Jmir Mental Health最新文献

{"title":"Practical Guide to Large Language Models for Information Extraction in Behavioral Health Notes: Tutorial.","authors":"Diya Saha, Juliet B Edgcomb","doi":"10.2196/97498","DOIUrl":"10.2196/97498","url":null,"abstract":"<p><strong>Background: </strong>Mental health clinical notes contain decision-critical information often absent from structured electronic health record fields. Large language models (LLMs) can extract clinically relevant signals from narrative text; however, variability in output format, limited reproducibility, and inconsistent evaluation remain barriers to clinical deployment. Despite rapid advances in LLM-based information extraction, clear and reproducible guidance for interdisciplinary clinical teams is limited.</p><p><strong>Objective: </strong>This tutorial aims to present a structured workflow for zero-shot information extraction from mental health clinical notes using locally deployed open-source LLMs. It aims to reduce barriers for clinicians and researchers with limited familiarity with natural language processing (NLP) or LLM-based pipelines. Each stage includes key decision points and examples. The workflow is illustrated on two tasks using synthetic notes: (1) detection of self-injurious thoughts and behaviors (SITB) in pediatric emergency department (ED) notes and (2) antipsychotic medication nonadherence detection in outpatient notes, using schema-constrained outputs and standardized evaluation.</p><p><strong>Methods: </strong>We describe a five-stage zero-shot LLM pipeline: (1) infrastructure setup with local deployment via <i>Ollama</i> to prevent protected health information (PHI) transmission; (2) task definition specifying the clinical construct, output format, and evaluation; (3) dataset preparation using synthetic notes; (4) iterative prompt development using a hold-out development set with binary and Likert scale outputs constrained via JSON schemas; and (5) output parsing, normalization, and validation. We generated 300 synthetic notes per task using separate LLMs for generation and evaluation; 200 notes were used for evaluation, and 100 notes (50 positive and 50 negative) were used as a prompt-development set and excluded from final metrics. Evaluation used Large Language Model Meta AI (Llama) 3.2 and Llama 3.3 with deterministic decoding (temperature=0). Performance was assessed using accuracy, precision, recall, and <i>F</i><sub>1</sub>-score; Likert thresholds were optimized using the Youden index with bootstrapped CIs.</p><p><strong>Results: </strong>We demonstrated the pipeline's functionality using 2 example behavioral health detection tasks. Across both examples, the more capable model (Llama 3.3) performed better than the lighter model used earlier in development (Llama 3.2), and we described how the pipeline's evaluation and error-analysis steps work in practice. These examples also illustrated 2 useful design choices: requiring the model to output in a fixed format reduced errors, and using a graded rating scale, rather than a simple yes/no format, allowed the detection threshold to be adjusted based on clinical risk tolerance. These results are meant to show that the pipeline works as intended, not to serve a","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"13 ","pages":"e97498"},"PeriodicalIF":7.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of Persistent Exposure to Self-Harm-Encouraging Websites and Subsequent Mental Health Outcomes in US Youth: Longitudinal Cohort Study.","authors":"Kimberly J Mitchell, Ateret Gewirtz-Meydan, Victoria Banyard","doi":"10.2196/95200","DOIUrl":"10.2196/95200","url":null,"abstract":"<p><strong>Background: </strong>Self-harm, including suicidal thoughts, self-injurious behavior, and disordered eating, is a major public health concern among adolescents and young adults. Youth increasingly encounter self-harm-related content online, including websites that explicitly encourage harmful behaviors. Although exposure to such content has been linked to poorer mental health, most research is cross-sectional and has not examined longitudinal exposure trajectories. Whether persistent exposure represents a distinct digital risk pattern remains unclear.</p><p><strong>Objective: </strong>This study examined longitudinal trajectories and correlates of exposure to self-harm-encouraging websites over 1 year and tested whether persistent exposure was associated with subsequent suicidal ideation, self-injury, and disordered eating.</p><p><strong>Methods: </strong>We analyzed data from 2197 US youth aged 13 to 22 years who completed waves 2 and 4 of Project Lift Up, a national longitudinal cohort study. Website exposure was categorized into 4 trajectories: none, desist (wave 2 only), new (wave 4 only), and persistent (both waves). Categories reflected reported exposure at the 2 assessment waves rather than the frequency or continuity of website use between assessments. Logistic regression models estimated associations between exposure trajectory and wave 4 suicidal ideation, self-injury, and disordered eating, restricting analyses to participants without the respective outcome at wave 2. Models were adjusted for demographics and wave 2 depression or anxiety symptoms and other mental health indicators.</p><p><strong>Results: </strong>Overall, 26.5% (583/2197) reported exposure to self-harm-encouraging websites at wave 2, and 18.5% (407/2197) reported persistent exposure. Privacy concerns, embarrassment, curiosity, and lack of offline support were associated with greater odds of persistence (adjusted odds ratios [aORs] 1.84-3.23), whereas accidental exposure was associated with lower odds of persistence (aOR 0.28, 95% CI 0.19-0.41). Compared with no exposure, persistent exposure was associated with higher odds of suicidal ideation (aOR 1.88, 95% CI 1.24-2.86; <i>P</i>=.003), self-injury (aOR 3.14, 95% CI 2.05-4.80; <i>P</i><.001), and disordered eating (aOR 2.46, 95% CI 1.54-3.93; <i>P</i><.001). Adjusted predicted probabilities showed a graded pattern, with persistent exposure associated with the highest predicted probabilities (suicidal ideation: 33.4% vs 21.3%; self-injury: 25.7% vs 10.2%; disordered eating: 11.7% vs 5.3%). New exposure was associated with increased odds of self-injury (aOR 2.32, 95% CI 1.30-4.15; <i>P</i>=.004) but was not significantly associated with suicidal ideation or disordered eating. The desist trajectory was not significantly associated with outcomes.</p><p><strong>Conclusions: </strong>Persistent exposure to self-harm-encouraging websites may represent a distinct digital risk pattern associated with higher subsequen","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"13 ","pages":"e95200"},"PeriodicalIF":7.4,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Reality-Assisted Therapy Compared to Cognitive Behavioral Therapy for Patients With Treatment-Resistant Schizophrenia: Assessor-Blind Randomized Controlled Trial.","authors":"Mélissa Beaudoin, Stéphane Potvin, Sabrina Giguère, Charles-Édouard Giguère, Frederick Aardema, Amal Abdel-Baki, Luigi De Benedictis, Olivier Lipp, Pierre Lalonde, Emmanuel Stip, Alexandra Fortier, Kingsada Phraxayavong, Alexandre Dumais","doi":"10.2196/106791","DOIUrl":"10.2196/106791","url":null,"abstract":"<p><strong>Background: </strong>Auditory verbal hallucinations (AVH) are among the most disabling symptoms of schizophrenia and often persist despite treatment. Virtual reality-assisted therapies (VRTs) are a new generation of relational interventions for AVH, but comparative evidence against active interventions is currently lacking.</p><p><strong>Objective: </strong>This study aimed to assess whether VRT (9 sessions) is superior to a short course of cognitive behavioral therapy (CBT) targeting AVH (9 sessions) in reducing AVH in individuals with treatment-resistant schizophrenia.</p><p><strong>Methods: </strong>In this assessor-blind, parallel-group randomized controlled trial conducted from 2019 to 2026 at an academic center in Montreal (Canada), adults with schizophrenia or schizoaffective disorder and persistent AVH were either referred by their health care team or self-referred. A total of 136 participants were randomly assigned 1:1 to VRT or CBT, stratified by sex and clozapine use status. Both 9-session interventions targeted maladaptive beliefs and relationships with voices and were administered by trained psychotherapists. The predetermined primary outcome was the evolution of AVH severity over time, measured at baseline, post treatment, and 3 months post therapy using the auditory hallucination subscale of the Psychotic Symptoms Rating Scale. Secondary outcomes notably included the general psychotic symptomatology measured using the Positive and Negative Syndrome Scale. Linear mixed-effects models were used to assess time-by-treatment interactions. Psychotherapy sessions and assessments were conducted primarily in person, with CBT being occasionally delivered via videoconferencing during the COVID-19 pandemic.</p><p><strong>Results: </strong>Participants had a mean age of 40.3 (SD 12.8) years, 63.2% (86/136) were male, and 56.6% (77/136) received clozapine. Intention-to-treat analyses (VRT, n=67; CBT, n=69) showed a significant time-by-treatment interaction favoring VRT (<i>P</i>=.013) with a moderate effect size at 3 months post therapy (Cohen <i>d</i>=0.614). Both therapies showed significant within-group improvements in the primary outcome, with large effect sizes for VRT (Cohen <i>d</i>=0.81 post therapy and Cohen <i>d</i>=1.17 at 3 months) and moderate for CBT (Cohen <i>d</i>=0.58 post therapy and Cohen <i>d</i>=0.39 at 3 months). While there were no between-group differences for secondary outcomes, within-group improvements were observed in psychotic symptoms, emotional regulation, and voice acceptance for both therapies, and VRT also reduced maladaptive beliefs about voices and improved self-esteem.</p><p><strong>Conclusions: </strong>VRT outperformed a targeted short course of CBT in reducing persistent AVH for up to 3 months after the intervention in a North American population with treatment-resistant schizophrenia. Improvements were also seen in some secondary outcomes, such as general psychotic symptomatology, and those wer","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"13 ","pages":"e106791"},"PeriodicalIF":7.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychotherapeutic Competencies in Blended Care Psychotherapy: Development of a Competence Framework.","authors":"Gerald Marc Weiher, Mirjam Naomi Woide, Maria Zirenko, Michael Tremmel, Ulrich Stangier, Holger Horz","doi":"10.2196/100125","DOIUrl":"10.2196/100125","url":null,"abstract":"<p><strong>Background: </strong>Blended care psychotherapy (BCP) combines face-to-face psychotherapy with digital interventions, such as videoconferencing, apps, or virtual reality, which can be incorporated in various ways and at different stages of the therapeutic process. Despite its increasing implementation, conceptual and terminological inconsistencies continue to impede a shared understanding of the competencies required for its effective delivery.</p><p><strong>Objective: </strong>This theoretical paper introduces a framework of psychotherapeutic competencies in BCP, designed to provide conceptual clarity.</p><p><strong>Methods: </strong>The framework was developed in four steps. (1) An exploratory literature search was conducted to identify existing competence and educational frameworks relevant to psychotherapy, digitalization, and educational psychology. (2) These models informed a preliminary theoretical framework. (3) This preliminary framework was critically reviewed and refined in an expert workshop with 5 licensed psychotherapists and researchers experienced in BCP. (4) Lastly, findings from a systematic review of 35 studies on BCP competencies were integrated, resulting in the final 8-domain framework.</p><p><strong>Results: </strong>The resulting framework comprises <i>Modalities</i> of BCP (eg, face-to-face, videoconferencing, and apps), <i>Competence Facets</i> (knowledge, skills, and attitudes), as well as 8 <i>Competence Domains</i> (Creation of Setting and Infrastructure; Transfer of Communication and Methods; Therapeutic Relationship; Self-Regulation, Self-Confidence, and Self-Care; Data Security, Legal Issues, Ethics, and Safety; Technological Aspects; Scientific Knowledge and Methods; and Individual and Cultural Diversity).</p><p><strong>Conclusions: </strong>This conceptual contribution aims to strengthen the theoretical foundation of BCP, support competence-based education for psychotherapists, and guide future research toward the empirical validation and refinement of BCP-specific competencies.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"13 ","pages":"e100125"},"PeriodicalIF":7.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Therapy in the Age of Large Language Models: Framework for Therapist-Delivered and AI-Supported Functions.","authors":"Shane Cross, Nickolai Titov, Blake Dear, John Gleeson, Mario Alvarez-Jimenez","doi":"10.2196/103712","DOIUrl":"10.2196/103712","url":null,"abstract":"<p><strong>Unlabelled: </strong>Large language models are increasingly used within and alongside therapy. As large language models perform more therapy functions, questions arise about what the future might hold for therapists and what they will do. We argue that the enduring therapist role in the age of AI-assisted care is currently best understood through relational, adaptive, and accountability functions. These functions include therapeutic challenge, use of the therapeutic relationship as a mechanism of change, rupture detection and repair, bearing witness to suffering, calibration of pace and treatment burden, and clinical judgment under uncertainty across the broader care pathway. Drawing on psychotherapy theory, digital mental health research, the declarative-procedural-reflective model by Bennett-Levy, and our clinical experience, we propose a clinically informed, hypothesis-generating, relational-adaptive-accountability framework. This framework is intended to support further empirical testing and may have implications for workforce development, supervision, training, and service design.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"13 ","pages":"e103712"},"PeriodicalIF":7.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Experiences in Brief Meditation Practices: Randomized Controlled Trial.","authors":"Otto Simonsson, Zishan Jiwani, Mini Ruiz, Jayanth Narayanan, Walter Osika, Matthew J Hirshberg, Simon B Goldberg","doi":"10.2196/95628","DOIUrl":"10.2196/95628","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Meditation has become increasingly popular in recent decades. However, relatively little remains known about the prevalence of and risk factors for adverse experiences related to a single meditation practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of our study was to examine adverse experiences associated with 3 brief, digitally delivered meditation practices (mindfulness, self-compassion, and gratitude) relative to using the internet as usual, as well as to investigate whether preintervention characteristics could predict such outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In a secondary analysis of a randomized controlled trial using samples that were representative of the US and UK adult populations with regard to ethnicity, sex, and age, we examined adverse experiences associated with 3 brief (ie, 5 or 10 minutes) meditation practices (ie, mindfulness, self-compassion, and gratitude) relative to using the internet as usual. We also investigated the potential of using preintervention characteristics to predict such outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 5049 participants completed all preintervention measures and were randomly assigned to meditation or control conditions. Across the sample, 4.1% (204/4925) of participants reported having a distressing experience during the intervention, and 7.1% (348/4908) of participants experienced an increase in negative affect from before to after the intervention. The results showed that participants who were randomized to a brief meditation intervention were no more likely to report a distressing experience than those who were randomized to use the internet as usual (odds ratio [OR] 1.05, 95% CI 0.76-1.47; P=.76). The results also showed that participants who were randomized to a brief meditation intervention were less likely to report clinically relevant increases in negative affect relative to using the internet as usual (OR 0.63, 95% CI 0.50-0.80; P&lt;.001). Notably, participants in the 10-minute condition had a significantly higher likelihood of reporting a distressing experience than those in the 5-minute condition (OR 1.42, 95% CI 1.07-1.89; P=.02). Preintervention characteristics showed acceptable discrimination ability to predict a distressing experience (area under the curve=0.73) and slightly lower ability to predict increased negative affect (area under the curve=0.67).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Taken together, we found that the brief, digitally delivered meditation practices tested in this study carry risks of adverse experiences that are comparable to or lower than those of typical activities on the internet; 10-minute condition was more likely to result in distressing experiences than 5-minute condition; and adverse responses to a brief meditation practice can, at least to a certain degree, be predicted using preintervention characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;Open Science Framework 94HKS; https://osf.io/94hks","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"13 ","pages":"e95628"},"PeriodicalIF":7.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tool or Companion? Reframing Conversational AI to Prevent Psychological Harm.","authors":"Asia Maurich Novelli, Sukhwinder Shergill, Andreia Sofia Teixeira","doi":"10.2196/99354","DOIUrl":"10.2196/99354","url":null,"abstract":"<p><strong>Unlabelled: </strong>People increasingly turn to conversational AI for companionship, emotional support, and well-being, using both purpose-built companion apps, such as Replika and Character.AI, and general-purpose assistants, such as ChatGPT and Claude. While some evidence suggests potential benefits, including short-term reductions in loneliness and mood improvement, several adverse outcomes have been reported in both clinical and nonclinical populations, including emotional dependence, exacerbation of symptoms, and self-harm. The fluent and apparently empathic responses from these models lead users to engage with them not only as tools but also as if they were social entities. This framing is conceptually misleading and may pose risks across different user profiles, particularly for vulnerable individuals. Drawing on research in AI, psychiatry, psychology, and network science, we highlight mechanisms through which emotional reliance develops and the boundary between tool and companion erodes. Design choices that evoke personality and warmth encourage users to anthropomorphize these systems. Simulated empathy, generated through probabilistic language patterns rather than genuine emotional experience, creates a structurally asymmetric interaction, in which the user discloses and the system responds, but without reciprocity, vulnerability, or accountability. Overvalidation and sycophancy can reinforce maladaptive cognitions, delusional ideation, and distorted perceptions of reality, as they tend to reinforce people's beliefs, even at the expense of the accuracy of models' responses. These mechanisms are not incidental: they emerge from alignment procedures that reward responses perceived as warm and empathic. The result is a self-reinforcing feedback loop between the model and the user that may amplify maladaptive beliefs, delusional ideation, and emotional distress, even in those who engage for largely functional purposes. Understanding these dynamics requires an examination of both what these agents can do-considering their technical limitations and implementations-and what humans believe they can do, including social and psychological impacts. We argue that conversational AI should be treated primarily as a tool supporting human systems rather than as a substitute for human relationships. Perhaps more importantly, reviewing the current hype surrounding AI interactions can help reformulate a paradigm that contributes to human well-being and societal value, while minimizing misconceptions, maladaptive interactions, or social disintegration.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"13 ","pages":"e99354"},"PeriodicalIF":7.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video and App-Based Games for Youth Emotion Regulation: Scoping Review.","authors":"Angela May Ashley, Jaidyn Kataryna Charlton, Hannah Wayne-Phillips, Aislin R Mushquash, Christine Wekerle","doi":"10.2196/96935","DOIUrl":"10.2196/96935","url":null,"abstract":"<p><strong>Background: </strong>Emotion regulation (ER) is a transdiagnostic construct encompassing distinct strategies that can be used to encourage adaptive coping skills in support of youth's (ages 10 to 24 years) mental health. ER is responsive to training and intervention, such as via video and app-based games. Previous literature shows that video and app-based games impact the psychological well-being of youth and may be an accessible way to help youth learn about and implement emotional regulation strategies in their lives.</p><p><strong>Objective: </strong>Previous reviews have not focused on video and app-based games that support ER and how they may be beneficial to youth with and without a mental health diagnosis. This scoping review sought to collect, review, and understand the scope of research on the effects of video and app-based games on ER outcomes in youth, and areas in need of further investigation.</p><p><strong>Methods: </strong>We conducted a scoping search of MEDLINE, Embase, and APA PsycInfo from the beginning of the database up to and including December 2025. Studies were included if they were in English, included youth with a mean age between 10 and 24 years, and that evaluated an intervention or an intervention adjunct to help improve their ER skills using a video or app-based game. We extracted population characteristics (for the video game or app), the effectiveness of the intervention, and ER strategies addressed.</p><p><strong>Results: </strong>Following the screening of 14,456 studies, we identified 33 studies for inclusion in the final review. Four recurrent outcomes emerged: change in overall ER skills, mood modification, mental health symptom management, and emotion identification.</p><p><strong>Conclusions: </strong>While most studies reported improvements in these areas, some studies reported areas of continued difficulty. The results suggest that video and app-based games could serve as beneficial, easy-to-access tools to support youth ER through various strategies, with areas for future research to address mixed results and recommendations for addressing digital health improvement.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"13 ","pages":"e96935"},"PeriodicalIF":7.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Care Expansion and Physician Follow-Up Among Youth With First Mental Health Contact Through a Hospital: Population-Based Repeated Cross-Sectional Study.","authors":"Erica Wennberg, Emily Hamovitch, Aditi Patrikar, Peter C Austin, Paul Kurdyak, Katherine E Nelson, Amreen Babujee, Astrid Guttmann","doi":"10.2196/94389","DOIUrl":"10.2196/94389","url":null,"abstract":"<p><strong>Background: </strong>Timely follow-up is crucial for youth whose first mental health contact is through a hospital; virtual care could facilitate this.</p><p><strong>Objective: </strong>This study aimed to examine the association between the significant expansion of virtual care in Ontario, Canada, and follow-up mental health care rates for these youths.</p><p><strong>Methods: </strong>We conducted a population-based repeated cross-sectional study using linked health administrative databases. We identified first-contact emergency department (ED) visits or hospital admissions for self-harm, mood disorders, or psychosis from March 1, 2009, to February 29, 2024, among Ontario youth (aged 10-24 years). Virtual care was expanded in March 2020; we examined 2 expansion stages (temporary and permanent). Autoregressive integrated moving average analyses estimated level and slope changes (vs before virtual care) in age- and sex-standardized monthly rates of 7-day mental health follow-up. Subgroup analyses examined rurality and socioeconomic status.</p><p><strong>Results: </strong>We identified 42,208 first-contact ED visits and 17,701 first-contact hospital admissions. Pre-virtual care mean follow-up rates were 17.64 (SD 2.97) per 100 first-contact ED visits and 21.90 (SD 5.05) per 100 first-contact hospital admissions. Temporary expansion was associated with immediate increases in follow-up that declined (level changes: 4.81, 95% CI 2.82-6.81 for ED visits and 7.51, 95% CI 4.41-10.60 for hospital admissions; slope changes: -0.31, 95% CI -0.42 to -0.21 for ED visits and -0.32, 95% CI -0.48 to -0.15 for hospital admissions). Permanent expansion was associated only with an immediate decrease in ED visit follow-up (level change: -3.81, 95% CI -6.70 to -0.92) that was significant in rural (-1.06, 95% CI -1.93 to -0.184) but not urban (0.44, 95% CI -0.179 to 1.06) areas; results were otherwise similar between subgroups.</p><p><strong>Conclusions: </strong>Virtual care was not associated with sustained changes or equity improvements in mental health follow-up for high-acuity youth, representing a missed opportunity to extend physician reach and address barriers. Further research and quality improvement are needed.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"13 ","pages":"e94389"},"PeriodicalIF":7.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remotely Supervised, Home-Based Transcranial Direct Current Stimulation for Major Depressive Disorder: Systematic Review and Meta-Analysis.","authors":"Motti Haimi, Natália Almeida-Antunes, Simao Pedro Rodrigues Ferreira, Nuno Barbosa Rocha","doi":"10.2196/92522","DOIUrl":"10.2196/92522","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Major depressive disorder affects over 280 million people worldwide, and access to effective treatment remains limited. Transcranial direct current stimulation (tDCS) is a noninvasive option, and portable devices now allow for home-based delivery under varying degrees of remote supervision.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to systematically review and meta-analyze the efficacy, safety, feasibility, and acceptability of home-based and remotely supervised tDCS for depressive disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension) guidelines, we searched MEDLINE, Embase, Web of Science, the Cochrane databases, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform up to July 2025, with backward and forward citation searching. Two reviewers independently screened records, extracted data, and assessed risk of bias (version 2 of the Cochrane risk-of-bias tool for randomized trials, Newcastle-Ottawa Scale for observational studies, and Critical Appraisal Skills Programme for qualitative studies) and certainty of evidence (Grading of Recommendations Assessment, Development, and Evaluation; GRADE).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This review included 12 distinct studies (16 reports), of which 6 (50%) were randomized sham-controlled trials forming the meta-analytic pool. Active home-based tDCS produced a small, statistically significant improvement over sham (pooled Hedges &lt;i&gt;g&lt;/i&gt;=0.36, 95% CI 0.06-0.66; &lt;i&gt;P&lt;/i&gt;=.03; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=34.3%). The effect was not robust to removal of the single largest positive trial (omitting the one study from 2025: &lt;i&gt;g&lt;/i&gt;=0.39, 95% CI -0.12 to 0.91), and trial-level results were mixed: the 2 largest trials (one unsupervised [n=210] and one self-administered [n=141]) were negative on their primary depression outcomes, whereas the largest real-time supervised trial (n=174) was positive (between-group 95% CI 0.51-4.01; &lt;i&gt;P&lt;/i&gt;=.01). This estimate was concordant in direction with an independent peer-reviewed meta-analysis of overlapping trials, which reported a pooled Montgomery-Åsberg Depression Rating Scale reduction (weighted mean difference -2.74, 95% CI -4.19 to -1.29) and Hamilton Depression Rating Scale reduction (weighted mean difference -2.24, 95% CI -4.16 to -1.49), attenuating to nonsignificance (&lt;i&gt;P&lt;/i&gt;&gt;.05) in major depressive disorder without comorbid cognitive impairment. The pooled effect fell at or near the minimal clinically important difference. GRADE certainty was moderate. Adverse events were predominantly mild: one pilot study was terminated early for skin lesions, and one nonfatal suicide attempt occurred in an unsupervised trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Home-based and remotely supervised tDCS produ","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"13 ","pages":"e92522"},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}