Jmir Mental Health最新文献

{"title":"The Prevalence and Incidence of Suicidal Thoughts and Behavior in a Smartphone-Delivered Treatment Trial for Body Dysmorphic Disorder: Cohort Study.","authors":"Adam C Jaroszewski, Natasha Bailen, Simay I Ipek, Jennifer L Greenberg, Susanne S Hoeppner, Hilary Weingarden, Ivar Snorrason, Sabine Wilhelm","doi":"10.2196/63605","DOIUrl":"10.2196/63605","url":null,"abstract":"<p><strong>Background: </strong>People with past suicidal thoughts and behavior (STB) are often excluded from digital mental health intervention (DMHI) treatment trials. This may perpetuate barriers to care and reduce treatment generalizability, especially in populations with elevated rates of STB, such as body dysmorphic disorder (BDD). We conducted a cohort study of randomized controlled trial (RCT) participants (N=80) who received a smartphone-based cognitive behavioral therapy (CBT) treatment for BDD that allowed for most forms of past STB, except for past-month active suicidal ideation.</p><p><strong>Objective: </strong>This study had two objectives: (1) to characterize the sample's lifetime prevalence of STB and (2) to estimate and predict STB incidence during the trial.</p><p><strong>Methods: </strong>We completed secondary analyses on data from an RCT of smartphone-delivered CBT for BDD. The primary outcomes consisted of STB severity and suicide attempt assessed at baseline with the Columbia-Suicide Severity Rating Scale (C-SSRS) and weekly during the trial via one item from the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR item #12; 1043 observations). We computed descriptive statistics (n, %) and ran a series of bi- and multivariate linear regressions predicting STB incidence during the 3-month trial.</p><p><strong>Results: </strong>At baseline, 40% of participants reported a lifetime history of active suicidal thoughts and 10% reported lifetime suicide attempts. During the 3-month trial, 42.5% reporting thinking about death or suicide via weekly assessment. No participants reported frequent or acute suicidal thoughts, plans, or attempts. Lifetime suicide attempt (odds ratio 11, 95% CI 2.14-59.14; P<.01) and lifetime severity of suicidal thoughts (odds ratio 1.76, 95% CI 1.21-2.77; P<.01) were significant bivariate predictors of death- or suicide-related thought incidence reported during the trial. Multivariate models including STB risk factor covariates (eg, age, and sexual orientation) modestly improved prediction of death- or suicide-related thoughts (eg, positive predictive value=0.91, negative predictive value=0.75, and area under the receiver operating characteristic curve=0.83).</p><p><strong>Conclusions: </strong>Although some participants may think about death and suicide during a DMHI trial, it may be safe and feasible to include participants with most forms of past STB. Among other procedures, researchers should carefully select eligibility criteria, use frequent, ongoing, low-burden, and valid monitoring procedures, and implement risk mitigation protocols tailored to the presenting problem.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e63605"},"PeriodicalIF":4.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046465","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":"Game Design, Effectiveness, and Implementation of Serious Games Promoting Aspects of Mental Health Literacy Among Children and Adolescents: Systematic Review.","authors":"Michael Zeiler, Sandra Vögl, Ursula Prinz, Nino Werner, Gudrun Wagner, Andreas Karwautz, Natalie Zeller, Lorenz Ackermann, Karin Waldherr","doi":"10.2196/67418","DOIUrl":"10.2196/67418","url":null,"abstract":"<p><strong>Background: </strong>The effects of traditional health-promoting and preventive interventions in mental health and mental health literacy are often attenuated by low adherence and user engagement. Gamified approaches such as serious games (SGs) may be useful to reach and engage youth for mental health prevention and promotion.</p><p><strong>Objective: </strong>This study aims to systematically review the literature on SGs designed to promote aspects of mental health literacy among adolescents aged 10 to 14 years, focusing on game design characteristics and the evaluation of user engagement, as well as efficacy, effectiveness, and implementation-related factors.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, and PsycINFO for original studies, intervention development studies, and study protocols that described the development, characteristics, and evaluation of SG interventions promoting aspects of mental health literacy among adolescents aged 10 to 14 years. We included SGs developed for both universal and selected prevention. Using the co.LAB framework, which considers aspects of learning design, game mechanics, and game design, we coded the design elements of the SGs described in the studies. We coded the characteristics of the evaluation studies; indicators of efficacy, effectiveness, and user engagement; and factors potentially fostering or hindering the reach, efficacy and effectiveness, organizational adoption, implementation, and maintenance of the SGs.</p><p><strong>Results: </strong>We retrieved 1454 records through database searches and other sources. Of these, 36 (2.48%) studies describing 17 distinct SGs were included in the review. Most of the SGs (14/17, 82%) were targeted to a universal population of youth, with learning objectives mainly focusing on how to obtain and maintain good mental health and on enhancing help-seeking efficacy. All SGs were single-player games, and many (7/17, 41%) were embedded within a wider pedagogical scenario. Diverse game mechanics and game elements (eg, minigames and quizzes) were used to foster user engagement. Most of the SGs (12/17, 71%) featured an overarching storyline resembling real-world scenarios, fictional scenarios, or a combination of both. The evaluation studies provided evidence for the short-term efficacy and effectiveness of SGs in improving aspects of mental health literacy as well as their feasibility. However, the evidence was mostly based on small samples, and user adherence was sometimes low.</p><p><strong>Conclusions: </strong>The results of this review may inform the future development and implementation of SGs for adolescents. Intervention co-design, the involvement of facilitators (eg, teachers), and the use of diverse game mechanics and customization to meet the needs of diverse users are examples of elements that may promote intervention success. Although there is promising evidence for the efficacy and effectiveness of SGs for promoting mental health","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e67418"},"PeriodicalIF":5.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992726","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":"Impact of Conversational and Animation Features of a Mental Health App Virtual Agent on Depressive Symptoms and User Experience Among College Students: Randomized Controlled Trial.","authors":"Stephanie Six, Elizabeth Schlesener, Victoria Hill, Sabarish V Babu, Kaileigh Byrne","doi":"10.2196/67381","DOIUrl":"https://doi.org/10.2196/67381","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Numerous mental health apps purport to alleviate depressive symptoms. Strong evidence suggests that brief cognitive behavioral therapy (bCBT)-based mental health apps can decrease depressive symptoms, yet there is limited research elucidating the specific features that may augment its therapeutic benefits. One potential design feature that may influence effectiveness and user experience is the inclusion of virtual agents that can mimic realistic, human face-to-face interactions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The goal of the current experiment was to determine the effect of conversational and animation features of a virtual agent within a bCBT-based mental health app on depressive symptoms and user experience in college students with and without depressive symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;College students (N=209) completed a 2-week intervention in which they engaged with a bCBT-based mental health app with a customizable therapeutic virtual agent that varied in conversational and animation features. A 2 (time: baseline vs 2-week follow-up) × 2 (conversational vs non-conversational agent) × 2 (animated vs non-animated agent) randomized controlled trial was used to assess mental health symptoms (Patient Health Questionnaire-8, Perceived Stress Scale-10, and Response Rumination Scale questionnaires) and user experience (mHealth App Usability Questionnaire, MAUQ) in college students with and without current depressive symptoms. The mental health app usability and qualitative questions regarding users' perceptions of their therapeutic virtual agent interactions and customization process were assessed at follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mixed ANOVA (analysis of variance) results demonstrated a significant decrease in symptoms of depression (P=.002; mean [SD]=5.5 [4.86] at follow-up vs mean [SD]=6.35 [4.71] at baseline), stress (P=.005; mean [SD]=15.91 [7.67] at follow-up vs mean [SD]=17.02 [6.81] at baseline), and rumination (P=.03; mean [SD]=40.42 [12.96] at follow-up vs mean [SD]=41.92 [13.61] at baseline); however, no significant effect of conversation or animation was observed. Findings also indicate a significant increase in user experience in animated conditions. This significant increase in animated conditions is also reflected in the user's ease of use and satisfaction (F(1, 201)=102.60, P&lt;.001), system information arrangement (F(1, 201)=123.12, P&lt;.001), and usefulness of the application (F(1, 201)=3667.62, P&lt;.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The current experiment provides support for bCBT-based mental health apps featuring customizable, humanlike therapeutic virtual agents and their ability to significantly reduce negative symptomology over a brief timeframe. The app intervention reduced mental health symptoms, regardless of whether the agent included conversational or animation features, but animation features enhanced the user experience. These effects were observed in both user","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e67381"},"PeriodicalIF":4.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054870","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":"Health Care Professionals' Engagement With Digital Mental Health Interventions in the United Kingdom and China: Mixed Methods Study on Engagement Factors and Design Implications.","authors":"Zheyuan Zhang, Sijin Sun, Laura Moradbakhti, Andrew Hall, Celine Mougenot, Juan Chen, Rafael A Calvo","doi":"10.2196/67190","DOIUrl":"10.2196/67190","url":null,"abstract":"<p><strong>Background: </strong>Mental health issues like occupational stress and burnout, compounded with the after-effects of COVID-19, have affected health care professionals (HCPs) around the world. Digital mental health interventions (DMHIs) can be accessible and effective in supporting well-being among HCPs. However, low engagement rates of DMHIs are frequently reported, limiting the potential effectiveness. More evidence is needed to reveal the factors that impact HCPs' decision to adopt and engage with DMHIs.</p><p><strong>Objective: </strong>This study aims to explore HCPs' motivation to engage with DMHIs and identify key factors affecting their engagement. Amongst these, we include cultural factors impacting DMHI perception and engagement among HCPs.</p><p><strong>Methods: </strong>We used a mixed method approach, with a cross-sectional survey (n=438) and semistructured interviews (n=25) with HCPs from the United Kingdom and China. Participants were recruited from one major public hospital in each country.</p><p><strong>Results: </strong>Our results demonstrated a generally low engagement rate with DMHIs among HCPs from the 2 countries. Several key factors that affect DMHI engagement were identified, including belonging to underrepresented cultural and ethnic groups, limited mental health knowledge, low perceived need, lack of time, needs for relevance and personal-based support, and cultural elements like self-stigma. The results support recommendations for DMHIs for HCPs.</p><p><strong>Conclusions: </strong>Although DMHIs can be an ideal alternative mental health support for HCPs, engagement rates among HCPs in China and the United Kingdom are still low due to multiple factors and barriers. More research is needed to develop and evaluate tailored DMHIs with unique designs and content that HCPs can engage from various cultural backgrounds.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e67190"},"PeriodicalIF":4.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11990651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784595","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":"Psychotherapy Access Barriers and Interest in Digital Mental Health Interventions Among Adults With Treatment Needs: Survey Study.","authors":"Isabella Starvaggi, Lorenzo Lorenzo-Luaces","doi":"10.2196/65356","DOIUrl":"10.2196/65356","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Digital mental health interventions (DMHIs) are a promising approach to reducing the public health burden of mental illness. DMHIs are efficacious, can provide evidence-based treatment with few resources, and are highly scalable relative to one-on-one face-to-face psychotherapy. There is potential for DMHIs to substantially reduce unmet treatment needs by circumventing structural barriers to treatment access (eg, cost, geography, and time). However, epidemiological research on perceived barriers to mental health care use demonstrates that attitudinal barriers, such as the lack of perceived need for treatment, are the most common self-reported reasons for not accessing care. Thus, the most important barriers to accessing traditional psychotherapy may also be barriers to accessing DMHIs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to explore whether attitudinal barriers to traditional psychotherapy access might also serve as barriers to DMHI uptake. We explored the relationships between individuals' structural versus attitudinal barriers to accessing psychotherapy and their indicators of potential use of internet-delivered guided self-help (GSH).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We collected survey data from 971 US adults who were recruited online via Prolific and screened for the presence of psychological distress. Participants provided information about demographic characteristics, current symptoms, and the use of psychotherapy in the past year. Those without past-year psychotherapy use (640/971, 65.9%) answered questions about perceived barriers to psychotherapy access, selecting all contributing barriers to not using psychotherapy and a primary barrier. Participants also read detailed information about a GSH intervention. Primary outcomes were participants' self-reported interest in the GSH intervention and self-reported likelihood of using the intervention if offered to them.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Individuals who had used psychotherapy in the past year reported greater interest in GSH than those who had not (odds ratio [OR] 2.38, 95% CI 1.86-3.06; P&lt;.001) and greater self-reported likelihood of using GSH (OR 2.25, 95% CI 1.71-2.96; P&lt;.001). Attitudinal primary barriers (eg, lack of perceived need; 336/640, 52.5%) were more common than structural primary barriers (eg, money or insurance; 244/640, 38.1%). Relative to endorsing a structural primary barrier, endorsing an attitudinal primary barrier was associated with lower interest in GSH (OR 0.44, 95% CI 0.32-0.6; across all 3 barrier types, P&lt;.001) and lower self-reported likelihood of using GSH (OR 0.61, 95% CI 0.43-0.87; P=.045). We found no statistically significant differences in primary study outcomes by race or ethnicity or by income, but income had a statistically significant relationship with primary barrier type (ORs 0.27-3.71; P=.045).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings suggest that attitudinal barriers to traditional psych","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e65356"},"PeriodicalIF":4.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12000781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755037","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":"Mental Health Professionals' Technology Usage and Attitudes Toward Digital Health for Psychosis: Comparative Cross-Sectional Survey Study.","authors":"Xiaolong Zhang, Natalie Berry, Daniela Di Basilio, Cara Richardson, Emily Eisner, Sandra Bucci","doi":"10.2196/68362","DOIUrl":"10.2196/68362","url":null,"abstract":"<p><strong>Background: </strong>Digital health technologies (DHTs) for psychosis have been developed and tested rapidly in recent years. However, research examining mental health professionals' views on the use of DHTs for people with psychosis is limited. Given the increased accessibility and availability of DHTs for psychosis, an up-to-date understanding of staff perception of DHTs for psychosis is warranted.</p><p><strong>Objective: </strong>In this study, we aimed to investigate mental health professionals' usage of technology and their perception of service users' technology usage; their views toward the use of DHTs for psychosis, including their concerns; and barriers for implementing DHTs in a mental health setting.</p><p><strong>Methods: </strong>Two cross-sectional surveys were distributed to mental health care staff who had experience of working with individuals experiencing psychosis in the United Kingdom. Survey 1 (from April 2018 to September 2020) was distributed to 3 local UK National Health Service (NHS) trusts in Northwest England; survey 2 was administered nationally across 31 UK NHS trusts or health boards (from November 2022 to March 2024). The COVID-19 pandemic occurred between the 2 survey periods. Data were analyzed descriptively.</p><p><strong>Results: </strong>A total of 155 and 352 participants completed surveys 1 and 2, respectively. Staff reported high levels of technology ownership and usage in both surveys. In general, staff expressed positive views regarding the use of DHTs for psychosis; however, barriers and concerns, including affordability, digital literacy, and potential negative effects on service users' mental health, were also reported. We did not find notable changes in terms of staff use of digital technology in clinical practice over time.</p><p><strong>Conclusions: </strong>Staff sampled from a broad and diverse range expressed consistent optimism about the potential implementation of DHTs in practice, though they also noted some concerns regarding safety and access. While the COVID-19 pandemic is frequently regarded as a catalyst for the adoption of digital health care tools, the sustainability of this transition from traditional to digital health care appeared to be suboptimal. To address staff concerns regarding safety and potentially facilitate the implementation of DHTs, systematic evaluation of adverse effects of using DHTs and dissemination of evidence are needed. Organizational support and training should be offered to staff to help address barriers and increase confidence in recommending and using DHTs with service users.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e68362"},"PeriodicalIF":4.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754847","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":"Defining Cyberpsychopathy : An Integrative Review.","authors":"Alexandre Hudon, Emmy Harvey, Sandrine Nicolas, Mathieu Dufour, Caroline Guérin-Thériault, Julie Bérubé-Fortin, Isabelle Combey, Yu Chen Yue, Antoine Perreault, Stéphanie Borduas Pagé, Véronique MacDermott","doi":"10.2196/75167","DOIUrl":"https://doi.org/10.2196/75167","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The rapid expansion of digital communication platforms has created new spaces for the expression of antisocial, manipulative, and emotionally detached behaviors. While traditional psychopathy has been well-characterized in clinical and forensic settings, the manifestation of similar traits in digital environments, referred to as cyberpsychopathy, remains conceptually fragmented and underdefined. Although several studies have examined dark personality traits in relation to online aggression, trolling, and social media misuse, an integrative framework for understanding how psychopathic tendencies operate in virtual contexts has yet to be established.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this integrative review was to synthesize the existing literature on cyberpsychopathy in order to (1) identify the primary conceptual domains underpinning this construct, (2) assess the methodological quality of included studies, and (3) offer a preliminary, evidence-based definition of cyberpsychopathy that reflects both dispositional traits and digital affordances.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An integrative search of peer-reviewed literature was conducted using multiple databases to identify empirical studies published that explored psychopathy or dark personality traits in relation to online behaviors. Thirty-five studies met the inclusion criteria and were analyzed using thematic synthesis. The methodological quality of each study was evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Six core conceptual domains were identified across the literature: (1) online behaviors (e.g., trolling, cyberbullying, deception), (2) online environment (e.g., anonymity, platform design, reward mechanisms), (3) sociodemographic factors (e.g., age, gender, culture), (4) personality traits (e.g., narcissism, Machiavellianism, psychopathy, sadism), (5) psychological factors (e.g., emotion dysregulation, impulsivity, low self-esteem), and (6) motivations (e.g., dominance, validation seeking, emotional compensation). These domains interact dynamically to shape the expression of psychopathic tendencies in online contexts. Most studies were of moderate to high quality, though methodological variability limited direct comparisons across findings. A working definition of cyberpsychopathy was proposed as a multidimensional construct involving the online expression of dark personality traits, shaped by digital affordances, psychological vulnerabilities, and social reinforcement mechanisms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Cyberpsychopathy represents a complex and context-dependent phenomenon that extends beyond traditional models of psychopathy. This review provides a foundational framework for its study and highlights the need for further empirical research, including the development of validated assessment tools tailored to digital behaviors. Understanding the mechanisms behind cyberpsychopathy is essential for designing effective interventions, inf","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744126","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":"Effectiveness of General Practitioner Referral Versus Self-Referral Pathways to Guided Internet-Delivered Cognitive Behavioral Therapy for Depression, Panic Disorder, and Social Anxiety Disorder: Naturalistic Study.","authors":"Jill Bjarke, Rolf Gjestad, Tine Nordgreen","doi":"10.2196/68165","DOIUrl":"10.2196/68165","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Therapist-guided, internet-delivered cognitive behavioral therapy (guided ICBT) appears to be efficacious for depression, panic disorder (PD), and social anxiety disorder (SAD) in routine care clinical settings. However, implementation of guided ICBT in specialist mental health services is limited partly due to low referral rates from general practitioners (GP), which may stem from lack of awareness, limited knowledge of its effectiveness, or negative attitudes toward the treatment format. In response, self-referral systems were introduced in mental health care about a decade ago to improve access to care, yet little is known about how referral pathways may affect treatment outcomes in guided ICBT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to compare the overall treatment effectiveness of GP referral and self-referral to guided ICBT for patients with depression, PD, or SAD in a specialized routine care clinic. This study also explores if the treatment effectiveness varies between referral pathways and the respective diagnoses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This naturalistic open effectiveness study compares treatment outcomes from pretreatment to posttreatment and from pretreatment to 6-month follow-up across 2 referral pathways. All patients underwent module-based guided ICBT lasting up to 14 weeks. The modules covered psychoeducation, working with negative or automatic thoughts, exposure training, and relapse prevention. Patients received weekly therapist guidance through asynchronous messaging, with therapists spending an average of 10-30 minutes per patient per week. Patients self-reported symptoms before, during, immediately after, and 6 months posttreatment. Level and change in symptom severity were measured across all diagnoses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 460 patients met the inclusion criteria, of which 305 were GP-referred (\"GP\" group) and 155 were self-referred (\"self\" group). Across the total sample, about 60% were female, and patients had a mean age of 32 years and average duration of disorder of 10 years. We found no significant differences in pretreatment symptom levels between referral pathways and across the diagnoses. Estimated effect sizes based on linear mixed modeling showed large improvements from pretreatment to posttreatment and from pretreatment to follow-up across all diagnoses, with statistically significant differences between referral pathways (GP: 0.97-1.22 vs self: 1.34-1.58, P&lt;.001-.002) and for the diagnoses separately: depression (GP: 0.86-1.26, self: 1.97-2.07, P&lt;.001-.02), PD (GP: 1.32-1.60 vs self: 1.64-2.08, P=.06-.02) and SAD (GP: 0.80-0.99 vs self: 0.99-1.19, P=.18-.22).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Self-referral to guided ICBT for depression and PD appears to yield greater treatment outcomes compared to GP referrals. We found no difference in outcome between referral pathway for SAD. This study underscores the potential of self-referral pathway","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e68165"},"PeriodicalIF":4.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711783","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":"Effects of Sound Interventions on the Mental Stress Response in Adults: Scoping Review.","authors":"Marina Saskovets, Irina Saponkova, Zilu Liang","doi":"10.2196/69120","DOIUrl":"10.2196/69120","url":null,"abstract":"<p><strong>Background: </strong>This scoping review examines the effects of various sound interventions, including music, natural sounds, and speech, on the stress response in adults.</p><p><strong>Objective: </strong>The review aims to identify key therapeutic factors, including sound type, individual listener characteristics, and environmental influences. It also synthesizes evidence on physiological responses to sound interventions and highlights current research gaps.</p><p><strong>Methods: </strong>We conducted a comprehensive search using databases such as PubMed, Web of Science, Scopus, and PsycINFO, focusing on studies from 1990 to 2024. Eligible studies included randomized controlled trials, clinical trials, and laboratory experiments that measured stress through physiological markers (eg, heart rate variability and cortisol) and self-reports. A total of 34 studies were included, and thematic analysis was conducted to identify recurring themes in the findings.</p><p><strong>Results: </strong>The findings suggest that music, especially classical and self-selected pieces, effectively reduces physiological stress markers, including cortisol levels, heart rate variability, and blood pressure. Nonmusical sounds, such as nature sounds and calming voices, also demonstrate potential for stress relief, although research in this area remains limited. While most sound interventions showed positive effects, some studies reported adverse effects, indicating that sound can both alleviate and induce stress. The outcomes were substantially affected by contextual factors such as personal preferences, delivery methods, cultural context, and emphasizing the importance of personalized interventions.</p><p><strong>Conclusions: </strong>Sound interventions offer promising, noninvasive methods for stress reduction. This review suggests that future research should address gaps in the study of nonmusical sound interventions and further investigate the neural mechanisms underlying stress responses to sound.</p><p><strong>International registered report identifier (irrid): </strong>RR2-10.2196/54030.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e69120"},"PeriodicalIF":4.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11976171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701346","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 Biases of Large Language Models in the Field of Mental Health: Comparative Questionnaire Study of the Effect of Gender and Sexual Orientation in Anorexia Nervosa and Bulimia Nervosa Case Vignettes.","authors":"Rebekka Schnepper, Noa Roemmel, Rainer Schaefert, Lena Lambrecht-Walzinger, Gunther Meinlschmidt","doi":"10.2196/57986","DOIUrl":"10.2196/57986","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Large language models (LLMs) are increasingly used in mental health, showing promise in assessing disorders. However, concerns exist regarding their accuracy, reliability, and fairness. Societal biases and underrepresentation of certain populations may impact LLMs. Because LLMs are already used for clinical practice, including decision support, it is important to investigate potential biases to ensure a responsible use of LLMs. Anorexia nervosa (AN) and bulimia nervosa (BN) show a lifetime prevalence of 1%-2%, affecting more women than men. Among men, homosexual men face a higher risk of eating disorders (EDs) than heterosexual men. However, men are underrepresented in ED research, and studies on gender, sexual orientation, and their impact on AN and BN prevalence, symptoms, and treatment outcomes remain limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We aimed to estimate the presence and size of bias related to gender and sexual orientation produced by a common LLM as well as a smaller LLM specifically trained for mental health analyses, exemplified in the context of ED symptomatology and health-related quality of life (HRQoL) of patients with AN or BN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We extracted 30 case vignettes (22 AN and 8 BN) from scientific papers. We adapted each vignette to create 4 versions, describing a female versus male patient living with their female versus male partner (2 × 2 design), yielding 120 vignettes. We then fed each vignette into ChatGPT-4 and to \"MentaLLaMA\" based on the Large Language Model Meta AI (LLaMA) architecture thrice with the instruction to evaluate them by providing responses to 2 psychometric instruments, the RAND-36 questionnaire assessing HRQoL and the eating disorder examination questionnaire. With the resulting LLM-generated scores, we calculated multilevel models with a random intercept for gender and sexual orientation (accounting for within-vignette variance), nested in vignettes (accounting for between-vignette variance).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In ChatGPT-4, the multilevel model with 360 observations indicated a significant association with gender for the RAND-36 mental composite summary (conditional means: 12.8 for male and 15.1 for female cases; 95% CI of the effect -6.15 to -0.35; P=.04) but neither with sexual orientation (P=.71) nor with an interaction effect (P=.37). We found no indications for main effects of gender (conditional means: 5.65 for male and 5.61 for female cases; 95% CI -0.10 to 0.14; P=.88), sexual orientation (conditional means: 5.63 for heterosexual and 5.62 for homosexual cases; 95% CI -0.14 to 0.09; P=.67), or for an interaction effect (P=.61, 95% CI -0.11 to 0.19) for the eating disorder examination questionnaire overall score (conditional means 5.59-5.65 95% CIs 5.45 to 5.7). MentaLLaMA did not yield reliable results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;LLM-generated mental HRQoL estimates for AN and BN case vignettes may be biased by ge","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e57986"},"PeriodicalIF":4.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665173","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}