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Digital Interventions for the Treatment and Prevention of Mental Health Disorders

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (31 July 2021) | Viewed by 28843

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Special Issue Editor

Dr. Claudia Buntrock

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Guest Editor

Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
Interests: mood disorders; depression; digital interventions; prevention; health economics

Special Issue Information

Dear Colleagues,

Meeting the demands for treatment and prevention of mental health disorders (MHDs) is a major public health challenge. MHDs are considered to be the leading cause of the burden of disease in both high-income and low-to-middle-income countries. Despite the existence of effective treatments, a substantial proportion of people suffering from MHDs go untreated. Structural as well as individual and social barriers are important in choosing to seek treatment. Internet- and mobile-based interventions (IMIs) may minimize barriers to treatment and increase access to evidence-based treatments. Several randomized controlled trials and meta-analyses have demonstrated that IMIs can be effective for various MHDs with outcomes that are comparable to face-to-face interventions. However, more research is warranted to fully determine the potential of IMIs to substantially reduce the immense disease burden of MHDs at the population level. In addition, despite the promising results of IMIs, it still is an enormous challenge to close the gap from research to implementation into routine care.

This Special Issue aims to summarize the latest research findings about IMIs to prevent and treat MHDs. We warmly welcome all rigorous research projects examining this area of interest. Specifically, the Special Issue aims to include:

1) Randomized controlled trials and systematic reviews/meta-analyses examining if IMIs can significantly improve mental health (treatment and prevention studies);

2) Pragmatic evaluations using qualitative, quantitative, and mixed-methods designs to gain insights into the feasibility, acceptability, and cost-effectiveness of IMIs in the prevention or treatment of MHDs;

3) Implementation studies to inform decisions on dissemination, implementation, and sustainability of IMIs in routine care settings.

Therefore, this Special Issue will present novel data on the impact of IMIs on public mental health care. This will increase our understanding and inform digital evidence-based interventions, while providing clear directions for future research required to take the field forward.

Dr. Claudia Buntrock
Guest Editor

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Keywords

Internet- and mobile-based interventions
Digital
Apps
Mental health disorders
Prevention
Treatment
Health economics

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Published Papers (6 papers)

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Research

14 pages, 386 KiB

Open AccessArticle

Feasibility and Acceptability of “Cuida tu Ánimo” (Take Care of Your Mood): An Internet-Based Program for Prevention and Early Intervention of Adolescent Depression in Chile and Colombia

by Vania Martínez, Daniel Espinosa-Duque, Álvaro Jiménez-Molina, Graciela Rojas, Paul A. Vöhringer, Mauricio Fernández-Arcila, Carolina Luttges, Matías Irarrázaval, Stephanie Bauer and Markus Moessner

Int. J. Environ. Res. Public Health 2021, 18(18), 9628; https://doi.org/10.3390/ijerph18189628 - 13 Sep 2021

Cited by 12 | Viewed by 8539

Abstract

The rapid internet penetration in Latin American countries has made it possible to implement digital mental health interventions. “Cuida tu Ánimo” (Take Care of Your Mood) is an internet-based program for the prevention and early intervention of depression in adolescents. A pilot study was conducted in Chile and Colombia to study the feasibility and acceptability of the program and estimate its effects. There were 199 participants (53.3% women; mean age = 14.8 years, SD = 1.0) recruited from two schools in Chile and two schools in Colombia. Qualitative and quantitative methods were applied for data collection and analyses. Although the levels of acceptance were moderate to high across all variables, adherence was lower than expected. The participants deemed important for an intervention of this type offered a higher level of interaction with team members through internet-based and face-to-face activities. Post-intervention outcomes show a reduction in depressive and anxious symptoms in adolescents in Chile, while there were no significant changes in the level of symptomatology in adolescents in Colombia. The women used the program more than the men. Results show the need to improve the intervention by increasing its levels of customization and developing strategies to achieve better adherence. The contradictory results of the program in Chile and Colombia suggest the importance of other variables beyond the content of the intervention, such as the setting or context of the intervention. Full article

(This article belongs to the Special Issue Digital Interventions for the Treatment and Prevention of Mental Health Disorders)

14 pages, 347 KiB

Open AccessArticle

Blended Care in In-Patient Acute Psychiatric Care. The Example of a Group Training for Social Competences in Adults—A Pretest–Posttest Feasibility Study

by Eileen Bendig, Ann-Marie Küchler, Harald Baumeister and Thomas Becker

Int. J. Environ. Res. Public Health 2021, 18(18), 9433; https://doi.org/10.3390/ijerph18189433 - 7 Sep 2021

Cited by 5 | Viewed by 2152

Abstract

Introduction: Deficits in social skills can be an important modulating factor in the development and progress of various mental disorders. However, limited resources in inpatient care often impede effective social skills training. This study investigates the feasibility of a blended group training for social skills (SST) in an inpatient psychiatric setting. Methods and Analysis: For this one-group pretest–posttest trial, inpatients with a diagnosed mental disorder were recruited. Participation in the blended SST lasted four weeks and took place within usual inpatient psychiatric care. The blended intervention comprised four face-to-face group sessions and three complementary online modules within four weeks. Assessments took place before (t1) and after (t2) the training. Feasibility outcomes (use, acceptance, satisfaction, implementability into usual psychiatric inpatient care) and effectiveness outcomes regarding social skills were assessed. Results: N = 15 participants were recruited. Most patients completed all questionnaires (93%) and all modules of the blended SST concept (60%). All participants (100%) would recommend the blended intervention to a friend. Regarding social skills, exploratory analyses revealed a non-significant medium-sized effect (Cohen’s d = 0.5 95%CI 0.3 to 1.25, p = 0.08). Discussion: This trial shows that a blended care SST is feasible for the use in acute psychiatric inpatient care setting. Although the wards were acute, with high turnover and change of inpatients, 60% of participants were treated per protocol over four weeks. Overall, the evidence on blended care concepts in psychiatric care settings is extremely poor to date. Hence, this trial should encourage intensified blended inpatient psychiatric care research. Full article

(This article belongs to the Special Issue Digital Interventions for the Treatment and Prevention of Mental Health Disorders)

17 pages, 800 KiB

Open AccessArticle

Pragmatic Quasi-Experimental Controlled Trial Evaluating the Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders

by Sanne P.A. Rasing, Yvonne A.J. Stikkelbroek, Wouter den Hollander, Heleen Riper, Maja Deković, Maaike H. Nauta, Daan H.M. Creemers, Marianne C.P. Immink, Mariken Spuij and Denise H.M. Bodden

Int. J. Environ. Res. Public Health 2021, 18(6), 3102; https://doi.org/10.3390/ijerph18063102 - 17 Mar 2021

Cited by 9 | Viewed by 5320

Abstract

Depression is a major problem in youth mental health. Current treatment is on average effective, but adolescents are hesitant to seek help. Blended treatment could lower the barriers to seeking treatment. Evidence on effectiveness is, however, scarce. The present pragmatic quasi-experimental controlled trial aimed to compare the outcomes of blended cognitive behavioral therapy (CBT) to face-to-face CBT and treatment as usual. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03) received blended CBT, face-to-face CBT or treatment as usual. Clinical diagnosis, depressive symptoms, and secondary outcomes were assessed at baseline, post-intervention, and six-months follow-up. Participants receiving blended CBT were, compared to participants receiving face-to-face CBT and treatment as usual, evenly likely to be in remission from their depressive disorder at post-intervention and at six-month follow-up. Depressive symptoms decreased significantly over time in all three conditions, and changes were not significantly different between conditions. Other secondary outcomes (suicide risk, internalizing and externalizing symptoms, severity of depression, and global functioning) did not differ between treatment conditions at post-intervention and six-month follow-up. Since there was no evidence for favorable outcomes for face-to-face therapies above blended CBT, blended CBT may also be an effective treatment format in clinical practice. Full article

(This article belongs to the Special Issue Digital Interventions for the Treatment and Prevention of Mental Health Disorders)

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15 pages, 2155 KiB

Open AccessArticle

Development, Implementation and First Evaluation of an Online Portal to Promote the Mental Health of University Students (me@JGU)

by Caroline Lutz-Kopp, Ursula Luka-Krausgrill, Bettina Honsbrok, Bozana Meinhardt-Injac and Maria Gropalis

Int. J. Environ. Res. Public Health 2021, 18(3), 1179; https://doi.org/10.3390/ijerph18031179 - 28 Jan 2021

Cited by 5 | Viewed by 2631

Abstract

Background: University students encounter various stressors such as exam preparation, workload and economic concerns. Having to deal with a multitude of stressors can lead to mental health problems and have a negative impact on academic outcomes in students attending university. This paper describes the development and usability evaluation of an open and easily accessible online portal (me@JGU) designed to help students build skills they need to cope with common stressors and manage their own mental health. Methods: We developed a website that addresses the most common stressors among university students and offers strategies for dealing with difficult situations. Initial evaluation results were collected using website statistics and a short anonymous survey regarding the attractiveness and usability of the website. Results: Over an eight-month period, there were 5739 visitors, a total of 16,495 page views and 3748 downloads. The survey results indicate that me@JGU covers relevant topics and that the students like the layout. Conclusions: Online interventions promoting mental health of university populations are easily accessible and cost effective for large populations. They may prevent study difficulties, inform students about mental health and offer possible solutions. In addition, at-risk students can receive information about other relevant resources, and feel encouraged to access support and treatment. Full article

(This article belongs to the Special Issue Digital Interventions for the Treatment and Prevention of Mental Health Disorders)

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14 pages, 1066 KiB

Open AccessArticle

A Pilot Evaluation of a Smartphone Application for Workplace Depression

by Daniel A.J. Collins, Samuel B. Harvey, Isobel Lavender, Nicholas Glozier, Helen Christensen and Mark Deady

Int. J. Environ. Res. Public Health 2020, 17(18), 6753; https://doi.org/10.3390/ijerph17186753 - 16 Sep 2020

Cited by 19 | Viewed by 5005

Abstract

Interventions delivered via mobile apps show particular promise in tackling the burden of common mental disorders. Appropriately targeting these interventions to at-risk populations is critical to their success. This pilot study aimed to assess the usability, feasibility, acceptability, and preliminary effects of an app-based intervention designed to target depressive symptoms in a stressed working population. Anchored, a smartphone app including a 30-day program of mindfulness and cognitive and behavioural therapeutic components, was tested in a pre-post pilot study with participants recruited via social media advertisements. Eligible participants (N = 81) were Australian adults who were employed and reported elevated stress levels on a single-item screening measure. Follow-up assessment occurred 5 weeks after baseline. The primary outcome measure was change in depressive symptoms, with secondary outcomes measuring change in anxiety, wellbeing, stress, resilience, exercise, alcohol use, absenteeism, and work performance. User feedback and in-app data were analysed to assess engagement and intervention adherence. At follow-up, there were significant reductions in depressive symptoms (t₆₁ = 6.35; p < 0.001) and anxiety symptoms (t₆₀ = 7.35; p < 0.001), along with significantly reduced cases of likely new onset depression compared to baseline (24% vs. 6%, p = 0.012). Significant improvements were also seen in wellbeing (t₆₀ = −5.64; p < 0.001), resilience (t₆₀ = −3.89; p < 0.001), stress (t₆₁ = 11.18; p < 0.001), and alcohol use (t₆₀ = 3.40; p = 0.001). Participants reported no significant changes in work performance, absenteeism or exercise. There were satisfactory levels of app usability, feasibility, and acceptability. Most participants found the app easy to use (93.2%), understood the app content well (83.0%), and rated the app highly or very highly overall (72.9%). User feedback suggestions were predominantly focused on improving app navigation and user interface. This pilot study provides encouraging evidence that Anchored has potentially beneficial effects, and is usable, feasible, and acceptable as an app-based intervention for the working population experiencing elevated stress. Further testing of Anchored in a randomised controlled trial is required to investigate its efficacy as an intervention for workplace mental ill-health. Full article

(This article belongs to the Special Issue Digital Interventions for the Treatment and Prevention of Mental Health Disorders)

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15 pages, 352 KiB

Open AccessArticle

Therapeutic Relationship in eHealth—A Pilot Study of Similarities and Differences between the Online Program Priovi and Therapists Treating Borderline Personality Disorder

by Sandra Köhne, Ulrich Schweiger, Gitta A. Jacob, Diana Braakmann, Jan Philipp Klein, Stefan Borgwardt, Nele Assmann, Mirco Rogg, Anja Schaich and Eva Faßbinder

Int. J. Environ. Res. Public Health 2020, 17(17), 6436; https://doi.org/10.3390/ijerph17176436 - 3 Sep 2020

Cited by 5 | Viewed by 4222

Abstract

eHealth programs have been found to be effective in treating many psychological conditions. Regarding Borderline Personality Disorder (BPD), few programs have been tested; nevertheless, results are promising. The therapeutic alliance is an important factor predicting treatment outcome in BPD. However, we do not know yet to what extent BPD patients form a therapeutic alliance with an eHealth tool and how this relationship differs from the relationship with their human therapist. This study aims to address this question using priovi, an interactive schema therapy-based eHealth tool for BPD. Semi-structured interviews were conducted to explore how patients perceived the therapeutic alliance with priovi and its differences compared to the alliance with their human therapist (N = 9). Interview data were analyzed following the procedures of qualitative content analysis. Additionally, the Working Alliance Inventory (WAI-SR) was administered in two versions (regarding the human therapist and priovi, N = 16) every three months during the treatment phase of one year. Results indicate that patients were able to form a good therapeutic relationship with priovi, but it differed from the relationship to their human therapist. Important categories were “priovi is helpful, supportive and always there” and “priovi is less flexible”. WAI ratings for the task subscale were high in both relationships but significantly higher in WAI_therapist compared to WAI_priovi in two measurements (nine-months measurement: t = 2.76, df = 15, p = 0.015; twelve-months measurement: t = 3.44, df = 15, p = 0.004). These results indicate that BPD patients can form a functioning alliance with an eHealth program and that eHealth programs may be especially useful for psychoeducation and cognitive exercises. Full article

(This article belongs to the Special Issue Digital Interventions for the Treatment and Prevention of Mental Health Disorders)

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