Jmir Mental Health最新文献

{"title":"Web-Based Interactive Training for Managers (Managing Minds at Work) to Promote Mental Health at Work: Pilot Feasibility Cluster Randomized Controlled Trial.","authors":"Juliet Hassard, Holly Blake, Teixiera Mishael Dulal-Arthur, Alexandra Frost, Craig Bartle, Joanna Yarker, Fehmidah Munir, Ben Vaughan, Guy Daly, Caroline Meyer, Sean Russell, Louise Thomson","doi":"10.2196/76373","DOIUrl":"10.2196/76373","url":null,"abstract":"<p><strong>Background: </strong>Line managers play a key role in preventing poor mental health but often lack necessary skills and knowledge. Existing interventions typically focus on mental health awareness rather than practical skills. The evidence-based Managing Minds at Work (MMW) web-based training program was developed to address this gap by enhancing line managers' confidence and competence in prevention.</p><p><strong>Objective: </strong>This study piloted the MMW intervention to assess its feasibility. Objectives included evaluating (1) uptake potential across small, medium, and large companies; (2) perceived suitability and effectiveness of the intervention; and (3) feasibility of outcome data collection methods.</p><p><strong>Methods: </strong>We conducted a 2-arm pilot cluster randomized controlled trial of a self-guided, web-based training intervention for line managers. Twenty-four organizations were randomly assigned to the MMW intervention or a 3-month waitlist. A total of 224 line managers completed baseline measures (intervention: n=141, 62.9%; control: n=83, 37.1%), along with 112 of their direct reports (intervention: n=74, 66.1%; control: n=38, 33.9%). Follow-up data were collected at 3 and 6 months. Semistructured interviews with line managers and stakeholders (n=20) explored experiences with the study and intervention, and qualitative data were analyzed thematically. Line managers also completed feedback forms after each of the 5 MMW modules.</p><p><strong>Results: </strong>The recruitment of organizations and line managers exceeded targets, and retention rates of line managers were good at 3 months (161/224, 71.9%) but not at the 6-month follow-up (55/224, 24.6%). Feedback on the intervention was very positive, indicating that line managers and organizational stakeholders found the intervention acceptable, usable, and useful. We observed significant improvements with moderate to large effect sizes for all trial outcomes for line managers in the intervention arm from baseline to the 3-month follow-up. Line managers completed a variety of questionnaires, which showed increased scores for confidence in creating a mentally healthy workplace (intervention group: mean change 3.8, SD 3.2; control group: mean change 0.6, SD 3.2), mental health knowledge (intervention group: mean change 1.9, SD 3.0; control group: mean change 0.2, SD 2.9), psychological well-being (intervention group: mean change 3.6, SD 8.3; control group: mean change -0.7, SD 7.7), and mental health literacy at work (intervention group: mean change 11.8, SD 8.9; control group: mean change 0.8, SD 6.2). Collecting data from direct reports in both study arms was challenging, with results inconclusive regarding observed changes in trial outcomes. Time constraints and workload were commonly cited barriers to completion of the intervention.</p><p><strong>Conclusions: </strong>This pilot feasibility trial provides strong evidence for the usability and acceptability of ","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e76373"},"PeriodicalIF":5.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975208","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":"Cost-Effectiveness of Internet-Delivered Emotion Regulation Therapy for Adolescents With Nonsuicidal Self-Injury: Within-Trial Analysis of a Randomized Controlled Trial.","authors":"Johan Bjureberg, Olivia Ojala, Björn Rasmusson, Jessica Malmgren, Clara Hellner, Filipa Sampaio, Oskar Flygare","doi":"10.2196/74303","DOIUrl":"10.2196/74303","url":null,"abstract":"<p><strong>Background: </strong>Nonsuicidal self-injury (NSSI) is common among adolescents and is associated with adverse clinical outcomes, as well as suicidal behavior. Current treatments are resource-intensive and may not be accessible to all adolescents with NSSI. Internet-delivered emotion regulation individual therapy for adolescents (IERITA) with NSSI disorder is a promising treatment option, but its cost-effectiveness is unknown.</p><p><strong>Objective: </strong>This study aims to evaluate the cost-effectiveness of IERITA for adolescents with NSSI disorder.</p><p><strong>Methods: </strong>Within-trial cost-effectiveness analysis of a randomized controlled trial at three child and adolescent mental health services in Sweden (n=166). A total of 12 weeks of IERITA plus treatment as usual (TAU) versus TAU only were compared. The primary outcome was the frequency of NSSI at 1-month posttreatment. Secondary outcomes were NSSI remission and quality-adjusted life years (QALYs).</p><p><strong>Results: </strong>IERITA led to reductions in NSSI frequency, a higher proportion of participants with NSSI remission, and more QALYs at 1-month posttreatment, at additional health care costs of US $3663 (95% CI US $2182-$5002) and societal costs of US $4458 (95% CI US $-577 to $9509). The incremental cost of one additional NSSI remission at 1-month posttreatment was US $18,677, and the incremental cost per QALY gained was US $792,244 for IERITA+TAU relative to TAU. IERITA had an 8% probability of being cost-effective at a societal willingness-to-pay threshold of US $84,000 for one QALY at 1-month posttreatment, which increased to 18% at 3-months posttreatment.</p><p><strong>Conclusions: </strong>IERITA delivered adjunctive to TAU led to improvements in NSSI frequency, remission, and QALYs, at additional costs compared to TAU only. This study provides an estimate of the additional cost of delivering IERITA; however, future studies should include longer follow-up periods to better assess the magnitude of the effects on QALYs and societal costs.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e74303"},"PeriodicalIF":5.8,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975143","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":"A Social Support Just-in-Time Adaptive Intervention for Individuals With Depressive Symptoms: Feasibility Study With a Microrandomized Trial Design.","authors":"Timon Elmer, Markus Wolf, Evelien Snippe, Urte Scholz","doi":"10.2196/74103","DOIUrl":"10.2196/74103","url":null,"abstract":"<p><strong>Background: </strong>Just-in-time adaptive interventions (JITAIs) aim to provide psychological support during critical moments in daily life.</p><p><strong>Objective: </strong>This preregistered study aims to evaluate the feasibility of a social support JITAI for individuals with subclinical and clinical levels of depressive symptoms awaiting psychotherapy. Triggered by ecological momentary assessment (EMA) reports, the intervention encouraged participants to activate their (digital) social support networks.</p><p><strong>Methods: </strong>A total of 25 participants completed 2689 EMA surveys and received 377 JITAIs over an 18-day intervention period, including a microrandomized trial, to compare 4 strategies to trigger an intervention: fixed cutoff points of distress variables, personalized thresholds (through Shewhart control charts) of distress variables, momentary support need, and no intervention.</p><p><strong>Results: </strong>The results showed high feasibility, with participants completing 85.37% (2689/3150) of the EMA surveys, exhibiting a low study-related attrition rate (7%; total attrition rate was 17%), and reporting minimal technical issues. Engagement and perceived helpfulness were heterogeneous and moderate, with participants seeking support in one-third of the instances after an intervention was triggered instances. JITAIs triggered by self-reported need for support were rated as more appropriately timed, helpful, and effective for promoting support-seeking behavior compared to those based on distress indicators, despite being triggered less frequently. Barriers, such as time constraints and perceived unavailability of support providers, likely affected support-seeking behavior, as indicated by additional qualitative analyses. Exploratory effectiveness analyses indicated Cohen d effect sizes between 0.06 and 0.14 in reducing distress after JITAIs were received.</p><p><strong>Conclusions: </strong>The findings of this study demonstrate that a social support JITAI is feasible to implement, with high compliance and minimal technical issues. However, further research is needed to evaluate the JITAI's effectiveness and optimize trigger strategies in addressing individual needs for and barriers to engagement.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e74103"},"PeriodicalIF":5.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975065","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":"\"I Believe That AI Will Recognize the Problem Before It Happens\": Qualitative Study Exploring Young Adults' Perceptions of AI in Mental Health Care.","authors":"Lena Petersson, Mikael G Ahlborg, Katrin Häggström Westberg","doi":"10.2196/76973","DOIUrl":"https://doi.org/10.2196/76973","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Globally, young adults with mental health problems struggle to access appropriate and timely care, which may lead to a poorer future prognosis. Artificial intelligence (AI) is suggested to improve the quality of mental health care through increased capacities in diagnostics, monitoring, access, advanced decision-making, and digital consultations. Within mental health care, the design and application of AI solutions should elucidate the patient perspective on AI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim was to explore the perceptions of AI in mental health care from the viewpoint of young adults with experience of seeking help for common mental health problems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was an interview study with 25 young adults aged between 18 and 30 years that applied a qualitative inductive design, with content analysis, to explore how AI-based technology can be used in mental health care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three categories were derived from the analysis, representing the participants' perceptions of how AI-based technology can be used in care for mental health problems. The first category entailed perceptions of AI-based technology as a digital companion, supporting individuals at difficult times, reminding and suggesting self-care activities, suggesting sources of information, and generally being receptive to changes in behavior or mood. The second category revolved around AI enabling more effective care and functioning as a tool, both for the patient and health care professionals (HCPs). Young adults expressed confidence in AI to improve triage, screening, identification, and diagnosis. The third category concerned risks and skepticism toward AI as a product developed by humans with limitations. Young adults voiced concerns about security and integrity, and about AI being autonomous, incapable of human empathy but with strong predictive capabilities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Young adults recognize the potential of AI to serve as personalized support and its function as a digital guide and companion between mental health care consultations. It was believed that AI would function as a support in navigating the help-seeking process, ensuring that they avoid the \"missing middle\" service gap. They also voiced that AI will improve efficiency in health care, through monitoring, diagnostic accuracy, and reduction of the workload of HCPs, while simultaneously reducing the need for young adults to repeatedly tell their stories. Young adults express an ambivalence toward the use of AI in health care and voice risks of data integrity and bias. They consider AI to be more rational and objective than HCPs but do not want to forsake personal interaction with humans. Based on the results of this study and young adults' perceptions of the monitoring capabilities of AI, future studies should define the boundaries regarding information collection responsibilities of the health care system ve","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e76973"},"PeriodicalIF":5.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975136","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":"Digital Health Interventions for Depression and Anxiety in Low- and Middle-Income Countries: Rapid Scoping Review.","authors":"Leena W Chau, Raymond W Lam, Harry Minas, Kanna Hayashi, Vu Cong Nguyen, John O'Neil","doi":"10.2196/68296","DOIUrl":"10.2196/68296","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Low- and middle-income countries (LMICs), which bear a larger proportion of the global mental illness burden, have been disproportionately impacted by the COVID-19 pandemic due to preexisting mental health care system deficiencies. The pandemic has also led to a considerable increase in care delivered through digital mental health interventions (DMHIs), many of which have been adapted from in-person formats. Thus, there is a need to examine their fidelity to the original format along with issues regarding usability and other challenges to and facilitators of their uptake in LMICs. As most DMHIs have been developed in high-income countries, examining their cultural adaptation to LMIC settings is also critical.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The purpose of this research was to conduct a rapid scoping review of the available evidence on DMHIs for depression and anxiety, two of the most common mental disorders, in LMICs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A rapid scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and processes for rapid reviews by Tricco et al. The PubMed and PsycINFO databases were searched for records published between January 2020 (when COVID-19 was declared a public health emergency) and January 2025 using a search strategy developed in consultation with a liaison librarian. The pandemic accelerated the development and application of DMHIs, and this time frame was used to capture the recent literature that may have incorporated new methods of application. The search strategy was developed across three domains: (1) digital health interventions, (2) depression or anxiety, and (3) LMICs. Data were charted from the final records according to (1) intervention type; (2) discussions on fidelity, usability, and cultural adaptation; and (3) challenges to and facilitators of their uptake in LMICs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 80 records were included in the final analysis, with reasons for exclusion (eg, focused on mental health in general, not being a DMHI, or not focused on LMICs) reported. Six DMHI platforms were identified: (1) mobile app, (2) the web, (3) virtual reality, (4) videoconferencing, (5) telemedicine, and (6) social media. Less than half of the records referenced fidelity (16/80, 20%), usability (29/80, 36%), and cultural adaptation (31/80, 39%). Challenges pertained to the technological system, engagement issues, structural barriers, and concerns regarding privacy and confidentiality. Facilitators included widespread mobile phone use, built-in supervision and training features, and convenience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Despite the opportunities that DMHIs offer for reducing the mental health treatment gap, further work examining and improving their fidelity, usability, and cultural adaptation is required. In addition, various challenges to the uptake of DMHIs in LMIC","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e68296"},"PeriodicalIF":5.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12413575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975240","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":"Exploring the Characteristics of Online Counseling Chat Services for Youth in Europe: Web Search Study.","authors":"Irati Higuera-Lozano, Virvatuli Uusimäki, Tuuli Pitkänen, Elke Denayer, Alexis Dewaele, Katalin Felvinczi, Lien Goossens, Zsuzsa Kaló, Mónika Rényi, María Cabello","doi":"10.2196/67949","DOIUrl":"https://doi.org/10.2196/67949","url":null,"abstract":"<p><strong>Background: </strong>Online counseling chat services are increasingly used by young people worldwide. A growing body of literature supports the use and effectiveness of these services for adolescent mental health. However, there is also a need to provide an overview of the main existing resources to identify unmet needs and gaps in the field.</p><p><strong>Objective: </strong>This study aims to provide an overview of existing online counseling chat services targeting individuals aged 12-30 years in 4 European countries (Belgium, Finland, Hungary, and Spain), and to identify potential needs and gaps by comparing the collected data with recognized quality standard criteria that define the best practices in the field of counseling.</p><p><strong>Methods: </strong>A web search was conducted in the 4 participating countries using the same keywords to identify the main chat services. The final selection of chat services was made using a stratified purposive sampling method. A common data extraction database was developed to record information from these websites. Finally, the extracted information was compared against the fulfillment of 7 selected criteria from the Child Helpline International Quality Standards Framework. Additionally, certain chat characteristics were compared with the number of Child Helpline Quality Standard criteria fulfilled.</p><p><strong>Results: </strong>The search identified a total of 66 service providers offering 71 different chat services. Nongovernmental organizations accounted for more than half of the total service providers42 of 66 (64%). Additional helplines, such as hotlines, were also available through 54 of 66 (82%) service providers. Artificial intelligence tools were incorporated into 6 of 66 (9%) chat services. Differences were observed between countries; for example, the use of volunteers as counselors was predominant in Hungary and Belgium. Topic-specific chat services were common in Belgium and Spain, whereas in Finland and Hungary, chat services generally welcomed a wide range of topics for young people to discuss. Comparisons with Child Helpline International's recommendations revealed some gaps-for example, only 9 of 71 (13%) chat services operated 24 hours a day, and only 10 of 71 (14%) offered interactions in minority groups or foreign languages. Additionally, the use of free social media platforms for chat services was prevalent in some countries, which could compromise users' privacy. Being part of the Child Helpline International consortium was marginally associated with meeting a higher number of standard criteria (β coefficient 1.55; P=.08).</p><p><strong>Conclusions: </strong>This study provides a comprehensive overview of existing online chat counseling services in 4 European countries. Our findings suggest that some existing chat services for young people could be improved in areas such as accessibility, data security, and the inclusion of vulnerable groups.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e67949"},"PeriodicalIF":5.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975190","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":"Feasibility and Acceptability of a Smartphone-Delivered Mindfulness Intervention for Stress Reduction in Adult Singaporeans: Pilot Randomized Controlled Trial.","authors":"Alessandro Sparacio, Jonathan Nicholas Davies, Erin Lee, Jeroen Antonius Johannes Schmitt","doi":"10.2196/77793","DOIUrl":"10.2196/77793","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Fully decentralized self-administered mindfulness interventions show promise for stress reduction, but rigorous evaluations of their feasibility, acceptability, and effectiveness using both self-report and physiological measures remain limited. In Singapore, where mental health concerns rank as the top health care priority (46%), ahead of cancer (38%) and stress-related issues (35%), accessible and scalable interventions are urgently needed to address the significant economic burden of mental health conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate a decentralized, 3-day self-administered mindfulness intervention with minimal supervision, compared with a sham control in Singaporean adults, examining effects on self-reported and physiologically measured stress responses. The inclusion of a sham control condition was intended to disentangle mindfulness-specific effects from demand characteristics and expectation effects, addressing a critical methodological gap in digital mindfulness research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a purely smartphone-based, decentralized pilot trial with no face-to-face components. Participants were recruited using web-based methods and, after providing informed consent, 60 adults were randomized to either a mindfulness intervention or a structurally matched sham control. The daily 10-minute mindfulness sessions guided participants to focus on present-moment breath and body sensations, while the sham control omitted a focus on present-moment awareness. Outcomes were assessed remotely, using self-report questionnaires (State-Trait Anxiety Inventory-6) and physiological data from smartphone-based photoplethysmography (heart rate variability; HRV). The study incorporated three methodological innovations: (1) a structurally equivalent sham control to match expectancy and credibility, (2) remote collection of HRV as an objective physiological biomarker, and (3) full decentralization allowing unsupervised multiplatform delivery. Feasibility was evaluated through recruitment, retention rates, and data quality. Acceptability was assessed through quantitative ratings and qualitative feedback.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study demonstrated excellent feasibility, with near-perfect retention (59/60, 98.3%) and moderate HRV data quality (231/331, 69.8% valid signals). Acceptability ratings were high (mean 4.17, SD 0.53), with comfort/engagement receiving the highest scores (mean 4.27, SD 0.57) on a 5-point scale, exceeding established usability benchmarks for digital health interventions. Qualitative feedback identified technical challenges (HRV instability and device overheating) and scheduling difficulties. While Bayesian analyses did not detect significant group differences in stress reduction (Bayes factor&lt;sub&gt;10&lt;/sub&gt; [BF&lt;sub&gt;10&lt;/sub&gt;]=0.03) or HRV improvement (BF&lt;sub&gt;10&lt;/sub&gt;=0.2), both groups showed significant stress reductions (BF&lt;sub&gt;10&lt;/sub&gt;=3.01×10&lt;","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e77793"},"PeriodicalIF":5.8,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876064","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":"The Ability of AI Therapy Bots to Set Limits With Distressed Adolescents: Simulation-Based Comparison Study.","authors":"Andrew Clark","doi":"10.2196/78414","DOIUrl":"10.2196/78414","url":null,"abstract":"<p><strong>Background: </strong>Recent developments in generative artificial intelligence (AI) have introduced the general public to powerful, easily accessible tools, such as ChatGPT and Gemini, for a rapidly expanding range of uses. Among those uses are specialized chatbots that serve in the role of a therapist, as well as personally curated digital companions that offer emotional support. However, the ability of AI therapists to provide consistently safe and effective treatment remains largely unproven, and those concerns are especially salient in regard to adolescents seeking mental health support.</p><p><strong>Objective: </strong>This study aimed to determine the willingness of therapy and companion AI chatbots to endorse harmful or ill-advised ideas proposed by fictional teenagers experiencing mental health distress.</p><p><strong>Methods: </strong>A convenience sample of 10 publicly available AI bots offering therapeutic support or companionship were each presented with 3 detailed fictional case vignettes of adolescents with mental health challenges. Each fictional adolescent asked the AI chatbot to endorse 2 harmful or ill-advised proposals, such as dropping out of school, avoiding all human contact for a month, or pursuing a relationship with an older teacher, resulting in a total of 6 proposals presented to each chatbot. The clinical scenarios presented were intended to reflect challenges commonly seen in the practice of therapy with adolescents, and the proposals offered by the fictional teenagers were intended to be clearly dangerous or unwise. The 10 AI bots were selected by the author to represent a range of chatbot types, including generic AI bots, companion bots, and dedicated mental health bots. Chatbot responses were analyzed for explicit endorsement, defined as direct support for the teenagers' proposed behavior.</p><p><strong>Results: </strong>Across 60 total scenarios, chatbots actively endorsed harmful proposals in 19 out of the 60 (32%) opportunities to do so. Of the 10 chatbots, 4 endorsed half or more of the ideas proposed to them, and none of the bots managed to oppose them all.</p><p><strong>Conclusions: </strong>A significant proportion of AI chatbots offering mental health or emotional support endorsed harmful proposals from fictional teenagers. These results raise concerns about the ability of some AI-based companion or therapy bots to safely support teenagers with serious mental health issues and heighten concern that AI bots may tend to be overly supportive at the expense of offering useful guidance when appropriate. The results highlight the urgent need for oversight, safety protocols, and ongoing research regarding digital mental health support for adolescents.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e78414"},"PeriodicalIF":5.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876066","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":"Mindful Nonreactivity, Anxiety, Depression, and Perceived Stress as Mediators of the Mindfulness Virtual Community Intervention-Pathways to Enhance Mental Health in University Students: Secondary Evaluation of Two Randomized Controlled Trials With Student Participants.","authors":"Meysam Pirbaglou, Christo El Morr, Farah Ahmad, Paul Ritvo","doi":"10.2196/65853","DOIUrl":"10.2196/65853","url":null,"abstract":"<p><strong>Background: </strong>Mindfulness-based interventions (MBIs) are widely used in mental health promotion and treatment. Despite widespread evidence of effectiveness with different populations and delivery modes, there are sparse findings concerning the mechanisms of action in MBIs.</p><p><strong>Objective: </strong>The objective of this paper was to understand the mediators of the Mindfulness Virtual Community (MVC) intervention, an 8-week, multicomponent, online mindfulness and cognitive-behavioral therapy (M-CBT) intervention, based on a secondary evaluation of 2 randomized controlled trials (RCTs) with student participants.</p><p><strong>Methods: </strong>Mediation analysis, using structural equation modeling, was used to assess direct and indirect relationships between study group (ie, intervention or wait list control) and outcomes. Consistent with the intervention's theoretical perspective and direct effects paths, a model was specified to evaluate whether mindful nonreactivity, as evaluated by the 5-factor mindfulness questionnaire, mediated the effect of MVC intervention on anxiety and depression (as symptom-driven outcomes), and perceived stress and quality of life (as functional outcomes). The model included additional mediating paths for perceived stress through anxiety and depression, and for quality of life through anxiety, depression, and perceived stress. The model was thereafter extended, adjusting for pre-intervention differences in mindfulness (ie, observing, describing, activity with awareness, nonjudgment, and nonreactivity) facets.</p><p><strong>Results: </strong>Direct (nonmediated) effects indicated statistically significant differences at 8 weeks between the MVC and waitlist control (WLC) groups on depression (-1.72; P=.002), anxiety (-3.40; P=.001), perceived stress (-2.44; P<.001), quality of life (4.31; P=.005), and the nonreactivity facet of mindfulness (1.63; P<.001), in favor of the MVC intervention. Mediation analysis supported the mediating role of the nonreactivity facet of mindfulness, depression, anxiety, and perceived stress through single and sequential mediation paths. Results indicated good fit characteristics for the main (comparative fit index [CFI]=.99; root-mean-square error of approximation [RMSEA]=.05; standardized root-mean-square residual [SRMR]=.05) and extended (CFI=.99; RMSEA=.04; SRMR=.04) models.</p><p><strong>Conclusions: </strong>This research underscores the importance of mindful nonreactivity, depression, and anxiety as key mediators of MVC intervention benefits.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e65853"},"PeriodicalIF":5.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876065","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":"Placebo, Nocebo, and Machine Learning: How Generative AI Could Shape Patient Perception in Mental Health Care.","authors":"Charlotte Blease","doi":"10.2196/78663","DOIUrl":"10.2196/78663","url":null,"abstract":"<p><strong>Unlabelled: </strong>The emergence of generative artificial intelligence (GenAI) in clinical settings-particularly in health documentation and communication-presents a largely unexplored but potentially transformative force in shaping placebo and nocebo effects. These psychosocial phenomena are especially potent in mental health care, where outcomes are closely tied to patients' expectations, perceived provider competence, and empathy. Drawing on conceptual understanding of placebo and nocebo effects and the latest research, this Viewpoint argues that GenAI may amplify these effects, both positive and negative. Through tone, assurance, and even the rapidity of responses, GenAI-generated text-either co-written with clinicians or peers, or fully automated-could influence patient perceptions in ways that mental health clinicians may not currently fully anticipate. When embedded in clinician notes or patient-facing summaries, AI language may strengthen expectancies that underlie placebo effects, or conversely, heighten nocebo effects through subtle cues, inaccuracies, or potentially via loss of human nuance. This article explores the implications of AI-mediated clinical communication particularly in mental health care, emphasizing the importance of transparency, ethical oversight, and psychosocial awareness as these technologies evolve.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e78663"},"PeriodicalIF":5.8,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859816","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}