Jmir Mental Health最新文献

{"title":"A Prompt Engineering Framework for Large Language Model-Based Mental Health Chatbots: Conceptual Framework.","authors":"Sorio Boit, Rajvardhan Patil","doi":"10.2196/75078","DOIUrl":"10.2196/75078","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI), particularly large language models (LLMs), presents a significant opportunity to transform mental health care through scalable, on-demand support. While LLM-powered chatbots may help reduce barriers to care, their integration into clinical settings raises critical concerns regarding safety, reliability, and ethical oversight. A structured framework is needed to capture their benefits while addressing inherent risks. This paper introduces a conceptual model for prompt engineering, outlining core design principles for the responsible development of LLM-based mental health chatbots.</p><p><strong>Objective: </strong>This paper proposes the Mental Well-Being Through Dialogue - Safeguarded and Adaptive Framework for Ethics (MIND-SAFE), a comprehensive, layered framework for prompt engineering that integrates evidence-based therapeutic models, adaptive technology, and ethical safeguards. The objective is to propose and outline a practical foundation for developing AI-driven mental health interventions that are safe, effective, and clinically relevant.</p><p><strong>Methods: </strong>We outline a layered architecture for an LLM-based mental health chatbot. The design incorporates (1) an input layer with proactive risk detection; (2) a dialogue engine featuring a user state database for personalization and retrieval-augmented generation to ground responses in evidence-based therapies such as cognitive behavioral therapy, acceptance and commitment therapy, and dialectical behavior therapy; and (3) a multitiered safety system, including a postgeneration ethical filter and a continuous learning loop with therapist oversight.</p><p><strong>Results: </strong>The primary contribution is the framework itself, which systematically embeds clinical principles and ethical safeguards into system design. We also propose a comparative validation strategy to evaluate the framework's added value against a baseline model. Its components are explicitly mapped to the Framework for AI Tool Assessment in Mental Health and Readiness Evaluation for AI-Mental Health Deployment and Implementation frameworks, ensuring alignment with current scholarly standards for responsible AI development.</p><p><strong>Conclusions: </strong>The framework offers a practical foundation for the responsible development of LLM-based mental health support. By outlining a layered architecture and aligning it with established evaluation standards, this work offers guidance for developing AI tools that are technically capable, safe, effective, and ethically sound. Future research should prioritize empirical validation of the framework through the phased, comparative approach introduced in this paper.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e75078"},"PeriodicalIF":5.8,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12594504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472246","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 Conversational Agents for the Mental Health of Treatment-Seeking Youth: Scoping Review.","authors":"Lisa D Hawke, Jingyi Hou, Anh T P Nguyen, Thalia Phi, Jamie Gibson, Brian Ritchie, Gillian Strudwick, Terri Rodak, Louise Gallagher","doi":"10.2196/77098","DOIUrl":"10.2196/77098","url":null,"abstract":"<p><strong>Background: </strong>Digital conversational agents (or \"chatbots\") that can generate human-like conversations have recently been adapted as a means of administering mental health interventions. However, their development for youth seeking mental health services requires further investigation.</p><p><strong>Objective: </strong>This youth-engaged scoping review synthesizes the recent research on digital conversational agents for youth seeking mental health or substance use services.</p><p><strong>Methods: </strong>Studies were included if they were published between 2016 and 2025 and examined digital conversational agents for youth aged 11 to 24 years with mental health or substance use challenges in clinical settings. Systematic literature searches were conducted in February 2024 in multiple databases and updated in March 2025. Data were extracted using codeveloped forms and synthesized narratively.</p><p><strong>Results: </strong>Ten studies were included, all focusing on mental health. Seven examined the acceptability and feasibility of digital conversational agents; others explored youth perceptions of use, design, and content, with some exploration of impact on mental health symptoms. Eight of ten studies reported high acceptability or positive user experiences. Three were randomized controlled trials that found potential reductions in depressive symptoms. Reporting on the ethical standards was limited. No studies focused on substance use alone.</p><p><strong>Conclusions: </strong>Literature on digital conversational agents for treatment-seeking youth is emerging but limited. Future rigorous research is needed that prioritizes data security, safety measures, and youth co-design in the development of safe, engaging, digital conversational agents for youth with mental health conditions.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e77098"},"PeriodicalIF":5.8,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12639337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472251","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":"An Overview of Reviews on Telemedicine and Telehealth in Dementia Care: Mixed Methods Synthesis.","authors":"Israel Júnior Borges do Nascimento, Hebatullah Mohamed Abdulazeem, Ishanka Weerasekara, Amin Sharifan, Victor Grandi Bianco, Indunil Kularathne, Ciara Cunningham, Brijesh Sathian, Genevieve Deeken, Lasse Østengaard, Rachel Frederique-Djurdjevic, Joost van Hoof, Ledia Lazeri, Cassie Redlich, Hannah R Marston, Nathalia Sernizon Guimarães, Jerome de Barros, Ryan Alistar Dos Santos, Natasha Azzopardi-Muscat, Yongjie Yon, David Novillo-Ortiz","doi":"10.2196/75266","DOIUrl":"10.2196/75266","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Population aging has intensified the global burden of dementia, creating significant challenges for patients, caregivers, and health care systems. While traditional in-person dementia care faces barriers, digital health technologies offer promising solutions to enhance accessibility, efficiency, and patient-centered care. However, evidence on applicability, safety, and effectiveness in dementia care remains fragmented, underscoring systematic evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to assess the effectiveness, applicability, safety, and cost-efficiency of telemedicine technologies in dementia care, providing a comprehensive summary of evidence spanning clinical, psychological, socioeconomic, and operational impacts for persons living with dementia and their caregivers and assess alignment with the World Health Organization (WHO) Age-friendly Cities and Communities' Framework and Dementia Inclusive Society Framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An overview of systematic and scoping reviews was conducted following a search in 5 databases (MEDLINE, Embase, Scopus, Epistemonikos, and Cochrane Database of Systematic Reviews), with a gray literature search on February 20, 2024. Eligible studies reported predefined outcomes related to telemedicine interventions for integrated dementia care, including effects on mental health, quality of life, physical activity, hospitalization, financial costs, safety, social isolation, and motor function. Screening and data extraction were performed by 10 reviewers. The findings were synthesized using the Thematic Analysis in Meta-Evidence (TAME) methodology, combining thematic and lexical analyses with single-proportion meta-analysis for comprehensive qualitative-quantitative synthesis. The methodological quality was assessed using the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews), with GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) for outcomes' confidence in evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ninety-one reviews provided evidence on the impact of telemedicine in dementia care. The most frequently reported outcomes were the effects of remote interventions on psychiatric and psychological well-being, particularly depression and anxiety (relative frequency of occurrence [RFO]=65%, 95% CI 54-75, moderate certainty of evidence). Fifty-seven studies highlighted the positive impact of telemedicine and telehealth on satisfaction and quality of life for persons living with dementia, caregivers, and health care providers (RFO=63%, 95% CI 52-73, moderate certainty of evidence). Remote technology-related interventions for reducing falls and managing behavioral symptoms were also frequently reported (RFO=33% 95% CI 23-44], moderate certainty of evidence). These interventions showed effectiveness in alleviating social isolation and loneliness (RFO=31%, 95% CI 22-41, moderate certainty of evidence). The methodological qual","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e75266"},"PeriodicalIF":5.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12975415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453705","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":"\"It's Not Only Attention We Need\": Systematic Review of Large Language Models in Mental Health Care.","authors":"Andreas Bucher, Sarah Egger, Inna Vashkite, Wenyuan Wu, Gerhard Schwabe","doi":"10.2196/78410","DOIUrl":"10.2196/78410","url":null,"abstract":"<p><strong>Background: </strong>Mental health care systems worldwide face critical challenges, including limited access, shortages of clinicians, and stigma-related barriers. In parallel, large language models (LLMs) have emerged as powerful tools capable of supporting therapeutic processes through natural language understanding and generation. While previous research has explored their potential, a comprehensive review assessing how LLMs are integrated into mental health care, particularly beyond technical feasibility, is still lacking.</p><p><strong>Objective: </strong>This systematic literature review investigates and conceptualizes the application of LLMs in mental health care by examining their technical implementation, design characteristics, and situational use across different touchpoints along the patient journey. It introduces a 3-layer morphological framework to structure and analyze how LLMs are applied, with the goal of informing future research and design for more effective mental health interventions.</p><p><strong>Methods: </strong>A systematic literature review was conducted across PubMed, IEEE Xplore, JMIR, ACM, and AIS databases, yielding 807 studies. After multiple evaluation steps, 55 studies were included. These were categorized and analyzed based on the patient journey, design elements, and underlying model characteristics.</p><p><strong>Results: </strong>Most studies assessed technical feasibility, whereas only a few examined the impact of LLMs on therapeutic outcomes. LLMs were used primarily for classification and text generation tasks, with limited evaluation of safety, hallucination risks, or reasoning capabilities. Design aspects, such as user roles, interaction modalities, and interface elements, were often underexplored, despite their significant influence on user experience. Furthermore, most applications focused on single-user contexts, overlooking opportunities for integrated care environments, such as artificial intelligence-blended therapy. The proposed 3-layer framework, which consists of the L1: LLM layer, L2: interface layer, and L3: situation layer, highlights critical design trade-offs and unmet needs in current research.</p><p><strong>Conclusions: </strong>LLMs hold promise for enhancing accessibility, personalization, and efficiency in mental health care. However, current implementations often overlook essential design and contextual factors that influence real-world adoption and outcomes. The review underscores that the self-attention mechanism, a key component of LLMs, alone is not sufficient. Future research must go beyond technical feasibility to explore integrated care models, user experience, and longitudinal treatment outcomes to responsibly embed LLMs into mental health care ecosystems.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e78410"},"PeriodicalIF":5.8,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12627976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439809","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":"Personalization Strategies for Increasing Engagement With Digital Mental Health Resources: Sequential Multiple Assignment Randomized Trial.","authors":"Julien Rouvere, Isabell R Griffith Fillipo, Meghan Romanelli, Ashish Sharma, Brittany A Mosser, Theresa Nguyen, Kevin Rushton, John Marion, Tim Althoff, Michael D Pullmann","doi":"10.2196/73188","DOIUrl":"10.2196/73188","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although web-based mental health resources have the potential to assist millions, particularly those who face barriers to treatment, most mental health website visitors disengage before accessing resources that can help improve their mental health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We used a sequential multiple assignment randomized trial to test whether personalized tailoring improved engagement on a self-guided mental health website.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were collected via voluntary response sampling on the Mental Health America website. Inclusion criteria included residing in the United States and viewing a postscreening survey after completing the Patient Health Questionnaire-9 (PHQ-9). Participants were randomized to 1 of 2 postscreening survey conditions: the demographics survey or the Next Steps survey, which included additional tailoring questions assessing perceived need and participants' intended next steps. Participants who viewed the following screening results page were subsequently randomized to 1 of 5 conditions that displayed nontailored or tailored messages and featured resources, as well as persistent general resources that did not vary by condition. Data were analyzed using logistic regressions predicting disengagement and clicks on featured resources (versus persistent general resources) by condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Adding questions to inform tailoring significantly increased the odds of disengaging by 14% (demographics survey: 25%; Next Steps survey: 27.5%; odds ratio [OR] 1.14, 95% CI 1.11-1.16; P&lt;.001). Among participants who viewed a postscreening survey (n=169,647), 87,712 participants were randomized to the demographics survey condition, and 81,935 participants were randomized to the Next Steps survey condition. Among participants who submitted the demographics survey (n=38,490), tailoring resources to demographics reduced the odds of disengaging by 10% (OR 0.90, 95% CI 0.87-0.94; P&lt;.001) and, among those who engaged, increased the odds of clicking a featured resource versus a persistent general resource by 90% (OR 1.90, 95% CI 1.79-2.01; P&lt;.001). Among participants who submitted the Next Steps survey (n=34,204), tailoring messages to perceived need (P=.33), tailoring resources to intended next steps (P=.51), and a combination of both (P=.52) did not significantly reduce the odds of disengaging compared with the nontailored condition. However, tailoring resources to intended next steps and combining a tailored message to perceived need with tailored resources to intended next steps increased the odds of clicking a featured resource by 25% (OR 1.25, 95% CI 1.14-1.37; P&lt;.001) and 34% (OR 1.34, 95% CI 1.23-1.47; P&lt;.001), respectively. Tailoring resources to demographics was significantly more effective in improving engagement than tailoring to perceived need or intended next steps (P≤.004).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;There was a small but statisticall","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e73188"},"PeriodicalIF":5.8,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12585131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446384","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":"Group Cognitive Behavioral Therapy With Virtual Reality Exposure Versus In-Vivo Exposure for Social Anxiety Disorder and Agoraphobia: Underpowered Results From the SoREAL Pragmatic Randomized Clinical Trial.","authors":"Benjamin Arnfred, Fatime Zeka, Carsten Hjorthøj, Clas Winding Christensen, Kirsten Stengaard Moeller, Mette Øllgaard Pedersen, Nicole Rosenberg, Lars Clemmensen, Louise Birkedal Glenthøj, Merete Nordentoft","doi":"10.2196/73815","DOIUrl":"10.2196/73815","url":null,"abstract":"<p><strong>Background: </strong>Social anxiety disorder (SAD) and agoraphobia are common, impairing conditions often treated with cognitive behavioral therapy (CBT) conducted in groups. In CBT, exposure therapy is a core element. However, in-vivo exposure therapy is logistically challenging and aversive for both patient and therapist, especially in a group context, often leading to exposure being skipped altogether in clinical practice. Virtual reality exposure (VRE), in which phobic stimuli are presented through immersive virtual reality technology, has shown promise as a flexible alternative to in-vivo exposure. We thus hypothesized that using VRE would result in more overall exposure and more individualized exposure, resulting in statistically significant symptom reduction compared with a group using in-vivo exposure.</p><p><strong>Objective: </strong>This trial evaluated the efficacy of group CBT with VRE (VR-CBT) versus CBT with in-vivo exposure for treating SAD and agoraphobia in clinical settings.</p><p><strong>Methods: </strong>In this randomized, parallel-group, assessor-blinded trial, 177 participants with SAD (n=150) or agoraphobia (n=27) as a primary diagnosis were assigned to either VR-CBT (n=81) or traditional CBT (n=96) across 5 Danish mental health outpatient clinics. Both groups received 14 weekly group sessions. The difference between the 2 treatments was that the VR-CBT group received exposure therapy via head-mounted displays (HMDs) displaying 360° videos of anxiogenic situations for individuals with SAD (eg, presenting at work) and agoraphobia (eg, faulty elevator), while the CBT group conducted traditional in-vivo exposure exercises (eg, presenting to the group, using the clinic elevator). Primary outcomes were phobic anxiety reductions, measured by the Liebowitz Social Anxiety Scale and the Mobility Inventory for Agoraphobia at baseline, posttreatment, and 1-year follow-up (from baseline). Secondary outcomes included work and social functioning, depressive symptoms, and quality of life.</p><p><strong>Results: </strong>Both groups showed significant reductions in primary, secondary, and exploratory outcomes, with no significant differences between groups at posttreatment (d=-0.026) and 1-year follow-up (d=0.097). Baseline characteristics and attrition rates were balanced across the groups.</p><p><strong>Conclusions: </strong>Due to insufficient recruitment and substantial missing data, no definitive conclusions can be drawn regarding group differences between VR-CBT and traditional CBT in group settings. The feasibility issues encountered suggest that careful consideration of the benefits and limitations of VR technology is essential before implementation in clinical practice.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e73815"},"PeriodicalIF":5.8,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12582524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439816","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":"Governing AI in Mental Health: 50-State Legislative Review.","authors":"J Nicholas Shumate, Eden Rozenblit, Matthew Flathers, Carlos A Larrauri, Christine Hau, Winna Xia, E Nicholas Torous, John Torous","doi":"10.2196/80739","DOIUrl":"10.2196/80739","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Mental health-related artificial intelligence (MH-AI) systems are proliferating across consumer and clinical contexts, outpacing regulatory frameworks and raising urgent questions about safety, accountability, and clinical integration. Reports of adverse events, including instances of self-harm and harmful clinical advice, highlight the risks of deploying such tools without clear standards and oversight. Federal authority over MH-AI is fragmented, leaving state legislatures to serve as de facto laboratories for MH-AI policy. Some states have been highly active in this area during recent legislative sessions. Yet, clinicians and professional organizations have mainly remained absent or sidelined from public commentary and policymaking bodies, raising concerns that new laws may diverge from the realities of mental health care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To systematically analyze recent state-level legislation relevant to MH-AI, categorize bills by relevance to mental health, identify major regulatory themes and gaps, and evaluate implications for clinicians and patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic analysis of bills introduced in all 50 US states between January 1, 2022, and May 19, 2025, using standardized searches on the legislative research website (LegiScan). Bills were screened and categorized using a custom 4-tier taxonomy based on their applicability to MH-AI. Bills passing threshold review were coded by topic using a 25-tag system developed through iterative consensus. Legally trained reviewers adjudicated final classifications to ensure consistency and rigor.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 793 state bills reviewed, 143 were identified as potentially impactful to MH-AI: 28 explicitly referenced mental health uses, while 115 had substantial or indirect implications. Of these 143 bills, 20 were enacted across 11 states. Legislative efforts varied widely, but 4 thematic domains consistently emerged: (1) professional oversight, including deployer liability and licensure obligations; (2) harm prevention, encompassing safety protocols, malpractice exposure, and risk stratification frameworks; (3) patient autonomy, particularly in areas of disclosure, consent, and transparency; and (4) data governance, with notable gaps in privacy protections for sensitive mental health data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;State legislatures are rapidly shaping the regulatory landscape for MH-AI, but most laws treat mental health as incidental to broader artificial intelligence or health care regulation. Explicit mental health provisions remain rare, and clinician and patient perspectives are seldom incorporated into policymaking. The result is a fragmented and uneven environment that risks leaving patients unprotected and clinicians overburdened. Mental health professionals must proactively engage with legislators, professional organizations, and patient advocates to ensure that emer","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e80739"},"PeriodicalIF":5.8,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12578431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423241","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":"Perceived Digital Well-Being Scale in the United States and United Kingdom: Psychometric Validation Study.","authors":"Germano Vera Cruz, Magdalena Liberacka-Dwojak, Monika Wiłkość-Dębczyńska, Merve Aktaş Terzioğlu, Todd Farchione, Tania Lecomte, Sandy Ingram, Riaz Khan, Yasser Khazaal","doi":"10.2196/78334","DOIUrl":"10.2196/78334","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Digital well-being encourages balanced mobile use. The Perceived Digital Well-Being in Adolescence Scale measures this in adolescents but has been validated only in Slovenia, raising questions about its relevance for other age groups and cultural contexts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study had three primary objectives: (1) confirm the 3-factor structure of an English version of the Perceived Digital Well-Being in Adolescence Scale, renamed the Perceived Digital Well-Being Scale (PDWS), in samples of young adults from the United States and the United Kingdom; (2) examine the associations between PDWS dimensions and participants' sociodemographic characteristics; and (3) explore the relationships between PDWS scores and patterns of smartphone use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 1854 young adults from the United States and the United Kingdom (ages 18-25 years; mean 22.4, SD 2.1; 892, 48.1% female, 872, 47.0% male, 90, 4.9% nonbinary) participated in an online survey including the PDWS, digital flourishing, and digital stress measures. Data were analyzed using descriptive statistics, confirmatory factor analysis, correlations, t tests, chi-squared tests, and moderation-mediation analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Smartphone screen time and smartphone time for nonessential activities were statistically higher in the US sample than in the UK sample (mean 6.95 vs mean 6.13; t1852=4.97; P&lt;.001; d=0.27 and mean 3.62 vs mean 3.29; t1852=5.57; P&lt;.001; d=0.25, respectively). The digital well-being total score was statistically higher among US participants when compared with the UK counterparts (mean 3.49 vs mean 3.38; t1852=3.33; P&lt;.001; d=0.15). Male participants were significantly more represented among the group with higher PDWB scores (χ2136=478.45; P&lt;.001). Confirmatory factor analysis supported the adequacy of the 3-factor model (emotional, social, and cognitive), indicating strong model fit (critical indices ≥0.90). Evidence of convergent validity was established through significant associations between PDWS scores and measures of digital flourishing and digital stress (most correlation coefficients being significant at P&lt;.001). Measurement invariance testing confirmed the scale's equivalence across US and UK samples (χ2246 change=17.90; P=.21); however, strict invariance across gender (male vs female) was not supported (χ2246 change=200.91; P&lt;.001). Gender, sexual orientation, relationship status, ethnicity, socioeconomic status, and education level significantly influenced PDWS scores. Gender and socioeconomic status also moderated the relationship between smartphone use or screen time and PDWS scores (b=0.048; P=.03 and b=0.020; P=.03, respectively), indicating that these factors affect how smartphone usage relates to psychological distress or well-being in different demographic groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The PDWS showed good psychometric properties in the US and UK samp","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e78334"},"PeriodicalIF":5.8,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12574938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410545","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 Web-Based Recognise and Respond Gatekeeper Training Program: Noninferiority Randomized Trial.","authors":"Cassandra Chakouch, Ann M Martin, Philip J Batterham, Demee Rheinberger, Fiona Shand","doi":"10.2196/63204","DOIUrl":"10.2196/63204","url":null,"abstract":"<p><strong>Background: </strong>Gatekeeper training teaches community members to identify individuals at risk of suicide and assist them with help-seeking. A new online program, Recognise and Respond (R&R), was developed to address the need for a program specific to the Australian context, created in consultation with clinicians, researchers, and people with a lived experience of suicide.</p><p><strong>Objective: </strong>This study aimed to evaluate whether the R&R gatekeeper training is noninferior to the established Question, Persuade, Refer (QPR) online program, in improving confidence to identify and support individuals experiencing suicidal thoughts. Secondary objectives examined the short- and medium-term effects of R&R on attitudes toward suicide prevention and knowledge of appropriate responses to signs of suicide.</p><p><strong>Methods: </strong>A total of 524 participants were enrolled at baseline and were then randomized to receive access to either R&R (n=263) or QPR (n=261). The primary outcome-gatekeeper confidence in identifying and supporting an individual experiencing suicidal thoughts-was assessed using a noninferiority framework. Secondary outcomes, including attitudes toward suicide prevention and knowledge of appropriate responses to signs of suicide, were assessed using superiority testing. Outcomes were assessed via online surveys at baseline, postintervention, and the 3-month follow-up. The trial was conducted entirely online, with no face-to-face contact with participants. Data were analyzed using mixed effects linear models.</p><p><strong>Results: </strong>Participants in both groups reported significant improvements in confidence across time indicating noninferiority of the R&R program. Both groups showed significant improvements on attitudes and knowledge scores at postintervention and the 3-month follow-up, 3. to baseline. Improvement in attitude scores between baseline and postintervention and follow-up were greater for the QPR group compared to the R&R group. Gains at postintervention were maintained at follow-up for both groups considering all outcomes. There were no other between-group differences.</p><p><strong>Conclusions: </strong>The findings demonstrate that R&R is as effective as QPR online in improving gatekeeper confidence to identify and support someone having thoughts of suicide.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e63204"},"PeriodicalIF":5.8,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12551934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368982","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":"Co-Developing Content Updates for the Card Sort Task for Self-Harm-Digital (CaTS-D) With People With Lived Self-Harm Experiences: Pilot Study and Thematic Analysis.","authors":"Katherine Bird, Ian Greentree, Brian O'Shea, Ellen Townsend","doi":"10.2196/71296","DOIUrl":"10.2196/71296","url":null,"abstract":"<p><strong>Background: </strong>Self-harm is a significant global concern with multiple negative outcomes. Self-harm research tools typically focus on single risk factors, meaning the temporal interplay between factors and their impact on self-harm is unknown. The Card Sort Task for Self-Harm (CaTS) addressed these deficits by using 117 cards to examine multiple self-harm factors. In-person research is time-consuming, costly, and limits participation opportunities. Developing an electronic version of CaTS (Card Sort Task for Self-harm-digital; CaTS-D) is necessary to address these issues, capture large datasets, and provide a stronger evidence base. Since CaTS' inception, understanding of self-harm has evolved, including increasing awareness that lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) people are at high risk. Updating CaTS is essential to ensure its relevance to both LGBTQIA+ and cisgender-heterosexual self-harm.</p><p><strong>Objective: </strong>We aimed to present results from two studies. Study 1 is a pilot study assessing the feasibility of CaTS-D. Study 2 used qualitative interviews to identify additions or amendments to CaTS to increase its relevance as understanding of self-harm evolves.</p><p><strong>Methods: </strong>Study 1 recruited UK residents (N=13, aged 18-30 y) with lived self-harm experience. Feasibility and acceptability of CaTS-D were assessed using the Systems Usability Scale (SUS) and visual analog scale (VAS). Study 2 recruited UK residents (N=13; LGBTQIA+ n=9 and cisgender-heterosexual n=4; aged 21-29 y) with lived self-harm experience to one-on-one interviews.</p><p><strong>Results: </strong>Study 1 found CaTS-D to be a feasible web application for use in self-harm research. VAS data showed no significant difference between pre- and poststudy mood (t9=1.59; P=.15). In Study 2, thematic analysis resulted in 13 additional cards (eg, \"Before 6 mo;\" \"I don't feel comfortable in my body;\" \"I was bullied on social media;\" and \"Self-harm gave me a feeling of control\"). Cards were worded clearly, but minor amendments to wording on cards to increase LGBTQIA+inclusivity were identified (ie, changing \"boyfriend/girlfriend\" to \"partner\"). While participants felt selective additions were necessary, too many may overwhelm participants. Therefore, future additions should be carefully considered.</p><p><strong>Conclusions: </strong>Pilot-testing shows CaTS-D is a usable, feasible web application to examine self-harm and capture large datasets. Importantly, completing CaTS-D does not negatively impact participants' mood. Updates and key additions were made to CaTS from consultation with people with lived self-harm experiences. These increase the relevance of CaTS and ensure LGBTQIA+ inclusivity.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e71296"},"PeriodicalIF":5.8,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12551937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368996","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}