -0·21 [95% CI -1·08 to 0·66]) or the self-monitoring app (0·32 [-0·54 to 1·19]) and the CBT app did not differ from the self-monitoring app (0·53 [-0·33 to 1·39]). 14 of 1315 participants were admitted to or treated in hospital (or both) for mental health-related reasons, which were considered unrelated to the interventions (five participants in the emotional competence app group, eight in the CBT app group, and one in the self-monitoring app group). No deaths occurred. INTERPRETATION The emotional competence app and the CBT app provided limited benefit in promoting mental wellbeing in healthy young people. This finding might reflect the low intensity of these interventions and the difficulty improving mental wellbeing via universal digital interventions implemented in low-risk populations. FUNDING European Commission.

Background High rates of adolescent depression demand for more effective, accessible treatment options. A virtual randomized controlled trial was used to assess the feasibility and acceptability of a 5-week, self-guided, cognitive behavioral therapy (CBT)-based mobile application, Spark, compared to a psychoeducational mobile application (Active Control) as an adjunct treatment for adolescents with depression during the COVID-19 pandemic. Methods A community sample aged 13–21, with self-reported symptoms of depression, was recruited nationwide. Participants were randomly assigned to use either Spark or Active Control (NSpark = 35; NActive Control = 25). Questionnaires, including the PHQ-8 measuring depression symptoms, completed before, during, and immediately following completion of the intervention, evaluated depressive symptoms, usability, engagement, and participant safety. App engagement data were also analyzed. Results 60 eligible adolescents (female = 47) were enrolled in 2 months. 35.6% of those expressing interest were consented and all enrolled. Study retention was high (85%). Spark users rated the app as usable (System Usability Scalemean = 80.67) and engaging (User Engagement Scale-Short Formmean = 3.62). Median daily use was 29%, and 23% completed all levels. There was a significant negative relationship between behavioral activations completed and change in PHQ-8. Efficacy analyses revealed a significant main effect of time, F = 40.60, p < .001, associated with decreased PHQ-8 scores over time. There was no significant Group × Time interaction (F = 0.13, p = .72) though the numeric decrease in PHQ-8 was greater for Spark (4.69 vs. 3.56). No serious adverse events or adverse device effects were reported for Spark users. Two serious adverse events reported in the Active Control group were addressed per our safety protocol. Conclusion Recruitment, enrollment, and retention rates demonstrated study feasibility by being comparable or better than other mental health apps. Spark was highly acceptable relative to published norms. The study's novel safety protocol efficiently detected and managed adverse events. The lack of significant difference in depression symptom reduction between Spark and Active Control may be explained by study design and study design factors. Procedures established during this feasibility study will be leveraged for subsequent powered clinical trials evaluating app efficacy and safety. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04524598

Background An increase in depression, anxiety, and stress symptoms worldwide, attributed to the COVID-19 pandemic, has been reported. If not treated, it may negatively affect a person's everyday life by altering physical and social well-being and productivity and increasing expenditure on health care. Cognitive behavioral therapy (CBT)–based interventions are gaining popularity as a means to reduce stress and alleviate anxiety and depression symptoms. Moreover, CBT delivered through a mobile app has the same elements as traditional CBT training (eg, guided discovery). However, unlike conventional training, users of mobile apps are allowed to tailor their own experience at their own speed and schedule. Objective This study aims to analyze Sensa users’ retrospective data and explore the dose-duration effect to find the optimal usage time when the user showed results. Methods The study cohort comprised 381 consecutive community-based nonclinical users who started using Sensa between October 2021 and March 2022. All users included in the study took the Depression Anxiety Stress Scale-21 (DASS-21) assessment at least 2 times. Other parameters from the database containing all self-reported data were gender, number of active days, total time of use, and age. The primary outcome of the study was a change in the DASS-21 score. Statistical analyses were performed using GraphPad Prism (version 9, GraphPad Software). In addition, a logistic regression model was created to predict how the obtained independent parameters influenced the DASS-21 score. Results The main finding of our study was that the majority of participants who started using Sensa were experiencing depression, anxiety, and stress symptoms (92.13%, 80.05%, and 87.93%, respectively). There was a statistically significant decrease of the DASS-21 subdomain scores after the use of the application (anxiety: mean 7.25, SD 4.03 vs mean 6.12, SD 4.00; P=.001; depression: mean 11.05, SD 4.26 vs mean 9.01, SD 4.77; P=.001; stress: mean 11.42, SD 3.44 vs mean 9.96, SD 3.65; P<.001). Finally, the logistic regression model showed that users who were using the app for more than 24 days and had at least 12 active days during that time had 3.463 (95% CI 1.142-11.93) and 2.644 (95% CI 1.024-7.127) times higher chances to reduce their DASS-21 subdomain scores of depression and anxiety, respectively. Conclusions Using the Sensa mobile app was related to decreased depression, anxiety, and stress symptoms.

INTRODUCTION Relapse following acute treatment for anorexia nervosa (AN) is common. Evidence suggests cognitive-behavioral therapy (CBT) may be useful in the post-acute period, but few patients have access to trained providers. mHealth technologies have potential to increase access to high-quality care for AN, including in the post-acute period. The aim of this study is to estimate the preliminary feasibility and effectiveness of a CBT-based mobile intervention plus treatment as usual (TAU), offered with and without an accompanying social networking feature. METHOD In the current pilot randomized controlled trial, women with AN who have been discharged from acute treatment in the past 2 months (N = 90) will be randomly assigned to a CBT-based mobile intervention plus treatment as usual (TAU), a CBT-based mobile intervention including social networking plus TAU, or TAU alone. We will examine feasibility, acceptability, and preliminary effectiveness of the three conditions in terms of reducing eating disorder psychopathology, reducing frequency of eating disorder behaviors, achieving weight maintenance, reducing depression and suicidal ideation, and reducing clinical impairment. We will examine rehospitalization and full recovery rates in an exploratory fashion. We will also examine whether the mobile intervention and social networking feature change the proposed targets and whether changes in targets are associated with benefit, as well as conduct exploratory analyses to identify within-mobile intervention predictors and moderators of outcome. DISCUSSION Ultimately, this research may lead to increased access to evidence-based treatment for individuals with AN and prevention of the extreme negative consequences that can result from this serious disorder. PUBLIC SIGNIFICANCE Relapse after acute treatment for anorexia nervosa is common, and few patients have access to trained providers to support them following acute care. This study will pilot a coached mobile app, including a social networking component, for this population. If ultimately successful, our approach could greatly increase access to evidence-based treatment for individuals with anorexia nervosa and ultimately prevent the extreme negative consequences that can result from this serious disorder.

Relationship Obsessive Compulsive Disorder (ROCD) is a disabling form of obsessive-compulsive disorder (OCD) centering on interpersonal relationships. Previous findings suggest ROCD symptoms are particularly detrimental to romantic relationships. In this randomized controlled trial (RCT), we assessed influence a CBT-based mobile application used by both partners on resilience to ROCD symptoms, cognitions, and relationship dissatisfaction. The app consists of brief, daily exercises targeting OCD symptoms, related cognitions and attachment insecurities. Heterosexual couples (Ncouples = 103; Mage = 26.15) were randomly assigned to individually use a mobile application for 15 days (n = 49 couples) or to a control group (n = 54 couples). All participants completed questionnaires at baseline (T1), 15 days from baseline (T2), and 45 days from baseline (T3). All couples also underwent an ROCD resilience task at T2. Intention-to-treat analyses revealed that, in contrast to the control group, couples who used the app exhibited enhanced resilience in the resilience task, as well as measures of ROCD symptoms, cognitions, and relationship dissatisfaction. These observed effects persisted even at the 1-month follow-up. Concurrent use of brief mobile delivered cognitive training by both romantic partners may foster resilience in romantic couples.

BACKGROUND Attention deficit is a growing problem in adults, and early diagnosis and treatment are needed. Previous studies have shown that cognitive behavioral therapy (CBT) is effective in improving attention deficit symptoms. However, many patients are not receiving adequate treatment due to time, space, and cost constraints. Recently, in other mental illnesses, mobile-based chatbots delivering CBT and psychoeducation have been used for symptom mitigation and treatment. OBJECTIVE This study aimed to investigate the feasibility and usability of a short-term intervention, specifically a mobile-based interactive chatbot application, in alleviating attention deficit symptoms. METHODS This was a randomized, non-blind parallel-group pilot study conducted from September 2019 to March 2020. Forty-six individuals with attention deficit aged 19-60 were randomly allocated to the chatbot (n = 23) and information-only control groups (n = 23) for 4 weeks. The former group was instructed to use the chatbot application "Todaki," while the latter group was provided with a book on managing attention deficit symptoms. Participants were administered questionnaires to assess their symptoms of attention deficit, depression, and anxiety and evaluated at baseline and 4 weeks after the intervention. The post-intervention survey assessed the chatbot's usability, acceptability, and side effects. RESULTS The average age of the participants was 25.1 years (standard deviation [SD] 7.5 years), and 56.5 % (26/46) participants were female. Intention-to-treat analysis (chatbot, n = 23; control, n = 23) revealed a significant reduction of attention deficit symptoms only in the chatbot group, which is represented by group-by-time interaction in Conner's Adult ADHD Rating Scale subscales of Diagnostic and Statistical Manual-IV Attention-Deficit/Hyperactivity Disorder (ADHD) Hyperactive-Impulsive symptoms (F = 4.39; p = .04) and ADHD symptoms total (F = 6.74, p = .01). Further, the results of the paired t-test were significant only in the chatbot group. The average number of times the chatbots were used in 4 weeks was 20.32 (SD 12.89). The total average usage time was 1 h 15 min (SD 1 h 20 min). The degree of improvement in the ADHD symptoms total score was correlated with the number of times the psychoeducation program was used. According to the participants, the empathic/friendly character and unnatural flow of conversation were the best and worst features of the chatbot, respectively. CONCLUSIONS This study identified the feasibility and usability of using the mobile-based chatbot to improve attention deficit and its associated psychiatric symptoms. Using this novel intervention to conduct CBT would provide a useful digital therapeutic tool that allows easy accessibility and self-guided management for people with attention deficit, which should be verified through the large scale randomized controlled trial.

Insomnia is highly prevalent among military veterans but access to cognitive-behavioral therapy for insomnia (CBT-I) is limited. Thus, this study examined the feasibility, acceptability, and potential efficacy of Insomnia Coach, a CBT-I-based, free, self-management mobile app. Fifty U.S. veterans, who were mostly male (58%) and mean age 44.5 (range = 28-55) years with moderate insomnia symptoms were randomized to Insomnia Coach (n = 25) or a wait-list control condition (n = 25) for 6 weeks. Participants completed self-report measures and sleep diaries at baseline, posttreatment, and follow-up (12 weeks postrandomization), and app participants (n = 15) completed a qualitative interview at posttreatment. Findings suggest that Insomnia Coach is feasible to use, with three quarters of participants using the app through 6 weeks and engaging with active elements. For acceptability, perceptions of Insomnia Coach were very favorable based on both self-report and qualitative interview responses. Finally, for potential efficacy, at posttreatment, a larger proportion of Insomnia Coach (28%) than wait-list control participants (4%) achieved clinically significant improvement (p = .049) and there was a significant treatment effect on daytime sleep-related impairment (d = -0.6, p = .044). Additional treatment effects emerged at follow-up for insomnia severity (d = -1.1, p = .001), sleep onset latency (d = -0.6, p = .021), global sleep quality (d = -0.9, p = .002), and depression symptoms (d = -0.8, p = .012). These findings provide preliminary evidence that among veterans with moderate insomnia symptoms, a CBT-I-based self-management app is feasible, acceptable, and promising for improving insomnia severity and other sleep-related outcomes. Given the vast unmet need for insomnia treatment in the population, Insomnia Coach may provide an easily accessible, convenient public health intervention for individuals not receiving care.

Objective Cognitive-behavioral therapy (CBT) has growing evidence of efficacy for Attention-Deficit/Hyperactivity Disorder (ADHD) in adults. Mobile health apps are promising tools for delivering scalable CBT. In a 7-week open study of Inflow, a CBT-based mobile app, we assessed usability and feasibility to prepare for a randomized controlled trial (RCT). Method 240 adults recruited online completed baseline and usability assessments at 2 (n = 114), 4 (n = 97) and after 7 weeks (n = 95) of Inflow use. 93 participants self-reported ADHD symptoms and impairment at baseline and 7 weeks. Results Participants rated Inflow’s usability favorably, used the app a median of 3.86 times per week, and a majority of those using the app for 7 weeks self-reported decreases in ADHD symptoms and impairment. Conclusion Inflow demonstrated usability and feasibility among users. An RCT will determine whether Inflow is associated with improvement among more rigorously assessed users and beyond non-specific factors.

Background The use of video games, a hobby for many teenagers in their leisure time, has brought with it a new potential for concerns. Internet gaming disorder (IGD) is a mental condition classified as a disorder due to addictive behaviors. It may include use of video games, both online and offline. Consequences of IGD may include introversion, social anxiety, mood swings, loneliness, sleep problems, behavioral problems, depression, low self-esteem, and increased violence. In order to design an app-based intervention for adolescents, a transtheoretical model (TTM) has been used. This widely used model in the field of behavioral change is also practical for health education programs. In addition, cognitive-behavioral therapy (CBT) has been used to make people more aware of their behaviors, feelings and thoughts and how to achieve behavioral change. The present study seeks to determine the effectiveness of this app-based intervention in in the treatment of IGD among adolescents. Method In this single-blinded, randomized, controlled trial, 206 high-school adolescents aged 13 to 18 years in Qazvin city will be recruited. Eligible adolescents will be randomly assigned into intervention and control groups. Eight consecutive sessions delivered over 2 months and based on the TTM and CBT will be delivered through the `app (named HAPPYTEEN) to the intervention group. The control group will receive a sleep hygiene intervention (8 consecutive sessions for 2 months) via the app. Data collection tools include the Internet Gaming Disorder Scale, Insomnia Severity Index, Depression, Anxiety, and Stress Scales, Stages of Change Questionnaire, Decision Balance, and Self-Efficacy. The study measures will be completed at baseline, post intervention, and 1 month and 3 months after the intervention. Discussion The results of this intervention could be used as adjunct therapy for adolescents with IGD. Trial registration Clinical Trial Registration Center of Iran (IRCT) IRCT20181226042140N1 . Registered on June 9, 2020.

Background: Although transdiagnostic forms of cognitive-behavioral therapy (CBT) have been evaluated in individuals with depressive and anxiety disorders, few studies have examined their suitability for more severe disorders, such as recurrent or persistent major depressive disorder, bipolar disorder, or psychotic spectrum disorders. This study examined the acceptability and initial efficacy of an app-enhanced Unified Protocol for Adolescents [UP-A] when including youth with more severe mood disorders or psychotic spectrum disorders. Methods: We first adapted a mobile application (app), based on user-centered feedback from adolescents and their parents, to assist participants in reviewing session content, practicing skills learned in previous treatment sessions, and monitoring symptomatic progress. A total of 24 adolescents (M age = 15.2 years, SD = 1.6) with mood or psychotic spectrum disorders and their parents then participated in an open trial of the app-enhanced group treatment given over 9 weekly sessions. Results: Adolescent participants and their parents rated the group treatment and mobile app as acceptable and useful. We observed significant improvements over the 9-week treatment in adolescents’ depressive symptoms, attenuated psychotic symptoms, and global functioning. The frequency with which adolescents used the mobile app between sessions was positively related to symptomatic and functional gains. Conclusions: Initial findings suggest the acceptability and feasibility of a mobile app that enabled adolescent participants and their parents to review session content and practice treatment skills. Findings also indicated improvements in psychiatric and functional outcomes among the adolescent participants over the course of the app-enhanced treatment. Randomized clinical trials are needed to evaluate the efficacy of app-enhanced CBT in improving symptoms and functioning in adolescents with mood or psychotic spectrum disorders.

BACKGROUND Cognitive behavioral therapy (CBT) is a well-established treatment for panic disorder, but many fewer patients receive this treatment compared to medication-based therapy. Mobile app-based interactive CBT using a chatbot can increase patient access to CBT. We performed a preliminary study to determine whether short-term use of a newly developed chatbot is feasible and effective for relieving panic symptoms. METHOD Forty-one patients were randomly assigned to either a chatbot group (n = 21) or control group (n = 20) for a period of 4 weeks. The chatbot group was guided in the use of the chatbot application, while the control group was provided with a book on panic disorder. MAIN RESULTS The severity of panic disorder was significantly decreased in the chatbot group, but not in the control group. The social phobia score was significantly decreased and the control helplessness score was significantly increased in the chatbot group compared to the control group. DISCUSSION AND CONCLUSION We found that mobile app-based interactive CBT using the chatbot was feasible and effective for reducing the severity of panic symptoms. Using this novel approach to provide CBT would allow clinicians to effect positive therapeutic outcomes with easy accessibility, interactivity, and self-management for patients with panic symptoms.

Introduction Bereaved parents, who have lost a child, have an elevated risk to develop mental health problems, yet, few studies have evaluated the effect of psychosocial interventions developed for bereaved parents. Cognitive–behavioural therapy (CBT), both face to face or digitally delivered, has shown to be an effective intervention for prolonged grief symptoms. Self-help mobile apps offer various advantages and studies show improved mental health after app interventions. No app has yet been evaluated targeting prolonged grief in bereaved parents. Therefore, the aim of this planned study is to develop and examine the effectiveness of a CBT-based mobile app, called My Grief, in reducing symptoms of prolonged grief, as well as other psychological symptoms, in bereaved parents. Another aim is to assess users’ experiences and adverse events of My Grief. Methods and analysis We will conduct a two-armed randomised waitlist-controlled trial. Parents living in Sweden, who lost a child between one and ten years ago, with elevated symptoms of prolonged grief, will be recruited to participate in the trial. The content of My Grief covers four main domains (Learn; Self-monitoring; Exercises; Get support) and builds on principles of CBT and the proven-effective PTSD Coach app. Participants in the intervention group will fill out online questionnaires at baseline and at 3, 6 and 12 months follow-ups, and the waitlist-controls at baseline and at 3 months. The primary outcome will be prolonged grief symptoms at the 3 months follow-up. Secondary outcomes are post-traumatic stress and depression symptoms, quality of life and cognitive behavioural variables (ie, avoidance, rumination, negative cognitions). Ethics and dissemination Ethical approval has been received from the Swedish Ethical Review Authority (project no. 2021-00770). If the app is shown to be effective, the app will be made publicly accessible on app stores, so that it can benefit other bereaved parents. Trial registration number NCT04552717.

Background Depression and anxiety symptoms are common among university students, but many do not receive treatment. This is often because of lack of availability, reluctance to seek help, and not meeting the diagnostic criteria required to access services. Internet-based interventions, including smartphone apps, can overcome these issues. However, a large number of apps are available, each with little evidence of their effectiveness. Objective This study aims to evaluate for the first time the effectiveness of a self-guided mobile app, Feel Stress Free, for the treatment of depression and anxiety symptoms in students. Methods A web-based randomized controlled trial compared a cognitive behavioral therapy (CBT)–based mobile app Feel Stress Free with a wait-list control. University students self-identified as experiencing symptoms of anxiety or depression and were randomized to 6 weeks of intervention (n=84) or control (n=84), unblinded. The app is self-guided and incorporates behavioral relaxation activities, mood tracking and thought challenging, and minigames. Participants completed the Hospital Anxiety and Depression Scale online at baseline and every fortnight. Results At week 6, the primary end point, there was evidence that the Feel Stress Free app reduced depression symptoms (mean difference −1.56; 95% CI −2.67 to −0.44; P=.006) but only very weak evidence that it reduced anxiety symptoms (mean difference −1.36; 95% CI −2.93 to 0.21; P=.09). At week 4, there was evidence to support the effectiveness of the intervention for anxiety symptoms (mean difference −1.94; 95% CI −3.11 to −0.77; P=.001) and, though weaker, depression symptoms (mean difference −1.08; 95% CI −2.12 to −0.04; P=.04). At week 6, 83% (34/41) of participants indicated that they were using the app weekly or more frequently. Conclusions The Feel Stress Free app is a promising mobile intervention for treating symptoms of anxiety and depression in students and overcomes many of the barriers to traditional CBT. Further research is needed to establish its effectiveness at and beyond 6 weeks. Trial Registration ClinicalTrials.gov NCT03032952; https://clinicaltrials.gov/ct2/show/NCT03032952

Background As an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined. Objective The aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone–based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app. Methods During the 2-hour training program delivered on 1 day titled “Overcoming insomnia without medication: How to use the ‘MIND MORE’ mobile app for systematic self-management of insomnia” (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended. Results Due to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, P<.001) and memory complaints (40/40; ρ=.46, P=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; t8=3.74, P=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact. Conclusions This study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period.

Background Recent evidence in mobile health has demonstrated that, in some cases, apps are an effective way to improve health care delivery. Health care interventions delivered via mobile technology have demonstrated both practicality and affordability. Lately, cognitive behavioral therapy (CBT) interventions delivered over the internet have also shown a meaningful impact on patients with anxiety and depression. Objective Given the growing proliferation of smartphones and the trust in apps to support improved health behaviors and outcomes, we were interested in comparing a mobile app with Web-based methods for the delivery of CBT. This study aimed to compare the usability of a CBT mobile app called MoodTrainer with an evidence-based website called MoodGYM. Methods We used convenience sampling to recruit 30 students from a large Midwestern university and randomly assigned them to either the MoodGYM or MoodTrainer user group. The trial period ran for 2 weeks, after which the students completed a self-assessment survey based on Nielsen heuristics. Statistical analysis was performed to compare the survey results from the 2 groups. We also compared the number of modules attempted or completed and the time spent on CBT strategies. Results The results indicate that the MoodTrainer app received a higher usability score when compared with MoodGYM. Overall, 87% (13/15) of the participants felt that it was easy to navigate through the MoodTrainer app compared with 80% (12/15) of the MoodGYM participants. All MoodTrainer participants agreed that the app was easy to use and did not require any external assistance, whereas only 67% (10/15) had the same opinion for MoodGYM. Furthermore, 67% (10/15) of the MoodTrainer participants found that the navigation controls were easy to locate compared with 80% (12/15) of the MoodGYM participants. MoodTrainer users, on average, completed 2.5 modules compared with 1 module completed by MoodGYM users. Conclusions As among the first studies to directly compare the usability of a mobile app–based CBT with smartphone-specific features against a Web-based CBT, there is an opportunity for app-based CBT as, at least in our limited trial, it was more usable and engaging. The study was limited to evaluate usability only and not the clinical effectiveness of the app.

ABSTRACT The need for treatment of common mental health problems such as depression or anxiety has steadily increased. However, many people still do not receive effective and timely treatment due to the low availability, accessibility, and acceptability of traditional counseling. In this study, we developed a scalable, effective, and accessible app to address the problems that arise in traditional face-to-face counseling and to treat common psychological problems such as mild depression that people experience in their daily lives. The suggested app features semi-crowdsourced counseling, immediate intervention from multiple counselors, Cognitive Behavioral Therapy (CBT)-based short comments, and gamification. In a two-week randomized control trial (RCT), we surveyed 47 college students in their 20 s to investigate the efficacy of the suggested app and found that depression levels were reduced significantly only in the experimental group using the app. In addition, we conducted a user survey to determine which design factors affected the user experience of clients and counselors using the app. The proposed app can be used to help those suffering from mild depression in daily life, and it can also be used as a training aid to enhance counselors’ counseling skills.

Background This study proposes a digital program for the treatment of mental illness that could increase motivation and improve learning outcomes for patients. Several studies have already applied this method by using an exposure and response prevention–inspired serious game to treat patients with obsessive-compulsive disorder (OCD). Objective We hypothesized that a mobile cognitive behavior therapy (CBT) program would be as effective in treating OCD as traditional offline CBT. In addition, the treatment efficacy in response to mobile CBT for OCD might be associated with increased brain activity within the cortico-striato-thalamo-cortical (CSTC) tract. Methods The digital CBT treatment program for OCD, OCfree, consists of 6 education sessions, 10 quests, and 7 casual games. Information was gathered from 27 patients with OCD (15 offline CBT and 12 OCfree CBT). During the 6-week intervention period, changes in clinical symptoms and brain function activity were analyzed. Results There was no significant difference in the change in OCD symptoms and depressive symptoms between the two groups. However, the OCfree group showed greater improvement in anxiety symptoms compared to the offline CBT group. Both offline CBT and OCfree CBT increased the functional connectivity within the CSTC tract in all patients with OCD. However, CBT using OCfree showed greater changes in brain connectivity within the thalamus and insula, compared to offline CBT. Conclusions OCfree, an OCD treatment app program, was effective in the treatment of drug-naïve patients with OCD. The treatment effects of OCfree are associated with increased brain connectivity within the CSTC tract. Multisensory stimulation by education, quests, and games in OCfree increases the activity within the thalamus and insula in patients with OCD.

Background Mobile device–based tools to help adolescents practice skills outside of cognitive behavioral therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains. Objective This study aimed to develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, a smartphone-based app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment. Methods This 3-phase study took place from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, we conducted 2 high-fidelity testing sessions using the think-aloud approach (acceptability, learnability, usability) and 10-item System Usability Scale with 10 adolescents receiving CBT. The high-fidelity MindClimb app was evaluated by 5 app developers based on Nielsen’s usability heuristics and 5-point severity ranking scale. In phase 3, a total of 8 adolescents and 3 therapists assessed the usability of MindClimb during CBT sessions by recording the frequency of skills practice, use of MindClimb features, satisfaction with the app, and barriers and facilitators to app use during treatment. Results Feedback from phase 1 consultations indicated that the app should (1) be responsive to user needs and preferences, (2) be easy to use and navigate, (3) have relevant content to the practice of CBT for anxiety, and (4) be aesthetically appealing. Using this feedback as a guide, a fully functional app prototype for usability testing and heuristic evaluation was developed. In phase 2, think-aloud and usability data resulted in minor revisions to the app, including refinement of exposure activities. The average system usability score was 77 in both testing cycles, indicating acceptable usability. The heuristic evaluation by app developers identified only minor errors (eg, loading speed of app content, with a score of 1 on the severity ranking scale). In phase 3, adolescents considered app features for completing exposure (6.2/10) and relaxation (6.4/10) modestly helpful. Both adolescents (average score 11.3/15, SD 1.6) and therapists (average score 10.0/12, 2.6 SD) reported being satisfied with the app. Conclusions The user-centered approach to developing and testing MindClimb resulted in a mobile health app that can be used by adolescents during CBT for anxiety. Evaluation of the use of this app in a clinical practice setting demonstrated that adolescents and therapists generally felt it was helpful for CBT practice outside of therapy sessions. Implementation studies with larger youth samples are necessary to evaluate how to optimize the use of technology in clinical care and examine the impact of the app plus CBT on clinical care processes and patient outcomes.

Most state-of-the-art treatments for mental health disorders such as post-traumatic stress (PTSD) rely substantially on in-person interactions between therapist and patient. Whereas traditional treatments can suffer high rates of attrition, the integration of mobile technology potentially enhances patient engagement. Furthermore, such technology can include others that care about the patient, to provide more regular and deeper insights for clinicians into the needs and status of those being treated. In this paper, we discuss our experiences building Connectd for PTSD and anger, a mobile app for use by both patients and a designated family member or friend, and deploying it within the context of an evidence-based CBT treatment. Built upon a flexible mobile health platform, we discuss how we built the app to adaptively target a specific population, included "supporters" that ranged in relationship to the patient, complemented a manualized treatment with heterogeneous online resources, and leveraged artificial intelligence techniques to further personalize the experience. We also discuss general app usage statistics and, via a sample dyad, demonstrate the value that continuous data collection can yield.

Introduction: While self-administered mobile app-based cognitive behavioral therapy (CBT) has shown efficiency and effectiveness over the past decade, attempts to address automatic and negative beliefs have been lacking. The purpose of this study was to introduce and verify a mobile app that directly intervenes in dysfunctional thoughts. This app-based treatment includes recognizing automatic and negative thoughts of the protagonist of scenarios, writing advice directly to the main character, and sharing advice provided by other participants. Materials and Methods: Thirty-four participants diagnosed with Other Specified Depressive Disorder were recruited and randomly allocated to a CBT-based mobile-app program, the Todac Todac (TT group), or a daily mood chart app program (control group). Participants were asked to use the software for 3 weeks. Assessments for autonomic thoughts and clinical symptoms were administered at baseline and at a follow-up evaluation. Results: After completing the 3-week program, Dysfunctional Attitude Scale (DAS) scores in TT group were lower than they were in the control group. In clinical measures, both TT group and control group showed reduced Beck Depression Inventory-II (BDI-II) scores and situation-dependent trait version of State-Trait Anxiety Inventory (STAI-X2) at follow-up. However, TT group showed significantly reduced STAI-X2 scores compared to control group. For all participants, changes in DAS scores were correlated with BDI-II and STAI-X2 scores. Conclusions: Our preliminary findings provide promising evidence that scenario-based CBT mobile apps can be used to deliver feasible and efficacious cognitive therapy. Long-term research is needed to determine the impact and effectiveness of this new treatment format.

Background Sleep disturbance is a major health concern among US veterans who have served since 2001 in a combat theater in Iraq or Afghanistan. We report subjective and objective sleep results from a pilot trial assessing self-management–guided use of a mobile app (CBT-i Coach, which is based on cognitive behavioral therapy for insomnia) as an intervention for insomnia in military veterans. Objective The primary aim of this study was to evaluate changes in subjective and objective sleep outcomes from pre to postintervention. Methods Subjective outcomes included the Insomnia Severity Index, the Pittsburgh Sleep Quality Inventory, and sleep-related functional status. A wearable sleep monitor (WatchPAT) measured objective sleep outcomes, including sleep efficiency, percent rapid eye movement (REM) during sleep, sleep time, and sleep apnea. A total of 38 participants were enrolled in the study, with 18 participants being withdrawn per the protocol because of moderate or severe sleep apnea and 9 others who dropped out or withdrew. Thus, 11 participants completed the full 6-week CBT-i Coach self-management intervention (ie, completers). Results Completer results indicated significant changes in subjective sleep measures, including reduced reports of insomnia (Z=–2.68, P=.007) from pre (mean 16.63, SD 5.55) to postintervention (mean 12.82, SD 3.74), improved sleep quality (Z=–2.37, P=.02) from pre (mean 12.82, SD 4.60) to postintervention (mean 10.73, SD 3.32), and sleep-related functioning (Z=2.675, P=.007) from pre (mean 13.86, SD 3.69) to postintervention (mean 15.379, SD 2.94). Among the objective measures, unexpectedly, objective sleep time significantly decreased from pre to postintervention (χ22=7.8, P=.02). There were no significant changes in percent REM sleep or sleep efficiency. Conclusions These findings suggest that the CBT-i Coach app can improve subjective sleep and that incorporating objective sleep measures into future, larger clinical trials or clinical practice may yield important information, particularly by detecting previously undetected sleep apnea. Trial Registration ClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000

Background The low utilisation of current treatment services by people with gambling problems highlights the need to explore new modalities of delivering treatment interventions. This protocol presents the design of a pragmatic randomized control trial aimed at assessing the effectiveness and acceptability of cognitive behavioral therapy (CBT) delivered via a mobile app for people with self-reported gambling problems. Methods An innovative CBT mobile app, based on Deakin University’s G ambling L ess online program, has been adapted with end-users (Manaaki). Six intervention modules have been created. These are interwoven with visual themes to represent a journey of recovery and include attributes such as avatars, videos, and animations to support end-user engagement. An audio facility is used throughout the app to cater for different learning styles. Personalizing the app has been accomplished by using greetings in the participant’s language and their name (e.g. Kia ora Tāne) and by creating personalized feedback. A pragmatic, randomized control two-arm single-blind trial, will be conducted in New Zealand. We aim to recruit 284 individuals. Eligible participants are ≥18 years old, seeking help for their gambling, have access to a smartphone capable of downloading an app, able to understand the English language and are willing to provide follow-up information at scheduled time points. Allocation is 1:1, stratified by ethnicity, gender, and gambling symptom severity based on the Gambling Symptom Assessment Scale (G-SAS). The intervention group will receive the full mobile cognitive behavioural programme and the waitlist group will receive a simple app that counts down the time left before they have access to the full app and the links to the data collection tools. Data collection for both groups are: baseline, 4-, 8-, and 12-weeks post-randomisation. The primary outcome is a change in G-SAS scores. Secondary measures include changes in gambling urges, frequency, expenditure, and readiness to change. Indices of app engagement, utilisation and acceptability will be collected throughout the delivery of the intervention. Discussion If effective, this study will contribute to the improvement of health outcomes for people experiencing gambling problems and have great potential to reach population groups who do not readily engage with current treatment services. Ethics approval NZ Health and Disability Ethics Committee (Ref: 19/STH/204) Trial registration Australian New Zealand Clinical Trial Registry ( ANZCTRN 12619001605189 ) Registered 1 November 2019.

No abstract available

Background Coproduction with users of new digital technology, such as passive mood monitoring, is likely to improve its utility, safety, and successful implementation via improved design and consideration of how such technology fits with their daily lives. Mood-monitoring interventions are commonly used by people with bipolar disorder (BD) and have promising potential for digitization using novel technological methods. Objective This study aims to explore how a passive behavioral monitoring platform, Remote Assessment of Disease and Relapse, would meet the needs of people with BD by specifically considering purpose and function, diversity of need, personal preference, essential components and potential risks, and harms and mitigation strategies through an iterative coproduction process. Methods A total of 17 people with BD were recruited via national charities. We conducted 3 web-based focus groups as a part of an iterative coproduction process in line with responsible research and innovation principles and with consideration of clinical challenges associated with BD. Data were analyzed thematically. Results were cross-checked by someone with lived experience of BD. Results Focus groups were transcribed and analyzed using thematic analysis. Six themes were identified as follows: (1) the purpose of using the app, (2) desired features, (3) when to use the app, (4) risks of using the app, (5) sharing with family and friends, and (6) sharing with health care professionals. Conclusions People with BD who are interested in using passive technology to monitor their mood wish to do so for a wide variety of purposes, identifying several preferences and potential risks. Principally, people with BD wished to use this novel technology to aid them in self-managing their BD with greater insight and a better understanding of potential triggers. We discuss key features that may aid this functionality and purpose, including crisis plans and sharing with others. Future development of passive mood-monitoring technologies should not assume that the involvement of formal mental health services is desired.

Abstract Background People with premenstrual dysphoric disorder (PMDD) experience a range of symptoms that increase and decline as a result of the natural hormonal fluctuations of the menstrual cycle. For the diagnosis of PMDD, symptom severity needs to be recorded daily for at least two symptomatic cycles. In recent years, the rise in interest in Femtech (tools and technology developed to address women’s health issues) has resulted in a large quantity of “period-tracking apps” being developed and downloaded. However, there is not currently a menstrual and mood tracking app that has the full capabilities to accurately capture the symptoms of PMDD to aid with diagnosis. Objective This study aimed to collect feedback and insights from potential users (ie, people with lived experience of PMDD or severe premenstrual syndrome) to inform the development of a prototype app that could support prospective mood monitoring of PMDD symptoms for research, and to support diagnosis. Methods We conducted two user-centered design studies. Study 1 consisted of 4 interviews with individual participants who had taken part in our previous web-based mood tracking study for PMDD. During the interviews, participants were encouraged to identify the strengths and weaknesses of the existing web-based mood tracking system. Study 2 consisted of 2 workshops with a total of 8 participants, in which participants were asked to discuss the needs and desirable features they would like in a PMDD-specific tracking app. Interviews and workshops were recorded, and the transcripts were analyzed inductively following a thematic approach. Results A total of four themes were identified from the interviews and workshops with potential users: (1) ease of use as a key consideration for users with PMDD; (2) avoiding a reductionist approach for a broad range of symptoms; (3) recognizing the importance of correct language; and (4) integrating features for the users’ benefits. These suggestions align with the current understanding of the implications of PMDD symptoms on daily activities and with findings from previous research on encouraging long-term engagement with apps. Conclusions To meet the needs of potential users with PMDD or suspected PMDD, there needs to be a special consideration to how their symptoms impact the way they might interact with the app. In order for users to want to interact with the app daily, particularly during the days where they may not have symptoms to track, the app needs to be simple yet engaging. In addition, if the app provides insights and feedback that can benefit the well-being of the users, it is suggested that this could ensure prolonged use.

In our increasingly digitized society, prioritizing mental health support has become imperative for overall well-being. This abstract outlines the development and core features of an innovative mental health support app aimed at empowering individuals to navigate their mental health journey effectively. This cutting-edge mobile application integrates mood tracking with a plethora of mental health resources, providing users with comprehensive support tailored to their needs. Amidst a landscape where mental well-being is paramount, this app serves as a digital ally, aiding users in understanding, monitoring, and enhancing their emotional health. Leveraging artificial intelligence, the app discerns patterns in users' mood data, offering personalized suggestions and interventions. These recommendations encompass mindfulness exercises, journal prompts, and connections to friends and support networks. Beyond personalized support, the app boasts an extensive library of mental health resources, including articles, videos, and audio content spanning stress management to mindfulness techniques. Moreover, it facilitates access to local mental health professionals and support groups, ensuring users can seek assistance as needed. This app represents a pivotal step towards democratizing mental health support and empowering individuals to foster their well-being proactively.

Background Supporting mental health and wellness is of increasing interest due to a growing recognition of the prevalence and burden of mental health issues. Mood is a central aspect of mental health, and several technologies, especially mobile apps, have helped people track and understand it. However, despite formative work on and dissemination of mood-tracking apps, it is not well understood how mood-tracking apps used in real-world contexts might benefit people and what people hope to gain from them. Objective To address this gap, the purpose of this study was to understand motivations for and experiences in using mood-tracking apps from people who used them in real-world contexts. Methods We interviewed 22 participants who had used mood-tracking apps using a semistructured interview and card sorting task. The interview focused on their experiences using a mood-tracking app. We then conducted a card sorting task using screenshots of various data entry and data review features from mood-tracking apps. We used thematic analysis to identify themes around why people use mood-tracking apps, what they found useful about them, and where people felt these apps fell short. Results Users of mood-tracking apps were primarily motivated by negative life events or shifts in their own mental health that prompted them to engage in tracking and improve their situation. In general, participants felt that using a mood-tracking app facilitated self-awareness and helped them to look back on a previous emotion or mood experience to understand what was happening. Interestingly, some users reported less inclination to document their negative mood states and preferred to document their positive moods. There was a range of preferences for personalization and simplicity of tracking. Overall, users also liked features in which their previous tracked emotions and moods were visualized in figures or calendar form to understand trends. One gap in available mood-tracking apps was the lack of app-facilitated recommendations or suggestions for how to interpret their own data or improve their mood. Conclusions Although people find various features of mood-tracking apps helpful, the way people use mood-tracking apps, such as avoiding entering negative moods, tracking infrequently, or wanting support to understand or change their moods, demonstrate opportunities for improvement. Understanding why and how people are using current technologies can provide insights to guide future designs and implementations.

Background e-Mental health apps targeting depression have gained increased attention in mental health care. Daily self-assessment is an essential part of e-mental health apps. The Self-administered Psycho-TherApy-SystemS (SELFPASS) app is a self-management app to manage depressive and comorbid anxiety symptoms of patients with a depression diagnosis. A self-developed item pool with 40 depression items and 12 anxiety items is included to provide symptom-specific suggestions for interventions. However, the psychometric properties of the item pool have not yet been evaluated. Objective The aim of this study is to investigate the validity and reliability of the SELFPASS item pool. Methods A weblink with the SELFPASS item pool and validated mood assessment scales was distributed to healthy subjects and patients who had received a diagnosis of a depressive disorder within the last year. Two scores were derived from the SELFPASS item pool: SELFPASS depression (SP-D) and SELFPASS anxiety (SP-A). Reliability was examined using Cronbach α. Construct validity was assessed through Pearson correlations with the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder Scale-7 (GAD-7), and the WHO-5-Wellbeing-Scale (WHO-5). Logistic regression analysis was performed as an indicator for concurrent criterion validity of SP-D and SP-A. Factor analysis was performed to provide information about the underlying factor structure of the item pool. Item-scale correlations were calculated in order to determine item quality. Results A total of 284 participants were included, with 192 (67.6%) healthy subjects and 92 (32.4%) patients. Cronbach α was set to .94 for SP-D and α=.88 for SP-A. We found significant positive correlations between SP-D and PHQ-9 scores (r=0.87; P<.001) and between SP-A and GAD-7 scores (r=0.80; P<.001), and negative correlations between SP-D and WHO-5 scores (r=–0.80; P<.001) and between SP-A and WHO-5 scores (r=–0.69; P<.001). Increasing scores of SP-D and SP-A led to increased odds of belonging to the patient group (SP-D: odds ratio 1.03, 95% CI 1.01-1.05; P<.001; SP-A: 1.05, 1.05-1.01; P=.01). The item pool yielded 2 factors: one that consisted of mood-related items and another with somatic-related items. Conclusions The SELFPASS item pool showed good psychometric properties in terms of reliability, construct, and criterion validity. The item pool is an appropriate source for daily mood tracking in future e-mental health apps among patients with depression. Our study provides general recommendations for future developments as well as recommendations within the item pool.

No abstract available

Users can easily export personal data from devices (e.g., weather station and fitness tracker) and services (e.g., screentime tracker and commits on GitHub) they use but struggle to gain valuable insights. To tackle this problem, we present the self-tracking meta app called InsightMe, which aims to show users how data relate to their wellbeing, health, and performance. This paper focuses on mood, which is closely associated with wellbeing. With data collected by one person, we show how a person's sleep, exercise, nutrition, weather, air quality, screentime, and work correlate to the average mood the person experiences during the day. Furthermore, the app predicts the mood via multiple linear regression and a neural network, achieving an explained variance of 0.55 and 0.50, respectively. We strive for explainability and transparency by showing the users p-values of the correlations, drawing prediction intervals. In addition, we conducted a small A-B test on illustrating how the original data influence predictions. The source code and app are available online.

The increasing prevalence of mental health issues necessitates innovative solutions to promote well-being. This Journal presents the "Companion App," a user-friendly mobile application developed using Flutter and Firebase. The app aims to empower individuals by providing tools for mood tracking, therapist support, motivational resources, and brain-boosting activities. By integrating real-time data synchronization with Firebase, the Companion App ensures efficient monitoring and management of mental health. The application leverages advanced user interface design principles to enhance accessibility and engagement. The proposed solution addresses the growing mental health crisis by offering personalized features that encourage self-care and resilience. Key Words: Mental Health, Flutter, Firebase, Mood Tracking, Therapist Support, Brain-Boosting Activities

ABSTRACT Adolescent depression and suicide remain pressing global health concerns, particularly in low- and middle-income countries where access to mental health services is limited. Digital interventions have emerged as promising, accessible, and stigma-free alternatives for promoting youth mental health. This study aimed to evaluate the impact of the Nyala app on depressive symptoms and suicidal risk among adolescents. A posttest-only control group design was employed involving 40 adolescents aged 12–15 years from a private junior high school in Surakarta. Participants were divided into intervention (n = 20) and control (n = 20) groups. The intervention group used the Nyala app—which integrates psychoeducation, mood tracking, thought diary, and SOS crisis support—for two weeks. Depressive symptoms and suicidal risk were measured using the  PHQ-9 and SBQ-R. Data were analyzed using the Mann–Whitney U test. The intervention group showed significantly lower mean scores for depressive symptoms (M = 2.35, SD = 2.64) compared to the control group (M = 8.50, SD = 7.02; p < 0.001). Similarly, suicidal risk scores were lower in the intervention group (M = 4.00, SD = 0.00) than in the control group (M = 4.55, SD = 2.84; p < 0.001). The Nyala app effectively reduced depressive symptoms and suicidal risk among adolescents. These findings support the integration of digital tools like Nyala into adolescent mental health services, especially in resource-limited and stigma-sensitive settings. Keywords: Adolescent Mental Health, Depression, Suicide Risk, Digital Intervention, Mobile Health, Nyala App.

Recently, the rise in mental health issues, especially depression, has significantly increased, requiring an additional support system. The objective of this work is to develop a mental health prediction app that provides support to individuals by integrating an AI-enabled chatbot. This app uses a client-server architecture with various modules and offers personalized treatment plans and self-care strategies based on evidence-based practices. It also includes features such as tracking and monitoring of mood, stress, and sleep patterns, peer support mechanism, and the option to connect with healthcare providers. The success of the app will depend on user engagement, adoption rates, privacy assurance, and data security. This work underscores the potential of mobile health (mHealth) Android apps to support mental health and well-being, offering a promising solution for enhancing accessibility and empowering individuals to manage their well-being. For this study, multi-tune transcript featuring dataset is utilized and simulated using python. The system performance is evaluated using standard metrics including accuracy, precision, recall, ROC etc. The proposed model achieved the accuracy of 93.5% which performs better than the traditional approach and demonstrates its effectiveness as a robust solution for mental health.

Abstract - Over the past years, Mental Health has risen as a significant international concern showing the pressing essential need of accessible tech-driven self-care tools. In this paper, we describe Journal Base, a user-centered web-based journaling application that helps people improve their mental health through mood tracking and introspective writing. The app offers functions for users to log their feelings constantly, tag journal entries with emotions or activities that come to mind, and visualize mood in aggregations and patterns over time through intuitive dashboards. By exploring the themes of privacy, simplicity, and engagement, as and when we prototype Journal Base, we also integrate basic sentiment analysis and data export features for users who are interested in learning about their own emotional fluctuations. The solution proposed is light-weight, device-agnostic, and accessible to a vast array of users, ideal for those in academic settings, working force and who may not have regular access to mental health resources. Pre-testing with users we able to establish high usability and perceived usefulness. contributing to digital mental health directions with a tangible application. The platform thus contributes to the treatment of emotional stress and psychological Index Terms: Mental health, Self-assessment, Web application, Emotional support, User interface, Real-time feedback, Privacy, Awareness tool, Lightweight design, Early intervention ___________________

Background Emergency service workers (ESWs) are routinely exposed to highly stressful and potentially traumatic events leading to high rates of psychological distress. Early intervention is vital to prevent chronic impairment and/or psychiatric disorders, with digital health innovations (e.g., smartphone apps) offering a potential means of scaling such intervention while overcoming barriers to help-seeking in this population. This study aims to evaluate the efficacy of an app designed to reduce psychological distress and related outcomes in ESWs. Methods We conducted a randomised controlled trial with ESWs experiencing psychological distress (Kessler Psychological Distress Scale; K10) score >15. Participants were assigned to the intervention group, a full version of the Build Back Better app (including mindfulness, behavioural activation, trauma-focused cognitive therapy skills, activity and mood monitoring, and healthy coping strategies) or a mood/activity tracking-only version of the same app. Assessment occurred via online self-report questionnaires at baseline (T0) and at 1- and 3-month post-baseline (T1, T2) timepoints. The primary outcome was the K10 score at T2. Linear mixed model analyses were conducted based on the intention-to-treat principle. Results N = 880 ESWs were randomized to the full (n = 440) or tracking-only (n = 440) condition. There was no Time x Condition effect for K10 scores, with both conditions showing similar improvements from baseline to 1-month (all ps < .001), and 3-month follow-up (all ps < .001). Exploratory analyses of moderators (engagement; baseline severity) found generally no significant differences in K10 score decreases across different levels of engagement in the full-app condition, however, app use was markedly low overall. At higher baseline psychological distress levels, there was a significant decrease in posttraumatic stress disorder symptoms from baseline to 1-month for the full-app group but not the tracking-only group (p = .002, d = −1.43). Conclusion Despite consistent improvement across both app conditions, the minimal between group differences found here highlight the difficulties in developing effective, scalable resources for ESWs and the limitations of unguided digital programs more broadly. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12622001324707

Objective Family-focused therapy (FFT) is associated with enhanced outcomes in youth with bipolar and depressive disorders, but has not been evaluated in conjunction with mobile health tools. In symptomatic adolescents whose parents had histories of mood disorders, we examined whether the effects of telehealth-based FFT were augmented by mobile health apps that emphasized mood tracking and family coping skills. Method Participants (aged 13-19 years) had active mood symptoms and a parent with major depressive or bipolar disorder. Participants received 12 sessions in 18 weeks of telehealth FFT, with random assignment to (1) a mobile app (MyCoachConnect, MCC) that enabled mood tracking, reviews of session content, and text reminders to practice mood management and family communication skills (FFT-MCC); or (2) a mobile app that enabled mood tracking only (FFT-Track). Independent evaluators assessed youth every 9 weeks over 6 months on depressive symptoms (primary outcome), anxiety, and psychosocial functioning. Results Participants (N = 65; mean age 15.8 ± 1.6 years) significantly improved in depressive symptoms over 6 months (F1,170 = 45.02, p < .0001; ή2 = 0.21, 95% CI = 0.11-0.31), but there were no effects of treatment condition or treatment by time interactions on depression scores. When secondary outcome measures were considered, the subgroup of youth with bipolar spectrum disorders showed greater improvements in anxiety and global functioning in FFT-MCC compared with FFT-Track. Conclusion Youth in the early stages of mood disorder may benefit from FFT enhanced by mobile health apps. Collaborations between researchers and information technologists on mobile app design and user experience may lead to increases in engagement among adolescents. Clinical trial registration information Technology Enhanced Family Treatment; https://clinicaltrials.gov/; NCT03913013.

We identify features of mood-tracking apps for managing mental health that foster engagement and sustained use by adolescents—a population that expresses a preference for digital apps over face-to-face support, yet demonstrates low levels of engagement with such apps. We developed a prototype of an adolescent-focused mood-tracking app, informed by literature about existing apps’ approaches to recording patients’ symptoms, the role of data representations in long-term mental health management, and the potential benefits of peer support tools. We then conducted a survey (n = 88) to assess adolescents’ preferences for various aspects of this prototype. We found that participants prefer tools for self-reflection and self-awareness over those for gamification or social support, and that they value function over entertainment when choosing wellness apps, especially among participants who disclosed a history of managing mental health. Qualitative analysis of open-ended responses revealed that customization and self-reflection are important design themes. Our findings have implications for the design of mental health apps that cater to the specific needs and preferences of adolescent users.

Background Mental health apps have shown promise in improving mental health symptoms, including depressive symptoms. However, limited research has been aimed at understanding how specific app features and designs can optimize the therapeutic benefits and adherence to such mental health apps. Objective The primary purpose of this study is to investigate the effect of avatar customization on depressive symptoms and adherence to use a novel cognitive behavioral therapy (CBT)–based mental health app. The secondary aim is to examine whether specific app features, including journaling, mood tracking, and reminders, affect the usability of the mental health app. Methods College students were recruited from a university study recruitment pool website and via flyer advertisements throughout campus. A total of 94 participants completed a randomized controlled trial in which they were randomized to either customization or no customization version of the app. Customization involved personalizing a virtual avatar and a travel vehicle to one’s own preferences and use of one’s name throughout the app. Participants completed a 14-day trial using a novel CBT-based mental health app called AirHeart. Self-report scores for depressive symptoms, anxiety, and stress were measured at baseline and after the intervention. Postintervention survey measures also included usability and avatar identification questionnaires. Results Of the 94 enrolled participants, 83 (88%) completed the intervention and postintervention assessments. AirHeart app use significantly reduced symptoms of depression (P=.006) from baseline to the end of the 2-week intervention period for all participants, regardless of the customization condition. However, no differences in depressive symptoms (P=.17) or adherence (P=.80) were observed between the customization (39/83, 47%) and no customization (44/83, 53%) conditions. The frequency of journaling, usefulness of mood tracking, and helpfulness of reminders were not associated with changes in depressive symptoms or adherence (P>.05). Exploratory analyses showed that there were 3 moderate positive correlations between avatar identification and depressive symptoms (identification: r=−0.312, P=.02; connection: r=−0.305, P=.02; and lack of relatability: r=0.338, P=.01). Conclusions These results indicate that CBT mental health apps, such as AirHeart, have the potential to reduce depressive symptoms over a short intervention period. The randomized controlled trial results demonstrated that customization of app features, such as avatars, does not further reduce depressive symptoms over and above the CBT modules and standard app features, including journal, reminders, and mood tracking. However, further research elucidating the relationship between virtual avatar identification and mental health systems is needed as society becomes increasingly more digitized. These findings have potential implications for improving the optimization of mental health app designs. Trial Registration Open Science Framework t28gm; https://osf.io/t28gm

Although many young people evince a preference for digital mental health support over face to face, engagement with smartphone apps for mental health remains relatively low, particularly in young people not accessing professional support services. While some of this can be attributed to stigma or embarrassment, there is also a need for developers and researchers to investigate features which promote long-term usage. MoodyTunes is a music-based smartphone app that has been co-designed with young people to help them develop effective self-management strategies for mood through music listening. Four focus groups with young people (N = 24, aged 13–25) were conducted to workshop how MoodyTunes could promote help-seeking behaviours and long-term engagement with the app. Online discussions following a broad topic guide were held in groups of 4–7 in which participants explored topics including the use of social features, promoting help-seeking behaviour, gamification and mood tracking. Participants also viewed visual materials and offered ideas about visual design both verbally and on paper. A general inductive approach was taken to analysis of qualitative data. Three primary themes were identified in the data: privacy; user empowerment; and engagement vs. achievement. Participants voiced a strong desire to remain anonymous and to feel empowered to make their own decisions about accessing professional help. Sensitive use of language was noted as critical, with some participants noting that the use of more directive language could have a negative impact on their mental health and that motivational features should focus on engagement with the primary aim of the app rather than rewarding achievement. Findings highlight the benefits of a co-design approach and provide key insights into how mental health apps may be able to improve long-term user engagement with young people.

Recently, mental health applications have gained increasing attention. This is because research shows that users find mental health apps as a good alternative for self-management of mental conditions, especially in the last two years when access to physicians was limited because of the pandemic. Despite the existence of several mobile apps for mental health, most available apps are not supported by empirical and scientific evidence, or they are designed based on experimental rather than real data. This work represents our first step toward designing evidence-based AI-driven mental health applications. In this paper, we show our initial results and discussion of in-the-wild users’ interactions and engagement with a mental health app (called Moodie) for a period of two years. Specifically, we investigate the interactions and engagements of 434 users (who used the app for two years) with the mood tracking feature where the app allows users to enter their moods and the corresponding factors associated with the mood. Chi-square analysis showed a significant correlation between moods and factors (or user's activities). The results also show that Home, Work, Relaxation, and Family-related activities are the most common factors that affect moods either positively or negatively and that these factors have a different impact on moods during different times of the year.

Mobile apps indicate a positive effect on suicidal ideation and potential impact on suicide attempts. As part of the SERO suicide prevention program, Lucerne Psychiatry in collaboration with partner organizations aims to reduce suicides and suicide attempts in its service area, and to improve the self-management of suicidal individuals with a mobile app. The concept for such an app was developed in a trialog with health professionals, persons at risk and their relatives and its functions were compared to six known essential app-based strategies for suicide prevention, such as the development of a safety plan, access to support networks and tracking of mood. We present the concept and architecture for the app and discuss potential added value, which may result from the intertwining of the strategies within the app, which will be available in its first version in late 2022.

No abstract available

Mood, often studied using smartphones, influences human perception, judgment, thought, and behavior. Mood measurements on smartphones face challenges concerning the selection of a proper mood measure and its transfer, or translation, into a digital application (app) that is user-engaging. Addressing these challenges, researchers sometimes end up developing a new interaction design and modifying the classic mood measure for an app. However, the extent to which such design alterations can impact user compliance, user experience, and the accuracy of mood measurements throughout a mood self-tracking study is unclear. In this paper, we explore and investigate how the selection of a mood measure (from two widely used measures) and its design alteration (from three options of classic, chatbot, and interactive designs) impact the (i) validity, (ii) user compliance, and (iii) user experience of mood measurement apps. For this purpose, we conducted a hybrid study with a mixed design in three parts. The first part suggests that a measure's validity can be susceptible to design modifications and introduces the concept of measure's resilience which can be essential when modifying the interaction design of a measurement tool. The second part discovers that both the type and design of the chosen measure can impact user compliance. This part also portrays a more complete picture of user compliance by demonstrating the use of several variables to investigate compliance. This investigation reveals that user compliance is not just about the response duration or length of a measurement tool. The final part finds that a measure or its design does not significantly influence the user experience for a well-designed app. In this part, we also discover which user experience criteria are more impactful for improving user compliance when designing mood tracking (or mood self-tracking) tools. Our results further suggest that, for a resilient measure, the interactive design is more likely to attract users and have higher user compliance and satisfaction as a whole. Ultimately, choosing a measure or design alternative would be a three-way trade-off between the measure's validity (or accuracy), user compliance, and user satisfaction, which researchers have to prioritize. A successful mood measurement with a smartphone needs to balance both concepts of app quality and assessment quality.

ABSTRACT Mobile devices and apps offer promising opportunities for both patients and healthcare professionals, for example, to monitor and assess health status, and also to provide relevant health information. However, health information seeking within a mood-tracking app has not yet been addressed by research. To bridge this gap, the depression-related health information seeking of 6,675 users of a mood-tracking smartphone app was unobtrusively monitored. The study shows that self-monitored depressive symptoms are associated with higher depression-related information seeking within the app. Health information seeking was low in general, with differences across 12 depression-related topics (e.g., depressive thoughts, a depression diagnosis, or depression facts), but the findings are also promising as the smartphone app was shown to be a place where users can inform themselves about health topics related to the main purpose of the app. Smartphone apps would therefore seem to be a vehicle through which to provide additional health information about, for example, comorbidities, or pre- or post-interventions, even going beyond the original purposes of such mobile health (mHealth) monitoring apps.

Background Automatically tracking mental well-being could facilitate personalization of treatments for mood disorders such as depression and bipolar disorder. Smartphones present a novel and ubiquitous opportunity to track individuals’ behavior and may be useful for inferring and automatically monitoring mental well-being. Objective The aim of this study was to assess the extent to which activity and sleep tracking with a smartphone can be used for monitoring individuals’ mental well-being. Methods A cohort of 106 individuals was recruited to install an app on their smartphone that would track their well-being with daily surveys and track their behavior with activity inferences from their phone’s accelerometer data. Of the participants recruited, 53 had sufficient data to infer activity and sleep measures. For this subset of individuals, we related measures of activity and sleep to the individuals’ well-being and used these measures to predict their well-being. Results We found that smartphone-measured approximations for daily physical activity were positively correlated with both mood (P=.004) and perceived energy level (P<.001). Sleep duration was positively correlated with mood (P=.02) but not energy. Our measure for sleep disturbance was not found to be significantly related to either mood or energy, which could imply too much noise in the measurement. Models predicting the well-being measures from the activity and sleep measures were found to be significantly better than naive baselines (P<.01), despite modest overall improvements. Conclusions Measures of activity and sleep inferred from smartphone activity were strongly related to and somewhat predictive of participants’ well-being. Whereas the improvement over naive models was modest, it reaffirms the importance of considering physical activity and sleep for predicting mood and for making automatic mood monitoring a reality.

Objective: The aim of this study was to establish the utility of a bespoke mobile app for mental health service users and clinicians. Design: Qualitative design using four focus groups. Methods: Work was conducted in three stages. The first stage involved a focus group with mental health service users and eight clinicians from a mental health early intervention service to discuss the utility of a bespoke mobile app. Visual, verbal and written prompts were used to demonstrate a mobile app and to prompt discussion. The results of the focus groups were used to create a ‘visual walk through, non-interactive mock up’ mobile app which was used to aid discussion with the same service users and clinicians in stage 2 focus groups. Stage 3 involved development of a mobile app prototype based on focus group feedback. Results: Key ideas emerging from the focus groups were adopted in the design of the app prototype. These were as follows: the use of colour to convey mood; simple mood tracking using familiar trigger icons; a calendar integrated with the service user’s care plan; a help button linked to personal support; an avatar to personalise the app; and the inclusion of evidence-based information. Conclusion: Digital health technology is an extremely important asset with scope to improve people’s lives when combined with behaviour change techniques. Co-design with service users, clinicians and digital technologists is critical to product design and adoption. The use of quality standard criteria and evidence-based content in app development and evaluation is essential.

Background Cannabis is the most frequently used illicit substance in the United States resulting in high rates of cannabis use disorders. Current treatments for cannabis use are often met with high rates of lapse/relapse, tied to (1) behavioral health factors that impact cannabis use such as poor sleep, and (2) access, stigma, supply, and cost of receiving a substance use intervention. Objective This pilot study examined the feasibility, usability, and changes in cannabis use and sleep difficulties following mobile phone–delivered Cognitive Behavioral Therapy for Insomnia (CBT-I) in the context of a cannabis cessation attempt. Methods Four male veterans with DSM-5 cannabis use disorder and sleep problems were randomized to receive a 2-week intervention: CBT-I Coach mobile app (n=2) or a placebo control (mood-tracking app) (n=2). Cannabis and sleep measures were assessed pre- and post-treatment. Participants also reported use and helpfulness of each app. Changes in sleep and cannabis use were evaluated for each participant individually. Results Both participants receiving CBT-I used the app daily over 2 weeks and found the app user-friendly, helpful, and would use it in the future. In addition, they reported decreased cannabis use and improved sleep efficiency; one also reported increased sleep quality. In contrast, one participant in the control group dropped out of the study, and the other used the app minimally and reported increased sleep quality but also increased cannabis use. The mood app was rated as not helpful, and there was low likelihood of future participation. Conclusions This pilot study examined the feasibility and initial patient acceptance of mobile phone delivery of CBT-I for cannabis dependence. Positive ratings of the app and preliminary reports of reductions in cannabis use and improvements in sleep are both encouraging and support additional evaluation of this intervention.

Tracking emotion fluctuations in adolescents’ daily lives is essential for understanding mood dynamics and identifying early markers of affective disorders. This study examines the potential of text-based approaches for emotion prediction by comparing nomothetic (group-level) and idiographic (individualized) models in predicting adolescents’ daily negative affect (NA) from text features. Additionally, we evaluate different Natural Language Processing (NLP) techniques for capturing within-person emotion fluctuations. We analyzed ecological momentary assessment (EMA) text responses from 97 adolescents (ages 14–18, 77.3% female, 22.7% male, NEMA=7,680). Text features were extracted using a dictionary-based approach, topic modeling, and GPT-derived emotion ratings. Random Forest and Elastic Net Regression models predicted NA from these text features, comparing nomothetic and idiographic approaches. All key findings, interactive visualizations, and model comparisons are available via a companion web app: https://emotracknlp.streamlit.app/. Idiographic models combining text features from different NLP approaches exhibited the best performance: they performed comparably to nomothetic models in R2 but yielded lower prediction error (Root Mean Squared Error), improving within-person precision. Importantly, there were substantial between-person differences in model performance and predictive linguistic features. When selecting the best-performing model for each participant, significant correlations between predicted and observed emotion scores were found for 90.7–94.8% of participants. Our findings suggest that while nomothetic models offer initial scalability, idiographic models may provide greater predictive precision with sufficient within-person data. A flexible, personalized approach that selects the optimal model for each individual may enhance emotion monitoring, while leveraging text data to provide contextual insights that could inform appropriate interventions.

Mental health issues among teenagers are on the rise due to academic stress, social pressures, and the challenges of adolescence. Access to timely and effective mental health support is crucial, yet traditional methods of seeking help may feel intimidating or inaccessible to many young people. This articlefocuses on developing an AI-driven mental health support apptailored for teenagers, aimed at providing a safe, accessible, and personalized platform for emotional well-being. The app leverages artificial intelligence to offer empathetic, real-time support through an AI-powered Chabotthat can engage users in meaningful conversations, detect emotional cues, and provide relevant coping strategies. Key features include a mood-tracking system to help users log and identify emotional patterns, personalized self-care plans, and access to a library of mental health resources. Additionally, the app integrates crisis intervention features, enabling immediate connection to professional support or helplines when high-risk behaviors are detected. Data privacy and security are prioritized, with advanced encryption and authentication mechanisms ensuring sensitive user data remains confidential. The app's user-friendly interface and scalable design make it adaptable to diverse educational and social settings. Regular updates and user feedback loops drive continuous improvements, ensuring the app remains relevant and effective in addressing the mental health needs of teenagers. This innovative AI-driven solution aims to enhance the accessibility, efficiency, and effectiveness of mental health support for teenagers, empowering them to manage their well-being with confidence and fostering a proactive approach to mental health care.

This paper presents the Mind Readers app, designed to support individuals dealing with mental health challenges such as depression and anxiety. This app features mood tracking, meditation resources, community forums, and personalized recommendations. We explore the potential of technology-driven mental health solutions and discuss the app's intended impact on user well-being. The paper reviews existing mental health apps, identifies gaps, and proposes solutions that make mental health support more accessible, inclusive, and engaging.

This paper presents a youth-centered co-design framework that combines Gratitude Journaling (GJ) and Citizen Science (CS) to explore new pathways for adolescent mental well-being and data literacy. Through a five-day workshop involving 85 Italian high school students, participants engaged in daily self-reflection and collaborative design sessions to ideate mobile app prototypes that express both personal and collective experiences of well-being. By integrating GJ as a prompt for emotional introspection and CS as a lens for shared data exploration, the process encouraged participants to frame their reflections as contributions to a broader community. The resulting prototypes illustrate how young people can link emotional awareness with design features such as mood tracking, gratitude prompts, and community visualizations. Based on this experience, we propose a replicable co-design workshop format that leverages positive psychology, participatory design, and civic engagement. This approach may help empower teenagers to interpret their emotional experiences, engage critically with well-being data, and co-create supportive digital tools.

Anxiety disorder is a prevalent mental health condition that disrupts daily functioning, affecting approximately 301 million people worldwide in 2019. In Indonesia, one in six individuals experiences this condition, yet only 27.6% receive proper care due to stigma, lack of awareness, and limited access to services. To address these challenges, this study developed an Android-based application featuring an emotion regulation chatbot powered by the RoBERTa NLP model to detect user emotions in Indonesian text. The application integrates personalized chatbot interactions, Cognitive Behavioral Therapy (CBT)-based breathing exercises, journaling, mood tracking, and educational resources. Built on an MVVM Android architecture with a Flask backend and PostgreSQL database, the system was tested for functionality and usability. A System Usability Scale (SUS) evaluation with nine participants yielded a score of 82.5, classifying the app as “Excellent.” These results demonstrate its potential to support individuals in effectively managing anxiety.

We investigated whether a mindfulness meditation program delivered via a smartphone application could improve psychological well-being, reduce job strain, and reduce ambulatory blood pressure during the workday. Participants were 238 healthy employees from two large United Kingdom companies that were randomized to a mindfulness meditation practice app or a wait-list control condition. The app offered 45 prerecorded 10- to 20-min guided audio meditations. Participants were asked to complete one meditation per day. Psychosocial measures and blood pressure throughout one working day were measured at baseline and eight weeks later; a follow-up survey was also emailed to participants 16 weeks after the intervention start. Usage data showed that during the 8-week intervention period, participants randomized to the intervention completed an average of 17 meditation sessions (range 0–45 sessions). The intervention group reported significant improvement in well-being, distress, job strain, and perceptions of workplace social support compared to the control group. In addition, the intervention group had a marginally significant decrease in self-measured workday systolic blood pressure from pre- to post-intervention. Sustained positive effects in the intervention group were found for well-being and job strain at the 16-week follow-up assessment. This trial suggests that short guided mindfulness meditations delivered via smartphone and practiced multiple times per week can improve outcomes related to work stress and well-being, with potentially lasting effects.

Background Mindfulness-based apps can be an effective and accessible resource for mental health support. However, little is known about their use outside of research settings and what user characteristics relate to app use. Objective This study aimed to examine the characteristics of people who decided to use, not use, or stop using Headspace within the context of a large-scale public deployment, which offered the mindfulness meditation app Headspace as a free mental health resource to community members. Methods Nearly 100,000 community members received Headspace. All members (N=92,311) received an email inviting them to complete a voluntary and uncompensated survey. In total, 2725 participants completed the survey. The 20-minute survey asked about the use of Headspace, user experience, mental health problems, mental health stigma, and mental health use. Logistic regression models were used to examine relationships between predictors and nonuse, past use, or current use of Headspace. Results Participants who were still using Headspace at the time of completing the survey (2076/2725, 76.18%) were more likely to experience mental health challenges and distress and make more use of other digital mental health resources (ie, online tools and connecting with people online) than people who were not using Headspace. In addition, current users of Headspace rated the app higher on user experience compared with past users. The most common reasons for abandoning Headspace were that people were already using other strategies to support their mental health (198/570, 34.7%), no longer needed Headspace (73/570, 12.8%), or did not think Headspace was useful (46/570, 8.1%). Conclusions Results indicate that a person’s mental health challenges, a perceived need for support, and familiarity with digital resources were associated with continued use of Headspace. While the most common reason for not using Headspace was that people were already using other resources, it is important to consider the continuity of mental health support beyond these free programs for those who may not have easy access to other resources. We discuss potential implications of our findings for offering and using apps such as Headspace as a mental health resource, along with factors that influence engagement with this app.

Objectives Mindfulness meditation apps are used by millions of adults in the USA to improve mental health. However, many new app subscribers quickly abandon their use. The purpose of this study was to determine the behavioral, demographic, and socioeconomic factors associated with the abandonment of meditation apps during the COVID-19 pandemic. Method A survey was distributed to subscribers of a popular meditation app, Calm, at the start of the COVID-19 pandemic in March 2020 that assessed meditation app behavior and meditation habit strength, as well as demographic and socioeconomic information. App usage data were also collected from the start of each participant’s subscription until May 2021. A total of 3275 respondents were included in the analyses. Participants were divided into three cohorts according to their subscription start date: (1) long-term subscribers (> 1 year before pandemic start), (2) pre-pandemic subscribers (< 4 months before pandemic start), and (3) pandemic subscribers (joined during the pandemic). Results Meditating after an existing routine was associated with a lower risk of app abandonment for pre-pandemic subscribers (hazard ratio = 0.607, 95% CI: 0.422, 0.874; p  = 0.007) and for pandemic subscribers (hazard ratio = 0.434, 95% CI: 0.285, 0.66; p  < 0.001). Additionally, meditating “whenever I can” was associated with lower risk of abandonment among pandemic subscribers (hazard ratio = 0.437, 95% CI: 0.271, 0.706; p  < 0.001), and no behavioral factors were significant predictors of app abandonment among the long-term subscribers. Conclusions These results show that combining meditation with an existing daily routine was a commonly utilized strategy for promoting persistent meditation app use during the COVID-19 pandemic for many subscribers. This finding supports existing evidence that pairing new behaviors with an existing routine is an effective method for establishing new health habits. Preregistration This study is not pre-registered.

Introduction This study examined the effect of 10-minute daily meditation app usage for 30 days on adult anxiety and mental well-being during the first year of the COVID-19 pandemic. Methods Participants were randomized into intervention (10 minutes of daily usage of the Insight Timer app) or control groups. Participants completed surveys to assess anxiety and well-being pre- and post-study. Data were analyzed using t-tests, analysis of variance (ANOVA), or nonparametric equivalents. Results Pre-study results were comparable between groups. The pre- vs. post-study General Anxiety Disorder-7 (GAD-7) scores for anxiety decreased in the intervention group (n=18, median 5.5 vs. 3.0 (pre vs. post), p=0.0233, d=0.50), but not in the control group (n=28). The intervention group had a lower median GAD-7 score than the control group post-study (3.0 vs. 8.0, p=0.0223, d=0.35). Pre- vs. post-study mean 5-item World Health Organization Well-Being Index (WHO-5) scores were improved in both the control (11.6 vs. 12.9 (pre vs. post), p=0.0408, d=0.36) and intervention groups (12.0 vs. 16.3 (pre vs. post), p=0.0001, d=0.77), although it was higher in the intervention group (16.3 vs. 12.9, p=0.0056, d=0.88). Conclusion Ten minutes of daily meditation app usage for 30 days may reduce anxiety and improve well-being in adults during the COVID-19 pandemic.

Background Mindfulness training (MT) includes a variety of contemplative practices aimed at promoting intentional awareness of experience, coupled with attitudes of nonjudgment and curiosity. Following the success of 8-week, manualized group interventions, MT has been implemented in a variety of modalities, including smartphone apps that seek to replicate the success of group interventions. However, although smartphone apps are scalable and accessible to a wider swath of population, their benefits remain largely untested. Objective This study aimed to investigate a newly developed MT app called Wildflowers, which was codeveloped with the laboratory for use in mindfulness research. It was hypothesized that 3 weeks of MT through this app would improve subjective well-being, attentional control, and interoceptive integration, albeit with weaker effects than those published in the 8 week, manualized group intervention literature. Methods Undergraduate students completed 3 weeks of MT with Wildflowers (n=45) or 3 weeks of cognitive training with a game called 2048 (n=41). State training effects were assessed through pre- and postsession ratings of current mood, stress level, and heart rate. Trait training effects were assessed through pre- and postintervention questionnaires canvassing subjective well-being and behavioral task measures of attentional control and interoceptive integration. State and trait training data were analyzed in a multilevel model using emergent latent factors (acceptance, awareness, and openness) to summarize the trait questionnaire battery. Results Analyses revealed both state and trait effects specific to MT; participants engaging in MT demonstrated improved mood (r=.14) and a reduction of stress (r=−.13) immediately after each training session compared with before the training session and decreased postsession stress over 3 weeks (r=−.08). In addition, MT relative to cognitive training resulted in greater improvements in attentional control (r=−.24). Interestingly, both groups demonstrated increased subjective ratings of awareness (r=.28) and acceptance (r=.23) from pre- to postintervention, with greater changes in acceptance for the MT group trending (r=.21). Conclusions MT, using a smartphone app, may provide immediate effects on mood and stress while also providing long-term benefits for attentional control. Although further investigation is warranted, there is evidence that with continued usage, MT via a smartphone app may provide long-term benefits in changing how one relates to their inner and outer experiences. Trial Registration ClinicalTrials.gov NCT03783793; https://clinicaltrials.gov/ct2/show/NCT03783793 (Archived by WebCite at http://www.webcitation.org/75EF2ehst)

No abstract available

No abstract available

No abstract available

DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The purpose of this study was to investigate the effects of the smartphone-based meditation app Ten Percent Happier on stress, mindfulness, well-being, and resilience in pharmacy students. METHODS Pharmacy students in a professional year of study were recruited to participate. Students were instructed to meditate using the Ten Percent Happier app for at least 5 days a week for 4 weeks. Students could use the app at their discretion for weeks 5 to 12. Baseline, week 4, and week 12 responses were collected from the following instruments: the Perceived Stress Scale, the Five-Facet Mindfulness Questionnaire-15, the Flourishing Scale, and the Brief Resilience Scale. RESULTS Eighty-nine pharmacy students volunteered for the study. Sixty (67%) enrolled by completing the baseline survey. Of these, 28 (47%) completed the week 4 survey and 22 (37%) completed the week 12 survey. Participants experienced a reduction in perceived stress (P = 0.0005) and increases in resilience (P < 0.0001) and well-being (P = 0.0006). Increases in mindfulness were seen in 4 of the 5 subscales of the Five-Facet Mindfulness Questionnaire-15 (P ≤ 0.05). These benefits were noted at week 4 and maintained at week 12. CONCLUSION Pharmacy students who practiced mindful meditation through the Ten Percent Happier app for an average of 5 days a week for 4 weeks experienced reduced stress and improved mindfulness, well-being, and resilience. Benefits experienced during the intervention were maintained at the 8-week follow-up, despite app usage decreasing to an average of 4 days a week.

Background The use of smartphone apps to monitor and deliver health care guidance and interventions has received considerable attention recently, particularly with regard to behavioral disorders, stress relief, negative emotional state, and poor mood in general. Unfortunately, there is little research investigating the long-term and repeated effects of apps meant to impact mood and emotional state. Objective We aimed to investigate the effects of both immediate point-of-intervention and long-term use (ie, at least 10 engagements) of a guided meditation and mindfulness smartphone app on users’ emotional states. Data were collected from users of a mobile phone app developed by the company Stop, Breathe & Think (SBT) for achieving emotional wellness. To explore the long-term effects, we assessed changes in the users’ basal emotional state before they completed an activity (eg, a guided meditation). We also assessed the immediate effects of the app on users’ emotional states from preactivity to postactivity. Methods The SBT app collects information on the emotional state of the user before and after engagement in one or several mediation and mindfulness activities. These activities are recommended and provided by the app based on user input. We considered data on over 120,000 users of the app who collectively engaged in over 5.5 million sessions with the app during an approximate 2-year period. We focused our analysis on users who had at least 10 engagements with the app over an average of 6 months. We explored the changes in the emotional well-being of individuals with different emotional states at the time of their initial engagement with the app using mixed-effects models. In the process, we compared 2 different methods of classifying emotional states: (1) an expert-defined a priori mood classification and (2) an empirically driven cluster-based classification. Results We found that among long-term users of the app, there was an association between the length of use and a positive change in basal emotional state (4% positive mood increase on a 2-point scale every 10 sessions). We also found that individuals who were anxious or depressed tended to have a favorable long-term emotional transition (eg, from a sad emotional state to a happier emotional state) after using the app for an extended period (the odds ratio for achieving a positive emotional state was 3.2 and 6.2 for anxious and depressed individuals, respectively, compared with users with fewer sessions). Conclusions Our analyses provide evidence for an association between both immediate and long-term use of an app providing guided meditations and improvements in the emotional state.

Background The increasing demand for mental health care, a lack of mental health care providers, and unequal access to mental health care services have created a need for innovative approaches to mental health care. Digital device apps, including digital therapeutics, that provide recommendations and feedback for dealing with stress, depression, and other mental health issues can be used to adjust mood and ultimately show promise to help meet this demand. In addition, the recommendations delivered through such apps can also be tailored to an individual’s needs (ie, personalized) and thereby potentially provide greater benefits than traditional “one-size-fits-all” recommendations. Objective This study aims to characterize individual transitions from one emotional state to another during the prolonged use of a digital app designed to provide a user with guided meditations based on their initial, potentially negative, emotional state. Understanding the factors that mediate such transitions can lead to improved recommendations for specific mindfulness and meditation interventions or activities (MMAs) provided in mental health apps. Methods We analyzed data collected during the use of the Stop, Breathe & Think (SBT) mindfulness app. The SBT app prompts users to input their emotional state before and immediately after engaging with MMAs recommended by the app. Data were collected from more than 650,000 SBT users engaging in nearly 5 million MMAs. We limited the scope of our analysis to users with 10 or more MMA sessions that included at least 6 basal emotional state evaluations. Using clustering techniques, we grouped emotions recorded by individual users and then applied longitudinal mixed effect models to assess the associations between individual recommended MMAs and transitions from one group of emotions to another. Results We found that basal emotional states have a strong influence on transitions from one emotional state to another after MMA engagement. We also found that different MMAs impact these transitions, and many were effective in eliciting a healthy transition but only under certain conditions. In addition, we observed gender and age effects on these transitions. Conclusions We found that the initial emotional state of an SBT app user determines the type of SBT MMAs that will have a favorable effect on their transition from one emotional state to another. Our results have implications for the design and use of guided mental health recommendations for digital device apps.

Abstract Background App-based mindfulness meditation programs have shown mixed effects in reducing stress levels. These studies have typically relied on limited assessments of dimensions of stress and on pre-post designs to detect effects. Purpose This randomized controlled trial examined the effect of the mindfulness meditation app Headspace on reducing subjective stress, stressor appraisals, perceived coping, and perseverative cognitions. It tested stress-reducing effects in everyday life throughout an eight-week intervention period. Method Non-faculty employees (n = 138; age M = 38.19; 75.36% female; 54.5% White, 27.54% Hispanic; 51.45% with a professional degree) from a university in California’s Central Valley were randomized into either the Headspace condition (instructed to complete 10 minutes of meditation daily) or wait-list (inactive) control group. Participants completed ecological momentary assessments of stress five times a day for four consecutive days at baseline, at two and five weeks after randomization (mid-intervention), and at eight weeks post-randomization (post-intervention), resulting in 6260 observations of stress dimensions. Results Hierarchical linear models were used to test the interaction of condition by time, revealing significant effects for subjective stress, perceived coping, and perseverative cognitions. By week 2, compared to the baseline, participants in the Headspace condition reported less subjective stress and perseverative cognitions, and by week 5 reported more perceived coping. These effects persisted through week 8. No changes were observed for stressor appraisal. Participants in the control condition reported increases in subjective stress and perseverative cognitions, and decreases in coping, throughout the intervention period. Discussion Headspace was effective at reducing stress in a high-stress environment. Findings suggest the potential for relatively quick and sustained gains in stress benefits from meditation practice that may help practitioners develop their future programs.

Background Probation officers and other professionals who work with youth in the legal system often experience high chronic workplace stress, which can contribute over time to elevations in anxiety, depression, and workplace burnout. Emotion dysregulation appears to function as a common mechanism underlying these elevations, and growing evidence suggests it can be improved with mindfulness meditation. Implemented successfully, app-based meditation programs could provide professionals with real-time tools for mitigating the effects of chronic workplace stress. Objective This paper describes the protocol for a hybrid type 2 effectiveness-implementation pilot randomized controlled trial (RCT) of Bodhi AIM+, a meditation app adapted with and for professionals who work with youth in the legal system. The adaptation process and implementation plan, as well as the pilot RCT design, were guided by theoretically driven implementation science frameworks. The primary outcome of the pilot RCT is app adherence (ie, ongoing app usage per objective analytics data). Methods The RCT will be fully remote. Officers and other professionals who work with youth in the legal system (N=50) will be individually randomized to use the meditation app or an active control app matched for time and structure. All participants will be asked to follow a 30-day path of brief audio- or video-guided content and invited to use additional app features as desired. In-app analytics will capture the objective usage of each feature. An adaptive engagement design will be employed to engage nonusers of both apps, whereby analytics data indicating nonuse will trigger additional support (eg, text messages promoting engagement). Mental health outcomes and potential moderators and covariates will be self-reported at baseline, posttest, and 6 months. Participants will also complete 1-week bursts of ecological momentary assessment (EMA) at baseline and over the last week of the intervention to capture the mechanistic target (ie, emotion regulation) in real time. All participants will be invited to complete qualitative posttest interviews. Descriptive statistics will be calculated for quantitative data. Qualitative data will be analyzed using a combined deductive-inductive approach. The quantitative and qualitative data will be incorporated into a mixed methods triangulation design, allowing for the evaluation of app adherence and other implementation outcomes as well as related barriers and facilitators to implementation. Results Enrollment into the trial started in December 2024 and is currently underway. Study results are anticipated to be available in 2026. Conclusions Completion of this pilot trial will inform a future, fully powered RCT to formally evaluate the effectiveness and implementation of Bodhi AIM+. Its use of implementation science methods, coupled with digital technology, positions the present study not only to help make meditation tools available to an important workforce at scale but also to inform broader efforts at implementing and evaluating health apps within workplace settings. Trial Registration ClincialTrials.gov NCT06555172; https://clinicaltrials.gov/study/NCT06555172 International Registered Report Identifier (IRRID) DERR1-10.2196/71867

Objective This study examined the effectiveness of a short video app–guided Loving-Kindness Meditation (LKM) intervention in enhancing interpersonal mindfulness, empathy, interdisciplinary collaboration, affective states, and workplace well-being among working professionals. Methods A randomized controlled trial (RCT) was conducted with 100 full-time employees (aged 25–60), randomly assigned to an intervention group (n = 50) or a control group (n = 50). The intervention group completed daily 3-min LKM sessions for 4 weeks via a secure short video app, while the control group received no intervention. Validated psychological scales were administered at baseline and post-intervention, including the Interpersonal Mindfulness Scale (IMS), Empathy Scale (ES), Interdisciplinary Collaboration Scale (ICS), Positive and Negative Affect Schedule–Short Form (PANAS-SF), and Workplace Well-being Scale (WWS). A 2 × 2 mixed ANOVA was used to assess group × time interaction effects. Results Significant group × time interaction effects emerged for all six outcomes. Compared with controls, the intervention group showed greater increases in interpersonal mindfulness (F = 7.789, p = 0.006, η2 = 0.038), empathy (F = 9.831, p = 0.002, η2 = 0.048), collaboration (F = 4.832, p = 0.038, η2 = 0.022), and positive affect (F = 8.580, p = 0.004, η2 = 0.042), along with reduced negative affect (F = 10.169, p = 0.002, η2 = 0.049) and improved workplace well-being (F = 5.660, p = 0.018, η2 = 0.028). Conclusion These findings demonstrate that short video–based LKM is a feasible and effective digital intervention for cultivating prosocial qualities, emotional regulation, and psychological well-being in workplace settings. The study supports integrating compassion-based practices into organizational wellness initiatives to promote employee functioning and workplace harmony. Clinical trial registration https://www.chictr.org.cn/bin/project/edit?pid=285511, ChiCTR2500108223.

Background: Law enforcement is a high-stress profession, with officers frequently exposed to traumatic events, leading to mental health challenges such as communication anxiety, post-traumatic stress disorder (PTSD), anger management difficulties, and mood disorders. Mindfulness meditation (MM), particularly when guided through short video applications, has shown promise in addressing these issues by enhancing emotional regulation and resilience. Objective: This study explores the effects of an 8-week MM intervention, delivered via short video apps, on communication anxiety, PTSD, anger management, and mood disorders in police officers. Methods: A randomized controlled trial (RCT) was conducted with 110 full-time police officers aged 25–55 in China. The final 92 eligible participants were divided into two groups: the MM group (n = 46) and the control group (n = 46). The intervention consisted of daily 10–15 min video-guided MM sessions. Pre- and post-intervention measures included validated questionnaires assessing communication anxiety (PRCA-24), PTSD (PCL-5), anger management (STAXI-2), and mood disorders (DASS-21). Data analysis was performed using MANOVA. Results: The intervention group showed significant improvements in communication anxiety (F = 8.505, p = 0.004), PTSD (F = 25.831, p < 0.001), anger management (F = 4.968, p = 0.027), and mood disorders (F = 13.058, p < 0.001) compared to the control group. These improvements were supported by significant interaction effects between group and time, indicating that the MM intervention had a positive impact on these mental health variables. Conclusions: Video-guided MM delivered via short video apps significantly reduced communication anxiety, PTSD symptoms, and mood disorders, and improved anger management among police officers. These findings highlight the potential of digital MM interventions as a scalable and accessible tool for enhancing mental well-being and resilience in law enforcement personnel.

Objective This study aimed to evaluate the effectiveness of a short video app–guided mindfulness meditation intervention in improving psychological flexibility and self-compassion and reducing rumination and depressive symptoms among failed entrepreneurs. Methods A randomized controlled trial was conducted with 100 recently failed entrepreneurs (aged 25–55), who were randomly assigned to either an intervention group (n = 50) or a waitlist control group (n = 50). Over five weeks, the intervention group completed daily 3-minute guided mindfulness meditation sessions via a secure mobile app. Psychological outcomes—including rumination, self-compassion, psychological flexibility, and depression—were assessed at pre- and post-intervention using validated instruments(Self-Compassion Scale – Short Form, SCS-SF), psychological flexibility (Acceptance and Action Questionnaire–II, AAQ-II). Data were analyzed using a two-step approach: a 2 (Group: Intervention vs. Control) × 2 (Time: Pre vs. Post) mixed-design MANOVA was first conducted to assess overall multivariate effects, followed by repeated measures ANOVAs for each outcome variable. Results Significant group × time interaction effects were observed across all outcome variables. Compared to the control group, the intervention group showed significant reductions in rumination (F (1, 98) = 14.485, p <.001, η² = .073) and depression (F(1, 98) = 9.241, p = .003, η² = .045), as well as significant improvements in self-compassion (F(1, 98) = 11.764, p <.001, η² = .057) and psychological flexibility (F(1, 98) = 13.464, p <.001, η² = .064). Conclusions This study provides robust empirical support for the efficacy of mobile-guided mindfulness interventions in promoting mental health recovery among failed entrepreneurs. The findings highlight the potential of short video–based mindfulness practices as scalable, low-barrier tools to reduce cognitive vulnerability and emotional distress following entrepreneurial failure. Clinical trial registration Chinese Clinical Trial Registry (ChiCTR), identifier ChiCTR2500106524.

Abstract Background While mindfulness meditation (MM) apps have gained popularity as a tool for promoting sleep, research focusing on bedtime mindfulness practice and app usage is limited. Objective As the first step toward understanding the efficacy and mechanisms of such bedtime practice and to inform future investigations, the goal of this pilot study was to explore the feasibility of app-guided bedtime MM practice with both in-lab and at-home physiological and self-report sleep remote assessments. Methods We conducted a single-arm, prospective mixed methods pilot study that included both standard in-lab sleep studies and remote at-home assessments of individuals with insomnia disorder with self-reported difficulty falling asleep. Participants practiced MM guided by a commercially available smartphone app at bedtime for 4 weeks. Pre-post assessments included a battery of sleep-related and psychological health questionnaires, objective physiological sleep measures (polysomnography and actigraphy), and daily sleep logs. We also conducted qualitative exit interviews to further assess feasibility and acceptability. Transcripts were analyzed for dominant themes using inductive and deductive qualitative methods. Results We recruited 13 participants with chronic insomnia (symptoms ≥3 nights weekly for ≥3 months) to complete the study protocol within 8 months (retention rate 77%). We were able to collect analyzable physiological and psychometric data with overall completion rates of more than 90%. The study was deemed feasible, meeting a priori benchmarks including recruitment, retention, completion, and adherence. The 10 participants retained in the program had excellent engagement (95% completion of in-lab studies, 100% completion of questionnaires, and 91% compliance with use of the app). Our preliminary analysis of subjective measures indicated improvement in sleep quality, insomnia severity, and presleep arousal, including Pittsburgh Sleep Quality Index change of −3.7 (95% CI −6.7 to −0.7), Insomnia Severity Index change of −4.5 (95% CI −7.7 to −1.4), Pre-Sleep Arousal Scale change of −7.7 (95% CI −13.1 to −2.3), and trend toward improvement in the Ford Insomnia Response to Stress Test indicated by a change of −2.5 (95% CI −5.9 to 0.9). From qualitative data, we identified domains that inform the feasibility and acceptability of the study, including (1) barriers to sleep prior to the study, (2) benefits and skills imparted by mindfulness, and (3) feedback on app use. Benefits and skills imparted by mindfulness included decreased catastrophizing, acceptance and nonreactivity, body awareness and relaxation, self-kindness, awareness of sleep hygiene and bedtime routine, earlier defusing of stress, increased focus and presence, and calm throughout the day. Conclusions Bedtime app-guided MM as an intervention in patients with insomnia and the hybrid study design with in-lab and at-home assessments are feasible and acceptable. This study informs the design of future clinical and mechanistic research examining app-guided MM to impact insomnia severity and presleep arousal.

Abstract Background Undergraduate students frequently experience negative emotional states and sleep quality, which is believed to have worsened following the COVID-19 pandemic. Objective This study piloted the use of a popular mobile mindfulness app (Calm) as a potential intervention to improve state depression, anxiety, stress, and sleep quality in undergraduate students attending a Canadian university, following the COVID-19 pandemic. Methods Undergraduate students were randomly assigned to a control or treatment group and completed a series of 3 questionnaires to evaluate baseline state emotional health (Depression Anxiety Stress Scale 42-Item Version [DASS-42], Perceived Stress Scale 10-Item Version [PSS-10], and Pittsburgh Sleep Quality Index). Treatment group participants were instructed to engage with the fully-automated Calm app’s sleep section for 30 days: 20 minutes daily, 5 days a week, along with an additional 30 minutes of interaction with other app sections each week, resulting in a goal of 130 minutes per week. The control participants were instructed to continue with everyday life and refrain from the use of mindfulness-based apps for 30 days. Following the 30-day treatment period, all participants repeated the 3 questionnaires. The impact of the treatment on all outcomes was examined using linear mixed model analyses. Independent samples t tests were used to determine if psychosocial health or sleep scores differed between baseline and follow-up and if differences in such scores were present between the groups. Results A total of 80 students met the inclusion criteria and were randomly assigned to the control (n=40) or treatment (n=40) group. One control participant was lost to follow-up and 3 treatment participants discontinued engaging with the Calm app. Both control (n=39) and treatment (n=37) groups began with similar demographic, emotional state, and sleep characteristics. Treatment participants engaged with the Calm app’s sleep section for an average of 234 minutes per week; however, 54% (20/37) met the minimum prescribed interaction time across all 4 weeks. Following the 30-day treatment period, compared to the control group, the treatment group’s state anxiety (mean 14, SD 7.4 vs mean 12, SD 7.8; P=.002), state stress (DASS-42: mean 20, SD 8.8 vs mean 15, SD 8.5; P<.001; PSS-10: mean 22, SD 5.9 vs mean 19, SD 5.9; P=.02), and sleep quality (mean 7.7, SD 2.7 vs mean 6.4, SD 3.5; P<.001) improved. Posttreatment, state stress and perceived stress severity was lower in the treatment versus control group (DASS-42: P=.02; PSS-10: P=.03, respectively). Conclusions These pilot findings indicate that a mindfulness app may be an effective tool for reducing state anxiety and stress, as well as enhancing sleep quality among undergraduate university students. A larger, randomized controlled trial should confirm these findings.

No abstract available

No abstract available

Objective The study investigated the effects of a short video app guided loving-kindness meditation (LKM) on college students’ mindfulness, self-compassion, positive psychological capital, and suicide ideation. The purpose of the study is to investigate the intervention effect of LKM training on suicidal ideation among college students with the help of the short video application and to provide an empirical basis for the exploration of early suicide intervention strategies for college students. Methods We recruited 80 college students from a university in China. The final 74 eligible participants were divided into two groups: app use group ( n  = 37) and the control group ( n  = 37). The app group accepted an 8-week app use interference, while the control group underwent no interference. We measured four major variable factors (mindfulness, self-compassion, positive psychological capital, and suicide ideation) before and after the app use intervention. Results In the app group, self-compassion and positive psychological capital were significantly higher, and suicide ideation was significantly lower than the control group. In the control group, there were no noticeable differences in any of the four variables between the pre-test and post-test. Conclusions Our findings demonstrate that the short video app guided LKM may help to improve self-compassion, and positive psychological capital, and reduce suicide ideation. The finding of the short video app-guided LKM’s effect extends our understanding of the integrative effects of positive psychology and digital media on the reduction of suicide ideation.

Background Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility. Objective The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy. Methods A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participant’s levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring. Results Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P<.0001). Hierarchical linear modeling revealed a statistically significant reduction in the physiological data reflective of stress in 1 of 6 heart rate variability metrics, the low-frequency power band, which decreased by 13% (P=.006). A total of 65% of study participants (n=13) reported their sleep improved during the trial, and 95% (n=19) stated that learning mindfulness helped with other aspects of their lives. Participant retention was 100%, with 65% of participants (n=13) completing about two-thirds of the intervention, and 50% of participants (n=10) completing ≥95%. Conclusions This study found evidence to support the Headspace app as an effective intervention to aid in stress and anxiety reduction during pregnancy.

Background College students experience high levels of stress. Mindfulness meditation delivered via a mobile app may be an appealing, efficacious way to reduce stress in college students. Objective We aimed to test the initial efficacy and sustained effects of an 8-week mindfulness meditation mobile app—Calm—compared to a wait-list control on stress, mindfulness, and self-compassion in college students with elevated stress. We also explored the intervention’s effect on health behaviors (ie, sleep disturbance, alcohol consumption [binge drinking], physical activity, and healthy eating [fruit and vegetable consumption]) and the feasibility and acceptability of the app. Methods This study was a randomized, wait-list, control trial with assessments at baseline, postintervention (8 weeks), and at follow-up (12 weeks). Participants were eligible if they were current full-time undergraduate students and (1) at least 18 years of age, (2) scored ≥14 points on the Perceived Stress Scale, (3) owned a smartphone, (4) were willing to download the Calm app, (5) were willing to be randomized, and (7) were able to read and understand English. Participants were asked to meditate using Calm at least 10 minutes per day. A P value ≤.05 was considered statistically significant. Results A total of 88 participants were included in the analysis. The mean age (SD) was 20.41 (2.31) years for the intervention group and 21.85 (6.3) years for the control group. There were significant differences in all outcomes (stress, mindfulness, and self-compassion) between the intervention and control groups after adjustment for covariates postintervention (all P<.04). These effects persisted at follow-up (all P<.03), except for the nonreacting subscale of mindfulness (P=.08). There was a significant interaction between group and time factors in perceived stress (P=.002), mindfulness (P<.001), and self-compassion (P<.001). Bonferroni posthoc tests showed significant within-group mean differences for perceived stress in the intervention group (P<.001), while there were no significant within-group mean differences in the control group (all P>.19). Similar results were found for mindfulness and self-compassion. Effect sizes ranged from moderate (0.59) to large (1.24) across all outcomes. A significant group×time interaction in models of sleep disturbance was found, but no significant effects were found for other health behaviors. The majority of students in the intervention group reported that Calm was helpful to reduce stress and stated they would use Calm in the future. The majority were satisfied using Calm and likely to recommend it to other college students. The intervention group participated in meditation for an average of 38 minutes/week during the intervention and 20 minutes/week during follow-up. Conclusions Calm is an effective modality to deliver mindfulness meditation in order to reduce stress and improve mindfulness and self-compassion in stressed college students. Our findings provide important information that can be applied to the design of future studies or mental health resources in university programs. Trial Registration ClinicalTrials.gov NCT03891810; https://clinicaltrials.gov/ct2/show/NCT03891810

(1) Background: 1–2% of children and adolescents are affected by Obsessive-Compulsive Disorder (OCD). The rigid, repetitive features of OCD and an assumed disability to inhibit recent mental representations are assumed to have led to a paradoxical advantage in that the Backward Inhibition (BI) effect was recently found to be lower in adolescents with OCD as compared to healthy controls. It was hypothesized that app-based mindfulness meditation training could reduce the disability to inhibit recent mental representations and thus increase the BI-effect by adapting cognitive flexibility and inhibition abilities according to healthy controls. (2) Methods: 58 adolescents (10–19 years) with OCD were included in the final sample of this interviewer-blind, randomized controlled study. Participants were allocated to an intervention group (app-based mindfulness meditation training) or an (active) control group (app-based audiobook) for eight weeks. Symptom (CY-BOCS), behavioral (reaction times and mean accuracy), and neurophysiological changes (in EEG) of the BI-effect were analyzed in a pre-post design. (3) Results: The intervention and the control group showed an intervention effect (Reliable Change Index: 67%) with a significant symptom reduction. Contrary to the hypothesis, the BI-effect did not differ between pre vs. post app-based mindfulness meditation training. In addition, as expected the audiobook application showed no effects. Thus, we observed no intervention-specific differences with respect to behavioral (reaction times and mean accuracy) or with respect to neurophysiological (perceptual [P1], attentional [N1], conflict monitoring [N2] or updating and response selection [P3]) processes. However, in an exploratory approach, we revealed that the BI-effect decreased in participants who did not benefit from using an app, regardless of group. (4) Conclusions: Both listening to an app-based mindfulness meditation training and to an audiobook reduce symptom severity in adolescent OCD as measured by the CY-BOCS; however, they have no specific effect on BI. The extent of the baseline BI-effect might be considered as an intra-individual component to predict the benefit of both mindfulness meditation training and listening to an audiobook.

Objectives Previous research indicates that mindfulness meditation reduces anxiety and depression and enhances well-being. We examined the impact of app-delivered mindfulness meditation on resting state functional MRI (fMRI) connectivity among physician assistant (PA) students and surgery residents. Methods PA students and residents were randomized to receive a popular meditation app or to wait-list control group. Before and after the 8-week meditation period, we acquired fMRI scans of participants’ resting state, and participants completed a self-report measure of mindfulness. We used a 2 × 2, within- and between-group factorial design and leveraged a whole-brain connectome approach to examine changes in within- and between-network connectivity across the entire brain, and to examine whether changes in connectivity were associated with app use or to changes in self-reported mindfulness. Results Meditation practitioners exhibited significantly stronger connectivity between the frontoparietal network and the left and right nucleus accumbens and between the default mode (DMN) and salience networks, among other regions. Mindfulness practice time was correlated with increased connectivity between the lateral parietal cortex and the supramarginal gyrus, which were also positively correlated with increased scores on the “Describing” subscale of the Five Facet Mindfulness Questionnaire between baseline and post-meditation. These findings are consistent with previous research indicating that mindfulness-based interventions alter functional connectivity within the DMN and between the DMN and other networks both during meditation and at rest, as well as increased connectivity in systems important for emotion and reward. Conclusions Recent commentaries call for healthcare provider and trainee wellness programs that are sustainable and preventive in nature rather than reactive; these data indicate that even brief sessions of app-delivered mindfulness practice are associated with functional connectivity changes in a dose-dependent manner.

Abstract Objective and Design: In a pragmatic, randomised, waitlist-controlled trial we tracked 250 first-year university students who were randomly assigned to 3 months of a mindfulness meditation app (Headspace) to use at their discretion in either semester 1 (intervention, n = 124) or semester 2 (waitlist, n = 126). Main Outcome Measures: Students reported their distress, college adjustment, resilience, self-efficacy, and mindfulness, at 3 timepoints: the beginning of semester 1, the beginning of semester 2, and the end of the academic year. With participants’ permission, the university provided academic achievement data and Headspace provided app use data. Results: Evidence for improvements in distress at the beginning of semester 2 was weak (intervention vs. waitlist) and app use was low (M = 7.91, SD = 15.16 sessions). Nevertheless, intervention participants who used the app more frequently reported improvements in psychological distress (−5 points, R2 change = .12) and college adjustment (+10 points, R2 change = .09) when compared to non-users. App initiation and persistence beyond the first week was higher when the app was provided in semester 1 than semester 2 (66.1% vs. 44.4%; 46.0% vs. 32.5%). Conclusion: Headspace use was associated with small improvements in distress and college adjustment in first-year university students. Intervening at the beginning of the academic year may encourage uptake.

The objective of this randomized controlled trial was to test whether a commercially available, mindfulness meditation mobile app, (i.e., Calm app), was effective in reducing fatigue (primary outcome), pre-sleep arousal, and daytime sleepiness (secondary outcomes) in adults with sleep disturbance (Insomnia Severity Index Score >10) as compared to a wait-list control group. Associations between the use of the Calm app (i.e., adherence to the intervention) and changes in sleep quality was also explored in the intervention group only. Adults with sleep disturbance were recruited (N = 640). Eligible and consenting participants (N = 263) were randomly assigned to the intervention (n = 124) or a wait-list control (n = 139) group. Intervention participants were asked to meditate using the Calm app ≥10 minutes/day for eight weeks. Fatigue, daytime sleepiness, and pre-sleep arousal were assessed at baseline, mid- (4-weeks) and post-intervention (8-weeks) in both groups, whereas sleep quality was evaluated only in the intervention group. Findings from intent-to-treat analyses suggest the use of the Calm app for eight weeks significantly decreased daytime fatigue (p = .018) as well as daytime sleepiness (p = .003) and cognitive (p = .005) and somatic (p < .001) pre-sleep arousal as compared to the wait-list control group. Within the intervention group, use of the Calm app was associated with improvements in sleep quality (p < .001). This randomized controlled trial demonstrates that the Calm app can be used to treat fatigue, daytime sleepiness, and pre-sleep arousal in adults with sleep disturbance. Given that the Calm app is affordable and widely accessible, these data have implications for community level dissemination of a mobile app to improve sleep-related symptoms associated with sleep disturbance. Trial registration: ClinicalTrials.gov NCT04045275.

OBJECTIVE The objective of this study was to 1) determine the effects of a meditation app on depression and anxiety in adults with sleep disturbance, and 2) explore the potential mediating effects of fatigue, daytime sleepiness, and pre-sleep arousal on the relationship between use of the meditation app and changes in depression and anxiety. METHODS Participants were 239 adults with elevated insomnia symptoms (i.e., scores ≥ 10 on the Insomnia Severity Index) and limited or no previous experience with meditation. Depression, anxiety, fatigue, daytime sleepiness, and pre-sleep arousal were assessed at baseline, four weeks, and eight weeks. Repeated-measures ANCOVAs assessed intervention effects on depression and anxiety. Mediation models were estimated using the PROCESS macro. RESULTS Participants in the meditation group had more improvement in depression and anxiety symptoms during the intervention period than did those in the control group. Changes in somatic and cognitive pre-sleep arousal at mid-intervention fully mediated effects on depression and partially mediated effects on anxiety. There were no significant indirect effects of fatigue and daytime-sleepiness on changes in mental health. CONCLUSIONS A meditation app may improve depression and anxiety in adults with sleep disturbance, with effects being driven by improvements in pre-sleep arousal. Future studies should consider targeting pre-sleep arousal to improve mental health in this population.

Abstract We investigated whether a brief mindfulness meditation programme delivered via a smartphone app improves perceived stress, self‐regulation and life satisfaction in part‐time working university students. Mindfulness and cognitive reappraisal were analysed as potential mediators. A total of 64 university students working at least 20 h per week during the semester were randomised to either a mindfulness‐based mobile intervention or a wait‐list control condition. Participants in the intervention group were asked to complete one training session of 10–15 min per day using the app. Psychological measures were assessed via a self‐report questionnaire at baseline and after 8 weeks. The online mindfulness programme was found to significantly decrease perceived stress (η p 2  = .180, a large effect). It also increased self‐regulation (η p 2  = .195, a large effect), mindfulness (η p 2  = .174; a large effect) and cognitive reappraisal (η p 2  = .136, a medium effect). Increments in life satisfaction were not significant. Changes in self‐regulation were mediated by increased mindfulness. Overall, the mobile application was effective in improving mental well‐being and coping abilities in a non‐clinical sample, encouraging further development of digital health treatments.

Use of mindfulness mobile apps has become popular, however, there is little information about subscribers’ perceptions of app content and its impact on sleep and mental health. The purpose of this study was to survey subscribers to Calm, a popular mindfulness meditation app, to explore perceived improvements in sleep and mental health, evaluate what components of the app were associated with improvements in sleep and mental health, and determine whether improvements differed based on sleep quality. Calm subscribers who had used a sleep-related component in the last 90 days completed a Web-based investigator-developed survey and the Pittsburgh Sleep Quality Index. The survey included questions about using Calm for sleep, sleep disturbances, mental health diagnoses (i.e., anxiety, depression, PTSD) and perceived impacts of the app. Participants reported on the extent to which they felt that using Calm had improved their sleep and mental health. Most participants reported sleep disturbance, and almost half reported a mental health diagnosis. The majority of participants reported that using Calm helped them fall asleep, stay asleep, and get restful sleep. All sleep components were associated with perceived improvements in sleep disturbance. Severity of sleep disturbance moderated relationships between using Calm components and reporting improved sleep. Among subscribers with mental health diagnoses, most reported that Calm helped improve symptoms. Perceived improvement in anxiety and depression was associated with using Calm’s meditation components but not Sleep Stories or music/soundscapes. Severity of sleep disturbance did not moderate relationships between using Calm components and reporting mental health improvements. Given the accessibility of app-based meditation, research is needed to evaluate the efficacy of meditation apps to improve sleep disturbance. While some sleep content may be helpful for sleep, more research is needed to test what specific content affects mental health.

A majority of the 34 million people who currently smoke cigarettes report wanting to quit smoking yet most attempts to quit end in relapse. A mindfulness based intervention (MBI) is an intervention package used to reinforce an individual's practice of mindfulness meditation in daily life. MBIs delivered by phone app offer daily prompts to guide bouts of mindfulness meditation, that is, sustained attention to moment-by-moment experience without behavior reactivity. Daily bouts of mindfulness meditation offer individuals a replacement behavior for smoking during a quit attempt, and MBI app instruction aims to increase an individual's skill in non-reactivity when they experience cravings. Our study objective is to test the effect of an app-based MBI on abstinence during a scheduled quit attempt among people who currently smoke and who are willing to make a voluntary quit attempt on a selected near-term date. Our delivery of a smartphone app-based MBI occurs daily for the two weeks preceding a planned quit date. Study participants are randomized to a either a app-based MBI or an app-based psychoeducation control group and asked to self-administer their intervention two times a day in 10-min segments for 14 sequential days for a total of 280 min. This preparatory period capitalizes on time to help participants orient toward a near-term goal to quit smoking, practice mindfulness meditation, and increase the skill of non-reactivity during states of craving to smoke. We recruit people who smoke cigarettes from all 58 counties in California. We test the hypothesis that an app-based MBI will outperform a time-matched psychoeducation control on increasing smoking abstinence. Findings contribute knowledge to the addictions treatment field about whether MBIs delivered by app can increase smoking cessation in a geographically diverse sample.

Background A growing number of randomized controlled trials (RCTs) suggest psychological benefits associated with meditation training delivered via mobile health. However, research in this area has primarily focused on mindfulness, only one of many meditative techniques. Objective This study aims to evaluate the efficacy of 2 versions of a self-guided, smartphone-based meditation app—the Healthy Minds Program (HMP)—which includes training in mindfulness (Awareness), along with practices designed to cultivate positive relationships (Connection) or insight into the nature of the self (Insight). Methods A three-arm, fully remote RCT compared 8 weeks of one of 2 HMP conditions (Awareness+Connection and Awareness+Insight) with a waitlist control. Adults (≥18 years) without extensive previous meditation experience were eligible. The primary outcome was psychological distress (depression, anxiety, and stress). Secondary outcomes were social connection, empathy, compassion, self-reflection, insight, rumination, defusion, and mindfulness. Measures were completed at pretest, midtreatment, and posttest between October 2019 and April 2020. Longitudinal data were analyzed using intention-to-treat principles with maximum likelihood. Results A total of 343 participants were randomized and 186 (54.2%) completed at least one posttest assessment. The majority (166/228, 72.8%) of those assigned to HMP conditions downloaded the app. The 2 HMP conditions did not differ from one another in terms of changes in any outcome. Relative to the waitlist control, the HMP conditions showed larger improvements in distress, social connectedness, mindfulness, and measures theoretically linked to insight training (d=–0.28 to 0.41; Ps≤.02), despite modest exposure to connection- and insight-related practice. The results were robust to some assumptions about nonrandom patterns of missing data. Improvements in distress were associated with days of use. Candidate mediators (social connection, insight, rumination, defusion, and mindfulness) and moderators (baseline rumination, defusion, and empathy) of changes in distress were identified. Conclusions This study provides initial evidence of efficacy for the HMP app in reducing distress and improving outcomes related to well-being, including social connectedness. Future studies should attempt to increase study retention and user engagement. Trial Registration ClinicalTrials.gov NCT04139005; https://clinicaltrials.gov/ct2/show/NCT04139005

No abstract available

Background People of color (POC) who experience race-related stress are at risk of developing mental health problems, including high levels of stress, anxiety, and depression. Mindfulness meditation may be especially well suited to help POC cope, given its emphasis on gaining awareness and acceptance of emotions associated with discriminatory treatment. However, mindfulness meditation rarely reaches POC, and digital approaches could reduce this treatment gap by addressing traditional barriers to care. Objective This study will test the effectiveness of a self-directed app-based mindfulness meditation program among POC who experience elevated levels of race-related stress. Implementation outcomes such as treatment acceptability, adherence, and satisfaction will be examined. Methods Participants (n=80) will be recruited online by posting recruitment materials on social media and sending emails to relevant groups. In-person recruitment will consist of posting flyers in communities with significant POC representation. Eligible participants will be block randomized to either the intervention group (n=40) that will complete a self-directed 4-week mindfulness meditation program or a wait-list control condition (n=40) that will receive access to the app after study completion. All participants will complete measures at baseline, midtreatment, and posttreatment. Primary outcomes include changes in stress, anxiety, and depression, and secondary outcomes constitute changes in mindfulness, self-compassion, rumination, emotion suppression, and experiential avoidance. Exploratory analyses will examine whether changes in the secondary outcomes mediate changes in primary outcomes. Finally, treatment acceptability, adherence, and satisfaction will be examined descriptively. Results Recruitment began in October 2021. Data will be analyzed using multilevel modeling, a statistical methodology that accounts for the dependence among repeated observations. Considering attrition issues in self-directed digital interventions and their potential effects on statistical significance and treatment effect sizes, we will examine data using both intention-to-treat and per-protocol analyses. Conclusions To our knowledge, this will be the first study to provide data on the effectiveness of a self-directed app-based mindfulness meditation program for POC recruited based on elevated race-related stress, a high-risk population. Similarly, meaningful clinical targets for POC affected by stressors related to race will be examined. Findings will provide important information regarding whether this type of intervention is an acceptable treatment among these marginalized groups. Trial Registration ClinicalTrials.gov NCT05027113; https://clinicaltrials.gov/ct2/show/NCT05027113 International Registered Report Identifier (IRRID) DERR1-10.2196/35196

BACKGROUND AND OBJECTIVES Few studies have focused on the utility of mindfulness-meditation for well-being in older adults. The present study investigated the feasibility, acceptability, and preliminary efficacy of an app-based mindfulness-meditation program among older adults. RESEARCH DESIGN AND METHODS A community-based sample of 46 participants aged between 63 and 81 (M = 70.85, SD = 4.70) engaged with a 30-day app-based mindfulness-meditation program for 10-minutes daily on their smartphones. Each meditation session comprised focusing on the breath, mentally scanning the body, monitoring the mind's activity, and cultivating a nonjudgmental orientation toward experiences. Participants completed questionnaires at baseline, day 10, and day 30. RESULTS On average, participants completed 25 sessions and almost 4 hours of application use across the 30-days. Results of linear mixed effects models showed significant improvements in positive affect, negative affect, and life satisfaction across the study interval, but no meaningful change in total mindfulness or perceived stress. Furthermore, relative to high levels of smartphone efficacy, low smartphone efficacy was associated with higher perceived stress and negative affect, and less life satisfaction at baseline; and steeper improvements on these outcomes across the study interval. On average, older adults rated the app-based mindfulness-meditation training as interesting, enjoyable, valuable, and useful. DISCUSSION AND IMPLICATIONS The findings provide preliminary support for the feasibility and acceptability of an app-based mindfulness-meditation program with community-dwelling older adults and demonstrate potential benefits for well-being. Results suggest the value of further research investigating the efficacy of digital mindfulness-meditation interventions for older adults via larger randomized-controlled trials.

Forming a habit of practicing mindfulness meditation around the same time of day is one strategy that may support long-term maintenance and in turn improve physical and mental health. The purpose of this study was to identify common patterns in the time of day of meditation associated with long-term meditation app use to assess the importance of temporal consistency for maintaining meditation over time. App usage data were collected from a random sample of 15,000 users who had paid for an annual membership to a commercial meditation app in 2017. We constructed three measures of temporal consistency in the time of day of meditation sessions in order to categorize users into one of three behavioral phenotypes: Consistent, Inconsistent, or Indeterminate. Panel data models were used to compare temporal consistency across the three phenotypes. Of the 4205 users (28.0%) in the final analytic sample, 1659 (39.5%) users were Consistent, 2326 (55.3%) were Inconsistent, and 220 users (5.23%) were Indeterminate. Panel models confirmed that temporal consistency had contrasting relationships with meditation maintenance among these three phenotypes (p < 0.01). These findings revealed that temporal consistency was associated with meditation maintenance for less than half of app users, which suggests that other behavioral mechanisms in addition to temporally consistent habits can support meditation app use over time. This has important implications for researchers and policymakers trying to promote the maintenance of meditation and other complex health behaviors, such as increased physical activity and healthier diets.

Background Health care provider and trainee burnout results in substantial national and institutional costs and profound social effects. Identifying effective solutions and interventions to cultivate resilience among health care trainees is critical. Although less is known about the mental health needs of physician assistants (PAs) or PA students, accumulating research indicates that they experience similarly alarming rates of burnout, depression, and emotional exhaustion. Mobile app–delivered mindfulness meditation may be an effective part of salubrious programming to bolster long-term resilience and health among PA students. Objective This study aims to examine the impact of app-delivered mindfulness meditation on self-reported mental health symptoms among PA students. A secondary aim is to investigate changes in brain connectivity to identify neurobiological changes related to changes in mental health symptoms. Methods We recruited PA students enrolled in their third semester of PA school and used a longitudinal, randomized, wait-list–controlled design. Participants randomized to the mindfulness group were provided 1-year subscriptions to the 10% Happier app, a consumer-based meditation app, and asked to practice every day for 8 weeks. Before randomization and again after completion of the 8-week program, all participants completed resting-state functional magnetic resonance imaging as well as self-report assessments of burnout, depression, anxiety, and sleep impairment. App use was acquired as a measure of mindfulness practice time. Results PA students randomized to the mindfulness group reported improvements in sleep impairment compared with those randomized to the wait-list control group (ηp2=0.42; P=.01). Sleep impairment decreased significantly in the mindfulness group (19% reduction; P=.006) but not in the control group (1% reduction; P=.71). There were no other significant changes in mental health for those randomized to app-delivered mindfulness. Across all students, changes in sleep impairment were associated with increased resting-state functional connectivity between the medial prefrontal cortex (a component of the default mode network) and the superior temporal gyrus, as well as between areas important for working memory. Changes in connectivity predicted categorical conversion from impaired to nonimpaired sleep in the mindfulness group. Conclusions This pilot study is the first to examine app-based mindfulness for PA students’ mental health and investigate the impact of mindfulness on PA students’ brain function. These findings suggest that app-delivered mindfulness may be an effective tool to improve sleep dysfunction and that it may be an important part of the programming necessary to reduce the epidemic of suffering among health profession trainees.

Background Body image concerns are prevalent among young adults, who may be vulnerable to developing body image concerns because of particular risk factors associated with this life period. With technological advancements, digital mobile health (mHealth) apps are cost-effective and scalable interventions. Thus, mHealth apps can be explored as a form of prevention effort to alleviate body image concerns in young adults. Objective In this randomized controlled trial, we examined the effectiveness of a self-guided mHealth app in improving body image and self-compassion in a sample of university students. Methods Participants (N=310) were randomized to a 9-day self-guided body image and self-compassion mHealth app (n=149) and to an active waitlist control group (n=161), where they completed a similarly structured 9-day program on cooperation. Both programs consisted of content learning and activities such as quizzes, with the number and length of activities matched for both programs. Measures were obtained at baseline, upon completion of the programs (after the intervention), and at 4-week follow-up. Results The intervention group for female participants reported significant reduction in body dissatisfaction (P<.001) and improvements in body appreciation (P<.001) and self-compassion (P=.001) compared with the active waitlist control group after the intervention. Similarly, for male participants after the intervention, a significant reduction was found in the intervention group in body dissatisfaction (P<.001) after the intervention as well as improvements in body appreciation (P=.02) and self-compassion (P=.047). The effects were maintained at 4-week follow-up for female participants on body dissatisfaction (P<.001), body appreciation (P<.001), and self-compassion (P=.02) but not for male participants. On body image risk factors, significant reductions were found for female participants after the intervention for thin-ideal internalization (P<.001), peer pressure (P=.002), and media pressure (P<.001) after the intervention, while the effects were only maintained for thin-ideal internalization (P=.008) and media pressure (P=.01) at 4-week follow-up, compared with the active waitlist control group. As for male participants, no intervention effects were found both after the intervention and at follow-up for all body image risk factors of muscularity internalization, peer pressure, and media pressure. Both apps were acceptable and participants engaged equally across the intervention and active waitlist control groups, as indicated on a measure of app engagement (P=.76). Conclusions This study provides preliminary evidence for a self-guided mHealth app in improving body image concerns and self-compassion in young adult university students. Future studies should include longer follow-ups, and examine its effects with the wider populations of young adults. Trial Registration ClinicalTrials.gov NCT04977973; https://clinicaltrials.gov/ct2/show/NCT04977973

Background Excessive stress is a major global health concern, particularly in young adults. Short skills-focused self-guided interventions (SGIs) on smartphones are a scalable way to improve stress-coping skills at the population level. Objective In this randomized controlled trial, we aimed to examine the possible efficacy of a recently developed stress-coping SGI (Intellect) in improving psychological distress, relative to an active control group and 2 potential moderators of this predicted relationship (ie, psychological mindedness [PM] and coping self-efficacy [CSE]). Methods University students (N=321) were randomly assigned to either an 8-day SGI on stress-coping or an active control group. Self-reported measures were obtained at baseline, after the intervention, and at the 1-month follow-up. The primary outcome was psychological stress (Psychological Stress Measure-9). Secondary outcomes were anxiety (Generalized Anxiety Disorder-7) and depressive symptoms (Patient Health Questionnaire-9). PM and CSE were assessed as potential moderators at baseline. Results The final sample (n=264) included 188 (71.2%) female, 66 (25%) male, 7 (2.7%) nonbinary, and 3 (1.1%) others participants with a mean age of 22.5 (SD 5.41) years. The intervention group reported significantly lower perceived stress (partial eta–squared [ηp2]=0.018; P=.03) and anxiety (ηp2=0.019; P=.03) levels after intervention relative to the active control group. The effects on perceived stress levels remained statistically significant at the 1-month follow-up (ηp2=0.015; P=.05). Students with the lowest CSE and highest PM experienced the fastest decline in perceived stress levels (β=6.37, 95% Cl 2.98-9.75). Improvements in anxiety levels were not observed at 1-month follow-up. Similarly, no intervention effects were found for depression levels at postintervention and follow-up periods. Conclusions This study provides evidence that the Intellect stress-coping SGI is effective in reducing perceived stress and anxiety levels among university students. Mobile health apps are brief, scalable, and can make important contributions to public mental health. Trial Registration ClinicalTrials.gov NCT04978896; https://www.clinicaltrials.gov/ct2/show/NCT04978896

Background Against a long-term trend of increasing demand, the COVID-19 pandemic has led to a global rise in common mental disorders. Now more than ever, there is an urgent need for scalable, evidence-based interventions to support mental well-being. Objective The aim of this proof-of-principle study was to evaluate the efficacy of a mobile-based app in adults with self-reported symptoms of anxiety and stress in a randomized control trial that took place during the first wave of the COVID-19 pandemic in the United Kingdom. Methods Adults with mild to severe anxiety and moderate to high levels of perceived stress were randomized to either the intervention or control arm. Participants in the intervention arm were given access to the Foundations app for the duration of the 4-week study. All participants were required to self-report a range of validated measures of mental well-being (10-item Connor-Davidson Resilience scale [CD-RISC-10], 7-item Generalized Anxiety Disorder scale [GAD-7], Office of National Statistics Four Subjective Well-being Questions [ONS-4], World Health Organization-5 Well-Being Index [WHO-5]) and sleep (Minimal Insomnia Scale [MISS]) at baseline and at weeks 2 and 4. The self-reported measures of perceived stress (10-item Perceived Stress Score [PSS-10]) were obtained weekly. Results A total of 136 participants completed the study and were included in the final analysis. The intervention group (n=62) showed significant improvements compared to the control group (n=74) on measures of anxiety, with a mean GAD-7 score change from baseline of –1.35 (SD 4.43) and –0.23 (SD 3.24), respectively (t134=1.71, P=.04); resilience, with a mean change in CD-RISC score of 1.79 (SD 4.08) and –0.31 (SD 3.16), respectively (t134=–3.37, P<.001); sleep, with a mean MISS score change of –1.16 (SD 2.67) and –0.26 (SD 2.29), respectively (t134=2.13, P=.01); and mental well-being, with a mean WHO-5 score change of 1.53 (SD 5.30) and –0.23 (SD 4.20), respectively (t134=–2.16, P=.02), within 2 weeks of using Foundations, with further improvements emerging at week 4. Perceived stress was also reduced within the intervention group, although the difference did not reach statistical significance relative to the control group, with a PSS score change from baseline to week 2 of –2.94 (SD 6.84) and –2.05 (SD 5.34), respectively (t134= 0.84, P=.20). Conclusions This study provides a proof of principle that the digital mental health app Foundations can improve measures of mental well-being, anxiety, resilience, and sleep within 2 weeks of use, with greater effects after 4 weeks. Foundations therefore offers potential as a scalable, cost-effective, and accessible solution to enhance mental well-being, even during times of crisis such as the COVID-19 pandemic. Trial Registration OSF Registries osf.io/f6djb; https://osf.io/vm3xq

Abstract Background Major depressive disorder is a common diagnosis among adolescents. Cognitive behavioral therapy is recommended as the first line of treatment. Digital health interventions, such as apps, could contribute to treatment. Advantages could be easy accessibility and availability, reduced time for face-to-face therapy, and the ability to intensify therapy by incorporating it into the patients’ everyday lives. Challenges such as low adherence rates are common in digital health interventions. Therefore, they need to undergo rigorous testing for feasibility and effectiveness. Objective An evaluated, cognitive behavioral therapy–based face-to-face therapy program for depression in adolescents was transformed into an app called e-MICHI. This study examined its feasibility and efficacy for use in blended therapy in outpatient settings. Methods Adolescents aged 12 to 18 years with major depressive disorder receiving outpatient care were recruited from 2 university hospitals (n=36 included in analysis). The e-MICHI intervention combined daily app engagement over 6 weeks with 3 face-to-face sessions with a therapist. Feasibility was measured using various variables, including an adherence score (0=no or little patient engagement to 3=excellent engagement) and engagement rates (number of modules completed, number of messages sent by participants via the in-app messenger), satisfaction ratings from both participants and therapists, as well as participants’ ratings of the usefulness of the antidepressant strategies covered in the app and the transfer of these strategies to everyday practice. Trends of efficacy were evaluated from multiple perspectives (participant self-rating, independent rater, or therapist), using the Beck Depression Inventory-II, the Children’s Depression Rating Scale-Revised, and the Clinical Global Impressions-Severity Scale. Feasibility metrics were assessed by analyzing their central tendency and dispersion, efficacy data were analyzed using a repeated measures ANOVA. Results e-MICHI was positively evaluated by both participants and therapists (participants: mean 7.3, SD 1.2 and therapists: mean 7.3, SD 1.1, on a scale from 0=bad to 10=excellent). Participants demonstrated high adherence rates (nearly 80%, n=25, received a “good” or “excellent” adherence score) and showed overall good engagement (app modules completed [maximum 6]: mean 5.03, SD 1.27 and messages sent via messenger: mean 23, SD 22.1). Participants rated the psychoeducational content of the app as particularly useful and reported consistent practice of the e-MICHI strategies in everyday life. Use of the app was associated with a significant reduction of depressive symptoms (before app use vs 3-month follow-up, Beck Depression Inventory-II: mean −6.76, SD 11.49, P=.01; Children’s Depression Rating Scale-Revised: mean −16.45, SD 16.76, P<.001; Clinical Global Impressions-Severity Scale: mean −1.1, SD 1.24, P<.001). Conclusions While acknowledging its limitations, such as the small number of participants and the limited validity concerning efficacy, this study confirms the feasibility of e-MICHI for treating adolescent depression in outpatient settings.

The prevalence of mental health app use by people suffering from mental health disorders is rapidly growing. The integration of mental health apps shows promise in increasing the accessibility and quality of treatment. However, a lack of continued engagement is one of the significant challenges of such implementation. In response, the M-health Index and Navigation Database (MIND)- derived from the American Psychiatric Association’s app evaluation framework- was created to support patient autonomy and enhance engagement. This study aimed to identify factors influencing engagement with mental health apps and explore how MIND may affect user engagement around selected apps. We conducted a longitudinal online survey over six weeks after participants were instructed to find mental health apps using MIND. The survey included demographic information, technology usage, access to healthcare, app selection information, System Usability Scale, the Digital Working Alliance Inventory, and the General Self-Efficacy Scale questions. Quantitative analysis was performed to analyze the data. A total of 321 surveys were completed (178 at the initial, 90 at the 2-week mark, and 53 at the 6-week mark). The most influential factors when choosing mental health apps included cost (76%), condition supported by the app (59%), and app features offered (51%), while privacy and clinical foundation to support app claims were among the least selected filters. The top ten apps selected by participants were analyzed for engagement. Rates of engagement among the top-ten apps decreased by 43% from the initial to week two and 22% from week two to week six on average. In the context of overall low engagement with mental health apps, implementation of mental health app databases like MIND can play an essential role in maintaining higher engagement and satisfaction. Together, this study offers early data on how educational approaches like MIND may help bolster mental health apps engagement.

Mental health disorders are prevalent among college students and increasing in frequency and severity. However, there is a significant gap between those who need treatment and those who engage in treatment. Given the documented efficacy of financial incentives for promoting health behavior change and engagement in treatment, financial incentives may help, along with nonfinancial behavioral incentives such as motivational messaging, gamification, and loss aversion techniques. We compared brief (28-day) use of two versions of a behavioral economics-inspired digital mental health app, NeuroFlow: (1) the full app including financial incentives and nonfinancial behavioral incentives (treatment group) and (2) a version of the app with nonfinancial behavioral incentives only (control group). In our intent-to-treat analyses, in order to examine the primary outcome of app engagement, a one-way analysis of variance (ANOVA) (treatment vs. control) was conducted, and to examine the secondary outcomes (depression, anxiety, emotion dysregulation, and wellbeing), a two-way repeated measures ANOVAs (treatment vs. control × baseline vs. post-trial) were conducted. We found that there were no differences between treatment groups on app engagement or the change in the mental health/wellness outcome measures. There was a main effect of timepoint on symptoms of anxiety and emotion dysregulation, such that there were significantly lower self-reported symptoms at post-trial relative to baseline. Our results suggest that financial incentives in digital mental health apps over and above nonfinancial behavioral incentives do not have an impact on app engagement or mental health/wellness outcomes.

Objective: The purpose of this study was to use the RE-AIM framework to evaluate the implementation of a mental health app designed for undergraduate and medical students during the COVID-19 pandemic. Participants: Medical (n = 270) and undergraduate students (n = 1386) from five universities in the Appalachian region in the United States participated in this study. Methods: Universities from the United States were recruited to deploy the Sharpen app for medical and undergraduate students. The Sharpen app provided psychoeducational modules in mental health literacy, social-emotional learning, mindfulness-based stress reduction, and suicide prevention to promote protective factors for students. The utilization of the Sharpen app was analyzed using the RE-AIM framework using a retrospective, cross-sectional design. Results: Reach: A total of 12.72% of medical students and 6.00% of undergraduate students participated in the study. Efficacy: Medical students viewed significantly more pages, had a significantly higher unique page view average, and a statistically significant exit percentage when compared to undergraduate students. Adoption: A total of 100% of the universities that were recruited participated in the study. Implementation: Five out of six implementation criteria were included, indicating high implementation. Maintenance: All of the universities continued using the Sharpen app following the end of data collection, resulting in a 100% maintenance rate. Conclusions: The RE-AIM framework indicated usability and maintenance by medical and undergraduate students. Future research needs to implement a more rigorous design to determine the impact of the Sharpen app on mental health outcomes in medical and undergraduate students.

Introduction: Metastatic cancer patients report elevated stress levels and unique stressors compared to other adults. This study tested the feasibility and efficacy of a mental health app with comedy content delivered to women living with advanced cancer (WLAC). Methods: The mental health platform Neolth was used as a self-guided intervention for WLAC, ages 18+ years. WLAC were recruited by The Comedy Cures Foundation through a press release, social media posts, an email newsletter, and a video call for participants on the foundation’s website. No compensation was provided to participants. After using the Neolth platform, which included watching comedy content for eight weeks, researchers evaluated engagement, and stress levels using The Perceived Stress Scale -10 (PSS-10), self-efficacy using The New General Self-Efficacy Scale (GSES), and anxiety and depression using The Hospital Anxiety and Depression Scale (HADS-A and HADS-D). Results: 54 WLAC (M = 52.2 years, R = 31-74) from 10 countries and 24 states participated by completing the baseline questionnaire. 20.5% identified as BIPOC and 33.0% had previous experience with a mental health app. 57.4% (N=31) completed the study surveys at Week 4 and Week 8. At Week 8, HADS-D scores decreased 18.1%, PSS-10 scores decreased 15.1%, HADS-A scores decreased by 9.7%, and GSES scores increased 7.6%. Participants spent an average of 116 minutes per week on Neolth with an average of 3.15 logins per week. 43.6% of time spent was completing self-guided relaxation practices and 17.2% watching Comedy Cures Foundation videos from cancer survivor Saranne Rothberg. The 30-day retention on Neolth was 100%, with 60-day retention 83%. Conclusion: This study demonstrated the ability of a mental health app with comedy content to engage and support the mental health of WLAC, presenting a cost-effective intervention. Further examination with a larger sample size is needed to conduct multivariate analyses for enhanced understanding of the role of mobile apps and comedy content in reducing stress, anxiety, and depression for WLAC. Citation Format: Saranne Rothberg, Katherine B. Grill, Claire Wheeler. Implementation and evaluation of a mental health app with comedy content for women living with advanced cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 720.

Background There has been a surge in mental health concerns during the COVID-19 pandemic, which has prompted the increased use of digital platforms. However, there is little known about the mental health needs and behaviors of the global population during the pandemic. This study aims to fill this knowledge gap through the analysis of real-world data collected from users of a digital mental health app (Wysa) regarding their engagement patterns and behaviors, as shown by their usage of the service. Objective This study aims to (1) examine the relationship between mental health distress, digital health uptake, and COVID-19 case numbers; (2) evaluate engagement patterns with the app during the study period; and (3) examine the efficacy of the app in improving mental health outcomes for its users during the pandemic. Methods This study used a retrospective observational design. During the COVID-19 pandemic, the app’s installations and emotional utterances were measured from March 2020 to October 2021 for the United Kingdom, the United States of America, and India and were mapped against COVID-19 case numbers and their peaks. The engagement of the users from this period (N=4541) with the Wysa app was compared to that of equivalent samples of users from a pre–COVID-19 period (1000 iterations). The efficacy was assessed for users who completed pre-post assessments for symptoms of depression (n=2061) and anxiety (n=1995) on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) test measures, respectively. Results Our findings demonstrate a significant positive correlation between the increase in the number of installs of the Wysa mental health app and the peaks of COVID-19 case numbers in the United Kingdom (P=.02) and India (P<.001). Findings indicate that users (N=4541) during the COVID period had a significantly higher engagement than the samples from the pre-COVID period, with a medium to large effect size for 80% of these 1000 iterative samples, as observed on the Mann-Whitney test. The PHQ-9 and GAD-7 pre-post assessments indicated statistically significant improvement with a medium effect size (PHQ-9: P=.57; GAD-7: P=.56). Conclusions This study demonstrates that emotional distress increased substantially during the pandemic, prompting the increased uptake of an artificial intelligence–led mental health app (Wysa), and also offers evidence that the Wysa app could support its users and its usage could result in a significant reduction in symptoms of anxiety and depression. This study also highlights the importance of contextualizing interventions and suggests that digital health interventions can provide large populations with scalable and evidence-based support for mental health care.

Abstract Background Despite significant advancements in healthcare technology, digital health solutions – especially those for serious mental illnesses – continue to fall short of their potential across both clinical practice and efficacy. The utility and impact of medicine, including digital medicine, hinges on relationships, trust, and engagement, particularly in the field of mental health. This paper details results from Phase 1 of a two-part study that seeks to engage people with schizophrenia, their family members, and clinicians in co-designing a digital mental health platform for use across different cultures and contexts in the United States and India. Methods Each site interviewed a mix of clinicians, patients, and their family members in focus groups (n = 20) of two to six participants. Open-ended questions and discussions inquired about their own smartphone use and, after a demonstration of the mindLAMP platform, specific feedback on the app's utility, design, and functionality. Results Our results based on thematic analysis indicate three common themes: increased use and interest in technology during coronavirus disease 2019 (COVID-19), concerns over how data are used and shared, and a desire for concurrent human interaction to support app engagement. Conclusion People with schizophrenia, their family members, and clinicians are open to integrating technology into treatment to better understand their condition and help inform treatment. However, app engagement is dependent on technology that is complementary – not substitutive – of therapeutic care from a clinician.

No abstract available

COVID-19 affected the well-being of healthcare workers (HCWs) globally. Mental health app interventions (MHAIs) may offer appropriate and accessible means to support HCWs' mental health. We conducted a pilot randomised controlled crossover trial involving 34 clinicians randomised to either a MHAI or a waitlisted group. After one month, outcome assessments were repeated and the waitlisted group then crossed over to the MHAI; they again completed outcome assessments after a month. The primary outcomes were feasibility, assessed with the Systems Usability Scale (SUS), and acceptability, assessed with the Client Satisfaction Questionnaire (CSQ). Secondary outcomes included efficacy for various mental health parameters. The SUS and CSQ scores indicated above average feasibility and acceptability. There was a significant difference in anxiety from baseline to 1-month follow-up between the groups, with greater improvement in the MHAI group. The groups differed in resilience and patient-related burnout from baseline to 1-month follow-up, with a trend towards significance, with greater improvements in the MHAI group. Anxiety and acute stress disorder severity improved significantly from pre- to post-intervention. We demonstrated that MHAIs hold potential for improving well-being of HCWs, although these findings will need to be replicated in adequately powered trials.

Mental health applications (apps) are proliferating to meet the needs of the increasing numbers of young people experiencing mental health challenges. However, many mental health apps for young people are either not evidence-based or fail to engage the interest of those who are not already receiving professional help. Since music listening is an activity that many young people are drawn to when experiencing high levels of psychological distress, MoodyTunes was developed to engage young people in learning about mental health within the context of their daily music listening activities. In this single cohort study, 70 participants aged 13–25 used MoodyTunes over a 4-week period. Pre- and post-intervention measures assessed mental health literacy, coping self-efficacy, depression, anxiety, and stress levels. Results demonstrated a significant increase in mental health literacy and decreases in anxiety and stress. Depression was found to have decreased, although not at a statistically significant level. No significant change in coping self-efficacy was found. These findings suggest that MoodyTunes may be an effective tool for improving mood regulation and psychological wellbeing in young people. Future research with larger, randomized samples and a comparative control group is recommended.

Background: Young people are at heightened risk for mental health problems. Apprenticeships are common pathways into the workforce at a critical developmental period. However, in some cases the working conditions for apprentices present significant challenges to mental wellness. As apprentices are unlikely to utilize traditional services, eHealth and mHealth interventions are a useful means of delivering interventions to this group. The aim of the current paper is to: (1) qualitatively explore the utility of an existing mental health app within an apprentice population; and (2) evaluate the usability, acceptability, feasibility and preliminary efficacy of a modified version of the app (HeadGear Apprentice), designed to reduce depressive symptoms in an apprentice working population. Methods: Study One: Twenty-six apprentices (aged 18–30) took part in one of eight (90-min) focus groups. Participants explored the HeadGear app, took part in group discussions, and completed uMARS questionnaires. Modifications were made to the app based on feedback. Study Two: In the follow-up pilot testing, 47 apprentices downloaded and used the modified app over 30 days. Assessment occurred online at baseline, 5-weeks, and 3-months post-baseline. Feasibility was evaluated using consent rates, adherence and attrition. Acceptability was assessed using questionnaires and a post-study interview. Depression, anxiety, well-being, and work performance scores were used to assess preliminary efficacy. Results: Overall, the app was well-received in both studies, with high self-reported scores for acceptability and utility. However, engagement—both in terms of self-report and adherence—was an issue in both studies. In Study Two, users completed approximately one-third of the app's therapeutic content, with increased usage associated with improved outcomes. This had implications for the preliminary effectiveness of the app [depression as measured by the PHQ-9 Cohen's d = 0.27 (95%CI:-0.16–0.69)]. At follow-up users reported improvements in all outcomes, but overall only change in well-being reached statistical significance [Cohen's d = −0.29 (95%CI:-0.72–0.14)]. Conclusion: Overall, findings from the two studies suggest that an eHealth tool, HeadGear Apprentice, was an acceptable and well-received intervention when adapted to young apprentices. However, questions remain regarding how to improve engagement and adherence to the program. These questions appear critical to effectiveness. The two studies also have implications for awareness raising in this population. Whilst preliminary results were encouraging, these improvements, along with a full-scale efficacy trial, are needed to better understand the utility of smartphone applications for mental health in this population. Trial registration: ACTRN12618001475235 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375875&isReview=true.

A growing market for mental health applications and increasing evidence for the efficacy of these applications have made apps a popular mode of mental healthcare delivery. However, given the gravity of mental illnesses, the potential harms of using these applications must be continually investigated. In this study, we conducted a thematic analysis using user-comments left on depression self-management applications. We analyzed 6,253 reviews from thirty-six, systematically selected apps from the Google Play and Apple App stores. We identified four themes regarding the potential, unintentional harms caused by these applications. This study uniquely contributes to the literature by examining the reported harms to users caused by depression self-management apps and contextualizing them in an ethical framework. We provide recommendations to developers for creating ethical depression self-management apps and resources for practitioners and consumers to aid in screening apps.