Somatic symptom distress and ICD-11 prolonged grief in a large intercultural sample.

Background: Grief is a multi-faceted experience including emotional, social, and physical reactions. Research in ICD-11 prolonged grief disorder (PGD) in different cultural contexts has revealed different or potentially missing grief symptoms that may be relevant.Objective: This study thus aimed to explore the prevalence of somatic symptom distress and its associations with grief and negative affect in a culturally diverse sample of bereaved individuals with symptoms of PGD.Methods: Based on cross-sectional survey data from the Measurement and Assessment of Grief (MAGIC) project, this study included 1337 participants (mean age 23.79 yrs, 76.1% female) from three regions (USA: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%), who experienced a loss of a significant other. Associations between somatic symptom distress (Somatic Symptom Scale, SSS-8), symptoms of PGD (International Prolonged Grief Disorder Scale, IPGDS-33), anxiety (Generalized Anxiety Disorder Questionnaire, GAD-7), depression (Patient Health Questionnaire, PHQ-9) as well as demographic and loss related characteristics were investigated. Three hundred and thirteen participants (23.4%) scored above the proposed cut-off for clinically severe PGD.Results: 'High' or 'very high' levels of somatic symptom distress were more frequent in a possible PGD group (58.2%), than in a non-PGD group (22.4%), p < .001, as divided per cut-off in the IPGDS. In a multiple regression analysis, PGD symptoms were significantly but weakly associated with somatic symptom distress (ß = 0.08, p < .001) beyond demographics, loss-related variables, and negative affect. Negative affect (anxiety and depression) mediated the relationship of PGD symptoms with somatic symptom distress and the indirect effect explained 58% of the variance.Conclusions: High levels of somatic symptom distress can be observed in a substantial proportion of bereaved across cultures. Our findings suggest that PGD is related to somatic symptom distress partly and indirectly through facets of negative affect.

30.8% of bereaved adults showed 'high' or 'very high' levels of somatic symptom distress.Anxiety and depression partially mediate relationship of PGD symptoms with somatic symptom distress.Findings encourage practitioners to consider somatic symptom distress in psychotherapeutic treatment of PGD.

Emotion dynamics and somatic symptoms in everyday life: Ecological momentary assessment in somatic symptom disorder and healthy controls.

OBJECTIVE: Negative affectivity (NA) is associated with the emergence and persistence of physical symptoms with unclear organic pathology. This study investigated the temporal dynamics of NA and somatic symptom burden using ecological momentary assessment (EMA) in adults with somatic symptom disorder (SSD) and healthy control participants (HC). METHODS: Participants underwent a seven-day, smartphone-based EMA, with 6 randomly-stratified time points per day. NA was assessed using a five-item short form of the Positive and Negative Affectivity Scale (PANAS) and somatic symptom burden with two self-constructed items. 22 persons with SSD and 20 HCs were included in multilevel analyses. RESULTS: Within-person analyses showed a significantly stronger (positive) association of concurrent NA with somatic symptom burden in participants with SSD than in HCs, ß = 0.15, SE = 0.04, p = .001. Time-lagged analyses demonstrated that, across groups, NA at a previous time point t-1 significantly predicted somatic symptom burden at the subsequent timepoint t, ß = 0.09, SE = 0.03, p = .005, but not in the other direction (somatic symptom burdent-1→ NAt, ß = 0.01, SE = 0.04, p = .79). Between-person analyses showed that both inertia (i.e., persistence of negative affective states), d = 0.74, and instability (i.e., magnitude of moment-to-moment fluctuations), d = 0.76 of NA were significantly higher in participants with SSD than in HCs. CONCLUSIONS: Our findings sustain the idea of (negative) affect-driven modulation in somatic signal processing and suggest that interoceptive and emotional differentiation training can advance the psychotherapeutic treatment of SSD.

Behavioral treatment for migraine prophylaxis in adults: Moderator analysis of a randomized controlled trial.

BACKGROUND: While growing evidence suggests the efficacy of various behavioral approaches to the preventive treatment of migraine, it remains largely unclear which behavioral interventions are indicated for which type of patient. This exploratory study aimed to identify moderators for the outcome between migraine-specific cognitive-behavioral therapy and relaxation training. METHODS: In this secondary analysis of an open-label randomized controlled trial, the data of N = 77 adults (completer sample) with migraine (mean age = 47.4, SD = 12.2, 88% female), who were allocated to either migraine-specific cognitive-behavioral therapy or relaxation training, was examined. Outcome was the frequency of headache days at the 12-month follow-up. We analyzed baseline demographic or clinical characteristics and headache-specific variables (disability, emotional distress, trigger sensitivity and avoidance, pain acceptance, self-efficacy) as candidate moderators. RESULTS: Higher headache-related disability (assessed via the Headache Impact Test, HIT-6, B = -0.41 [95% CI: -0.85 to -0.10], p = .047), higher anxiety (assessed via the subscale Anxiety of the Depression, Anxiety and Stress scales, DASS-A, B = -0.66 [95% CI: -1.27 to -0.02], p = .056), and the presence of a comorbid mental disorder (B = -4.98, [95% CI: -9.42 to -0.29], p = .053), moderated the outcome in favor of migraine-specific cognitive-behavioral therapy. CONCLUSION: Our findings contribute to an individualized treatment selection and suggest that preference for complex behavioral treatment (migraine-specific cognitive-behavioral therapy) should be given to patients with high headache-related disability, increased anxiety, or a comorbid mental disorder.Study Registration: Original study registered in the German Clinical Trials Register (https://drks.de/search/de; DRKS-ID: DRKS00011111).

Is Therapist Support Needed? Comparing Therapist- and Self-Guided Internet-Based CBT for Somatic Symptom Distress (iSOMA) in Emerging Adults.

Persistent somatic symptoms of varying etiology are very common in emerging adults and can lead to distress and impairment. Internet-delivered interventions could help to prevent the burden and chronicity of persistent somatic symptoms. This study investigated the impact of therapist guidance on the effectiveness of a cognitive-behavioral Internet intervention for somatic symptom distress (iSOMA) in emerging adults, as a secondary analysis of a two-armed randomized controlled trial. We included 149 university students (83.2% female, 24.60 yrs) with varying degrees of somatic symptom distress who were either allocated to the 8-week intervention with regular, written therapeutic guidance (iSOMA guided) or to the control group (waitlist), which was afterwards crossed over to receive iSOMA with guidance-on-demand (iSOMA-GoD). Primary outcomes were somatic symptom distress (assessed by the PHQ-15) and psychobehavioral symptoms of the somatic symptom disorder (assessed by the SSD-12) at pre- and post-treatment. Secondary outcomes included depression, anxiety, and disability. Both treatments showed statistically significant pre-post improvements in primary (iSOMA-guided: d = 0.86-0.92, iSOMA-GoD: d = 0.55-0.63) and secondary outcomes. However, intention-to-treat analysis revealed non-significant between-group effects for all outcomes (ps ≥ .335), after controlling for confounding variables, and effect sizes were marginal (d = -0.06 to 0.12). Overall, our findings indicate that Internet-delivered cognitive behavioral therapy with regular guidance is not unequivocally superior to guidance-on-demand in alleviating somatic symptom distress and associated psychopathology in emerging adults. As a next step, non-inferiority studies are needed to test the robustness of these findings and their impact on clinical populations.

Efficacy of Cognitive-Behavioral Therapy for the Prophylaxis of Migraine in Adults: A Three-Armed Randomized Controlled Trial.

Background: Behavioral approaches are central to the preventive treatment of migraine but empirical evidence regarding efficacy and effectiveness is still sparse. This study aimed to evaluate the efficacy of a newly developed migraine-specific, integrative cognitive-behavioral therapy program (miCBT) combining several approaches (trigger and stress management, coping with fear of attacks, relaxation training) by comparing it with a single behavioral approach (relaxation training, RLX) as an active control group and a waiting-list control group (WLC). Methods: In a three-armed open-label randomized controlled trial, 121 adults with migraine were assigned to either miCBT, RLX or WLC. The outpatient group therapy (miCBT or RLX) consisted of seven sessions each 90 min. Participants who completed the WLC were subsequently randomized to one of the two treatment groups. Primary outcomes were headache days, headache-related disability, emotional distress, and self-efficacy. The baseline was compared to post-treatment, and followed by assessments 4- and 12-months post-treatment to compare miCBT and RLX. Results: Mixed-model analyses (intention-to-treat sample, 106 participants) showed significantly stronger pre-post improvements in self-efficacy (assessed by the Headache Management Self-Efficacy Scale, HMSE-G-SF) in both treatment groups compared to the WLC (mean difference at post; miCBT: 4.67 [0.55-8.78], p = 0.027; RLX: 4.42 [0.38 to 8.46], p = 0.032), whereas no other significant between-group differences were observed. The follow-up analyses revealed significant within-group improvements from baseline to 12-month follow-up in all four primary outcomes for both treatments. However, between-group effects (miCBT vs. RLX) were not significant at follow-up. Conclusion: The miCBT has no better treatment effects compared to RLX in migraine-prophylaxis. Both treatments effectively increase patients' self-efficacy. Trial Registration: German Clinical Trials Register (www.drks.de; DRKS-ID: DRKS00011111).

Acceptance of E-Mental Health Services for Different Application Purposes Among Psychotherapists in Clinical Training in Germany and Switzerland: Secondary Analysis of a Cross-Sectional Survey.

Background: Despite solid evidence supporting the efficacy of electronic mental health (EMH) services, their acceptance among psychotherapists is limited and uptake rates remain low. However, the acceptance of different EMH services has yet barely been examined in future generations of psychotherapists in a differentiated manner. The aims of this study were (1) to elaborate the intention to use various EMH services for different application purposes and (2) to determine predictors of EMH service acceptance among psychotherapists in clinical training (PiT). Materials and Methods: Our paper is based on a secondary data analysis of a cross-sectional survey. Respondents were recruited via recognized educational institutions for psychotherapy within Germany and the German-speaking part of Switzerland between June and July of 2020. The survey contained items on the intention to use different EMH services (i.e., guided and unguided programs, virtual reality, psychotherapy by telephone and videoconference) for various application purposes (i.e., prevention, treatment addition, treatment substitute, aftercare). Potential predictors of EMH service acceptance (e.g., barriers and advantages) were examined based on an extension of the Unified Theory of Acceptance and Use of Technology (UTAUT). Results: Most of the n = 216 respondents were female (88.4%) and located in Germany (72.2%). General acceptance of EMH was moderate (M = 3.4, SD = 1.12, range 1-5), while acceptance of psychotherapy via videoconference was highest (M = 3.7, SD = 1.15) and acceptance of unguided programs was lowest (M = 2.55, SD = 1.14). There was an interaction effect of EMH service and application purpose (η2 = 0.21). Barriers and advantages both had a uniform influence on EMH service acceptance (Pr > 0.999), while impersonality, legal concerns, concerns about therapeutic alliance, simplified information provision, simplified contact maintenance, time flexibility, and geographic flexibility were significant predictors (all p < 0.05). Results showed that the extended UTAUT model was the best fitting model to predict EMH service acceptance (Pr > 0.999). Conclusions: The intention to use different EMH services varied between application purposes among PiT. To increase acceptance of EMH services and reduce misconceptions, we identified predictors that should be addressed in future acceptance-facilitating interventions when educating PiT.

Internet-based CBT for somatic symptom distress (iSOMA) in emerging adults: A randomized controlled trial.

OBJECTIVE: Persistent somatic symptom distress is common in emerging adults and is associated with adverse health outcomes and impairment. Internet-based interventions could help to prevent burden and chronicity. This randomized controlled trial tested the efficacy of a guided, cognitive-behavioral internet intervention for somatic symptom distress (iSOMA) in emerging adults at risk for somatic symptom disorder compared to a waitlist control condition. METHOD: 158 participants (N = 156 analyzed; 24.53 years, 83.3% female) with multiple somatic symptoms were recruited among German-speaking universities and randomly allocated to either receive the 8-week iSOMA intervention with psychologist support or the waitlist, both with access to treatment as usual. Primary outcomes were somatic symptom distress Patient Health Questionnaire, somatic symptom scale (PHQ-15) and psychobehavioral features of somatic symptom disorder-12 (SSD-12), assessed at baseline and 8-weeks postrandomization. Secondary outcomes included depression, anxiety, illness worries, functional impairment, and attitudes toward psychological treatment. RESULTS: Participants in the iSOMA group showed significantly greater improvements (ps < .001) in primary outcomes (PHQ-15: d = 0.70 [0.36, 1.05], SSD-12: d = 0.65 [0.30, 0.99], and secondary outcomes (ps < .05; d = 0.41-0.52) compared to the waitlist, except for attitudes toward psychological treatment (p = .944). Satisfaction with iSOMA was high (91.0%), most participants (72.8%) completed at least 4 of 7 modules and negative treatment effects were infrequent (14.9%). CONCLUSIONS: Our intervention had a substantial positive impact on somatic symptom distress across a broad range of persistent physical symptoms in a vulnerable target group, opening up promising possibilities for indicative prevention and blended care for somatic symptom disorders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Somatosensory amplification moderates the efficacy of internet-delivered CBT for somatic symptom distress in emerging adults: Exploratory analysis of a randomized controlled trial.

OBJECTIVE: While studies mainly provide positive evidence for the efficacy of internet-delivered cognitive-behavioral therapy (ICBT) for various persistent somatic symptoms, it remains largely unclear for whom these interventions work or not. This exploratory analysis aimed to identify moderators for the outcome between ICBT for somatic symptom distres and a waitlist control group (WL) in a vulnerable target group of emerging adults. METHODS: Based on data from a randomized controlled trial on 156 university students with varying degrees of somatic symptom distress who were allocated to either an eight-week, therapist guided ICBT (iSOMA) or to the WL, we examined pretreatment demographic characteristics, health-related variables (e.g., somatic symptom duration), mental distress (e.g., depression, anxiety) and cognitive-emotional factors (emotional reactivity, somatosensory amplification) as candidate moderators of the outcome, somatic symptom distress (assessed by the Patient Health Questionnaire, PHQ-15) from pre- to posttreatment. RESULTS: Somatosensory amplification (assessed by the Somatosensory Amplification Scale, SSAS) moderated the outcome in favor of iSOMA (B = -0.17, SE = 0.08, p = 0.031), i.e., higher pretreatment somatosensory amplification was associated with better outcome in the active compared to the control intervention. No significant moderation effects were found among demographic characteristics, health-related variables, or mental distress. CONCLUSION: Our findings suggest that an internet-delivered CBT for somatic symptom distress should be preferred over no active treatment particularly in individuals with moderate to high levels of somatosensory amplification, which as a next step should be tested against further treatments and in clinical populations. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00014375).

Diagnostic Performance of an App-Based Symptom Checker in Mental Disorders: Comparative Study in Psychotherapy Outpatients.

BACKGROUND: Digital technologies have become a common starting point for health-related information-seeking. Web- or app-based symptom checkers aim to provide rapid and accurate condition suggestions and triage advice but have not yet been investigated for mental disorders in routine health care settings. OBJECTIVE: This study aims to test the diagnostic performance of a widely available symptom checker in the context of formal diagnosis of mental disorders when compared with therapists' diagnoses based on structured clinical interviews. METHODS: Adult patients from an outpatient psychotherapy clinic used the app-based symptom checker Ada-check your health (ADA; Ada Health GmbH) at intake. Accuracy was assessed as the agreement of the first and 1 of the first 5 condition suggestions of ADA with at least one of the interview-based therapist diagnoses. In addition, sensitivity, specificity, and interrater reliabilities (Gwet first-order agreement coefficient [AC1]) were calculated for the 3 most prevalent disorder categories. Self-reported usability (assessed using the System Usability Scale) and acceptance of ADA (assessed using an adapted feedback questionnaire) were evaluated. RESULTS: A total of 49 patients (30/49, 61% women; mean age 33.41, SD 12.79 years) were included in this study. Across all patients, the interview-based diagnoses matched ADA's first condition suggestion in 51% (25/49; 95% CI 37.5-64.4) of cases and 1 of the first 5 condition suggestions in 69% (34/49; 95% CI 55.4-80.6) of cases. Within the main disorder categories, the accuracy of ADA's first condition suggestion was 0.82 for somatoform and associated disorders, 0.65 for affective disorders, and 0.53 for anxiety disorders. Interrater reliabilities ranged from low (AC1=0.15 for anxiety disorders) to good (AC1=0.76 for somatoform and associated disorders). The usability of ADA was rated as high in the System Usability Scale (mean 81.51, SD 11.82, score range 0-100). Approximately 71% (35/49) of participants would have preferred a face-to-face over an app-based diagnostic. CONCLUSIONS: Overall, our findings suggest that a widely available symptom checker used in the formal diagnosis of mental disorders could provide clinicians with a list of condition suggestions with moderate-to-good accuracy. However, diagnostic performance was heterogeneous between disorder categories and included low interrater reliability. Although symptom checkers have some potential to complement the diagnostic process as a screening tool, the diagnostic performance should be tested in larger samples and in comparison with further diagnostic instruments.

Acceptance towards digital health interventions - Model validation and further development of the Unified Theory of Acceptance and Use of Technology.

Internet- and mobile-based interventions (IMI) offer an effective way to complement health care. Acceptance of IMI, a key facilitator of their implementation in routine care, is often low. Based on the Unified Theory of Acceptance and Use of Technology (UTAUT), this study validates and adapts the UTAUT to digital health care. Following a systematic literature search, 10 UTAUT-grounded original studies (N = 1588) assessing patients' and health professionals' acceptance of IMI for different somatic and mental health conditions were included. All included studies assessed Performance Expectancy, Effort Expectancy, Social Influence, Facilitating Conditions and acceptance as well as age, gender, internet experience, and internet anxiety via self-report questionnaires. For the model validation primary data was obtained and analyzed using structural equation modeling. The best fitting model (RMSEA = 0.035, SRMR = 0.029) replicated the basic structure of UTAUT's core predictors of acceptance. Performance Expectancy was the strongest predictor (γ = 0.68, p < .001). Internet anxiety was identified as an additional determinant of acceptance (γ = -0.07, p < .05) and moderated the effects of Social Influence (γ = 0.07, p < .05) and Effort Expectancy (γ = -0.05, p < .05). Age, gender and experience had no moderating effects. Acceptance is a fundamental prerequisite for harnessing the full potential of IMI. The adapted UTAUT provides a powerful model identifying important factors - primarily Performance Expectancy - to increase the acceptance across patient populations and health professionals.

Acceptance and Commitment Therapy for Major Depressive Disorder: Insights into a New Generation of Face-to-Face Treatment and Digital Self-Help Approaches.

Major depressive disorder (MDD) represents a key contributor to the global burden of mental illness given its relatively high lifetime prevalence, frequent comorbidity, and disability rates. Evidence-based treatment options for depression include pharmacotherapy and psychotherapy, such as cognitive behavioral therapy (CBT). Beyond traditional CBT, over 15 years ago, Hayes proclaimed a new generation of contextualistic and process-orientated so-called third wave of CBT interventions, including acceptance and commitment therapy (ACT). Using mindfulness and acceptance as well as commitment and behavior change processes, the transdiagnostic ACT approach aims to increase psychological flexibility as universal mechanism of behavior change and to build a value-driven orientation in life. ACT for MDD can be provided as either stand-alone individual, group, or self-help formats (e.g., apps) or combined with other approaches like behavioral activation. To date, a steadily growing empirical support from outcome and process research suggests the efficacy of ACT, which appears to work specifically through the six proposed core processes involved in psychological flexibility, such as defusion. In view of an ongoing interest of clinicians in "third-wave" CBTs and the important role of clients' preferences in providing therapy choices that work, the purpose of this chapter is to give a brief overview on the application of ACT in the treatment of MDD in adults.

Exploring User-Related Drivers of the Early Acceptance of Certified Digital Stress Prevention Programs in Germany.

Electronic mental health services represent innovative instruments to increase the dissemination of stress programs in primary prevention. However, little is known about facilitators of their uptake. This study aimed to explore determinants of the acceptance of centrally certified digital stress coping programs and preferences for service delivery modes among adult members of German statutory health insurances. Participants completed a multi-construct 45-item questionnaire covering acceptance of digital stress prevention (behavioral use intention) and potential predictors we assessed using hierarchical regression analysis-(1) socio-demographic variables and time spent online, (2) openness to experience, (3) perceived stress, and (4) attitudes toward e-mental health. Preferences in terms of the willingness to use online, face-to-face and blended programs were analyzed using paired t-tests. Participants (N = 171, 66% female, 18-69 years) reported a moderate acceptance of digital stress management (M = 2.76, SD = 1.16, range: 1-5). We identified younger age (ß = -0.16, P = .009), openness to experience (ß = 0.17, P = .003), and positive attitudes (ß = 0.61, P < .001) as predictors of acceptance (R 2 = .50, P < .001). Face-to-face was preferred over online (d = 0.40) and blended (d = 0.33), and blended over stand-alone online delivery mode (d = 0.19; all P < .001). Our findings indicate that promoting favorable attitudes toward digital stress prevention through tailored information may be a starting point to facilitate their adoption.

Determinant Factors of Public Acceptance of Stress Management Apps: Survey Study.

BACKGROUND: Chronic stress is a major public health concern. Mobile health (mHealth) apps can help promote coping skills in daily life and prevent stress-related issues. However, little is known about the determinant factors of public acceptance of stress management in relation to preferences for psychological services. OBJECTIVE: The aim of this survey study was to (1) assess determinant factors of public acceptance (behavioral use intention) of stress management apps based on an adapted and extended version of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and (2) explore preferences for mHealth apps compared with other mental health services. METHODS: Using convenience sampling, participants completed a multiscale 54-item Web-based survey. Based on significant correlations with acceptance, hierarchical stepwise regression analysis was performed within three blocks: (1) background and stress-related control variables, (2) beliefs and attitudes toward using mHealth, and (3) the core UTAUT determinants. The preference for mHealth apps in comparison with nine other mental health services (operationalized as readiness to use) was analyzed using paired t tests. RESULTS: Of 141 participants, nearly half (69/141, 48.9%) indicated prior mHealth use. Acceptance of stress coping apps was moderate (mean 3.10, SD 1.03, range 1-5). Hierarchical stepwise regression including four of 11 variables (R2=.62; P=.01, f2=1.63) identified positive attitudes toward using mHealth for stress coping (beta=0.69, P<.001, 46% R2 increase above block 1, f2=0.85), skepticism/perceived risks (beta=-0.14, P=.01, f2=0.16), and stress symptoms (beta=0.12, P=.03, f2=0.14) as significant predictors of acceptance. UTAUT determinants added no predictive contribution beyond attitudes (all P>.05, R2 increase of 1%), whereas post hoc analysis showed significant R2 increases of attitudes and skepticism/perceived risks beyond UTAUT determinants (all P<.001, R2 increase of 13%). The readiness to use apps was equivalent to or significantly higher than most service types, but lower than information websites. CONCLUSIONS: Attitudes may be at least as predictive for the acceptance of stress management apps as for more elaborated outcome beliefs. Efforts aimed at improving the public adoption of mHealth could put more emphasis on the pleasant aspects of app use, address misconceptions, offer stress screening tools on health websites, and increase options to try high-quality apps.

Acceptance of mHealth Apps for Self-Management Among People with Hypertension.

BACKGROUND: Mobile health applications (mHealth apps) have the potential to help patients with chronic conditions such as hypertension by supporting self-management activities in daily life. However, the uptake of mHealth apps remains poor among patients. To improve the utilization of mHealth apps for hypertension, the analysis of the behavioral intention to use such applications must consider personality traits and illness-related perceptions. METHOD: Adults with hypertension in Germany and Austria filled out a self-administered questionnaire in a cross-sectional study based on the UTAUT-model in order to identify potential predictors for the behavioral intention to use mHealth applications as an indicator for their early acceptance. Beyond the four core determinants of acceptance of the UTAUT (performance expectancy, effort expectancy, social influence and facilitating conditions), self-efficacy, openness to experience and perceived health threat were analyzed as predictors. RESULTS: 145 participants (mean age 52.51 years, SD 14.33; 60% female) completed the survey. Acceptance was moderate on average (M = 3.26, SD = 1.07, min 1 to max 5). In a multiple hierarchical regression, performance expectancy and effort expectancy were confirmed as significant predictors of acceptance (step 1, R2 = .57, p < .001), while self-efficacy could not be confirmed (step 2, p = .87). In addition, perceived health threat (ß = .12, p < .05) and openness to experience (ß = .22, p < .001) had a significant influence on acceptance of mHealth apps for hypertension (step 3, overall model with R2 = .62). Age showed a negative association with the intention to use (ß = .22, p = .005) while no influence of gender could be found (p = .06). CONCLUSION: Above expectations regarding effectiveness and usability, openness to experience and perceived health threat make a significant contribution in predicting the acceptance of mHealth solutions in the field of chronic diseases.

Internet- and mobile-based aftercare and relapse prevention in mental disorders: A systematic review and recommendations for future research.

BACKGROUND: Mental disorders are characterized by a high likelihood of recurrence. Thus, aftercare and follow-up interventions aim to maintain treatment gains and to prevent relapse. Internet- and mobile-based interventions (IMIs) may represent promising instruments in tertiary prevention. This systematic review summarizes and evaluates the research on the efficacy of IMIs as aftercare or follow-up interventions for adults with mental health issues. METHODS: A systematic database search (PsycInfo, MEDLINE, CENTRAL) was conducted and studies selected according to predefined eligibility criteria (RCTs, adult population, clinical symptoms/disorder, assessed with validated instruments, clinical-psychological intervention rationale, aftercare/follow-up intervention, web-/mobile-based, minimum follow-up measurement of three months, inclusion of a control group). Inspected outcomes were symptom severity, recurrence- and rehospitalization rates, functioning, quality of life and adherence to primary treatment.Systematic review registration: PROSPERO CRD42017055289. RESULTS: Sixteen RCTs met the inclusion criteria, covering trials on depression (n = 5), eating disorders (n = 4) and transdiagnostic interventions (n = 7). The majority of the interventions were based on Cognitive Behavioral Therapy (CBT) principles and were web-based (n = 11). Methodological quality of included studies was suboptimal. Limitations included attrition bias and non-specification of routine care co-interventions. IMIs yielded small to medium post-treatment effects for symptom severity (d = -0.08 - d = -0.45) in comparison to control groups. Best evidence base was found for symptom severity of depression and anxiety. Study results regarding recurrence and rehospitalization were inconsistent. DISCUSSION: There is some evidence, that IMIs are feasible instruments for maintaining treatment gains for some mental disorders. However, further high quality, large-scale trials are needed to expand research fields, improve adherence to and uptake of IMIs and facilitate implementation of effective interventions into routine care.

Efficacy of a guided internet-based intervention (iSOMA) for somatic symptoms and related distress in university students: study protocol of a randomised controlled trial.

INTRODUCTION: Persistent and distressing somatic symptoms are common in younger age cohorts such as university students. However, the majority does not receive adequate psychosocial care. Internet-based and mobile-based interventions may represent low threshold and effective extensions to reduce somatic and associated mental symptom severity. The planned study aims to investigate the feasibility and efficacy of an internet-based intervention in reducing somatic and psychological symptoms in an international population of university students with somatic symptom burden. METHODS AND ANALYSIS: This parallel two-armed randomised controlled trial evaluates an 8-week guided intervention, including web-based consecutive modules based on cognitive behavioural therapy (CBT) principles against a waitlist control group. Guidance will be provided by trained psychologists with weekly written supportive feedback. As part of the 'Studicare' project, the present study aims to recruit n=154 university students indicating somatic symptom burden at baseline in German-speaking universities. Self-report assessments will take place at baseline and after intervention completion (8, 16 weeks after randomisation). The primary outcome will be the severity of somatic symptoms and associated mental distress. Secondary outcomes include depression, (health) anxiety, disability, intervention satisfaction and adherence. ETHICS AND DISSEMINATION: Ethics approval has been granted. Results from this study will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER: DRKS00014375; Pre-results.

Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study.

BACKGROUND: Mobile health (mHealth) apps might have the potential to promote self-management of people with multiple sclerosis (MS) in everyday life. However, the uptake of MS apps remains poor, and little is known about the facilitators and barriers for their efficient utilization, such as technology acceptance. OBJECTIVE: The aim of this study was to examine the acceptance of mHealth apps for disease management in the sense of behavioral intentions to use and explore determinants of utilization among people with MS based on the Unified Theory of Acceptance and Use of Technology (UTAUT). METHODS: Participants for this Web-based cross-sectional study were recruited throughout Germany with the support of regional MS associations and self-help groups. To identify determinants of intention to use MS apps, a measure based on the UTAUT was adapted with 4 key determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) and extended by Intolerance of Uncertainty (IU) and electronic health literacy. Potential influencing effects of both MS and computer self-efficacy (C-SE) as mediators and fatigue as a moderator were analyzed using Hayes's PROCESS macro (SPSS version 3.0) for IBM SPSS version 24.0. RESULTS: A total of 98 participants (mean age 47.03 years, SD 10.17; 66/98, 67% female) with moderate fatigue levels completed the survey. Although most participants (91/98, 92%) were daily smartphone users, almost two-thirds (62/98, 63%) reported no experience with MS apps. Overall, the acceptance was moderate on average (mean 3.11, SD 1.31, minimum=1 and maximum=5), with lower scores among persons with no experience (P=.04) and higher scores among current users (P<.001). In multiple regression analysis (R2=63% variance explained), performance expectancy (beta=.41) and social influence (beta=.33) were identified as significant predictors of acceptance (all P<.001). C-SE was confirmed as a partial mediator in the relationship between IU and acceptance (indirect effect: B=-.095, 95% CI -0.227 to -0.01). Furthermore, a moderated mediation by C-SE was shown in the relationship between IU and behavioral intentions to use MS apps for low (95% CI -0.42 to -0.01) and moderate levels (95% CI -0.27 to -0.01) of fatigue. CONCLUSIONS: Overall, this exploratory pilot study indicates for the first time that positive expectations about the helpfulness for self-management purposes and social support might be important factors to be considered for improving the acceptance of MS apps among smartphone users with MS. However, given some inconsistent findings, especially regarding the role of effort expectancy and IU and self-efficacy, the conceptual model needs replication with a larger sample of people with MS, varying more in fatigue levels, and a longitudinal assessment of the actual usage of MS apps predicted by acceptance in the sense of behavioral intentions to use.

["Morbus Google" vs. e-Health: A Qualitative Study of Acceptance and Implementation of Online-Aftercare in Inpatient Rehabilitation]. / "Morbus Google" vs. e-Health: Qualitative Untersuchung zur Akzeptanz und Implementierung von Online-Nachsorge in der stationären Rehabilitation.

INTRODUCTION: Internet- and mobile-based health interventions (IMIs) e. g. in the form of internet-based aftercare can supplement existing treatments of inpatient rehabilitation. Acceptance presents a key precondition to the utilization and clinical implementation of new technologies and was examined in patients and health professionals with qualitative research methods. METHODS: In 3 inpatient rehabilitation clinics with various diagnostic and age groups, we interviewed n=15 patients individually and n=29 health professionals of various occupational groups in focus groups based on the 'Unified Theory of Acceptance and Use of Technology'. RESULTS: Benefits of online-aftercare were seen in the access to health information, motivation to health promotion or in monitoring or correcting health behavior. Occupational stress was not seen as an area of application. Reservations were expressed in terms of lack of trust in online contact. Overall, acceptance was higher in patients in comparison to health professionals. CONCLUSION: Barriers of uptake or application of IMIs in rehabilitation exceed technical and demographic aspects and provide important information for specific facilitation of acceptance of patients as well as health professionals.

Acceptance and barriers to access of occupational e-mental health: cross-sectional findings from a health-risk population of employees.

PURPOSE: Occupational e-mental-health (OEMH) may extend existing instruments for preservation or restoration of health and work ability. As a key precondition to efficient implementation, this study examined acceptance and person-centered barriers to potential uptake of OEMH for work-related distress in employees with an elevated risk of early retirement. METHODS: Within the framework of the "Third German Sociomedical Panel of Employees", 1829 employees with prior sickness absence payments filled out a self-administered questionnaire. Participants had a mean age of 49.93 years (SD = 4.06). 6.2% indicated prior use of eHealth interventions. Potential predictors of acceptance of OEMH were examined based on the "Unified Theory of Acceptance and Use of Technology" (UTAUT) extended by work ability, mental health, eHealth literacy and demographic characteristics. RESULTS: 89.1% (n = 1579) showed low to moderate acceptance (M = 2.20, SD = 1.05, range 1-5). A path analysis revealed significant, positive direct effects of UTAUT predictors on acceptance (performance expectancy: 0.48, SE = 0.02, p < 0.001; effort expectancy: 0.20, SE = 0.02, p < 0.001; social influence: 0.28, SE = 0.02, p < 0.001).Online time and frequency of online health information search were further positive direct predictors of acceptance. Model fit was good [χ 2(7) = 12.91, p = 0.07, RMSEA = 0.02, CFI = 1.00, TLI = 0.99, SRMR = 0.01]. CONCLUSIONS: Attitudes towards OEMH are rather disadvantageous in the studied risk group. Implementation of OEMH, therefore, requires a-priori education including promotion of awareness, favorable attitudes regarding efficacy and usability in a collaborative approach.

Internet- and mobile-based aftercare and follow-up for mental disorders: protocol of a systematic review and meta-analysis.

INTRODUCTION: Mental disorders are characterised by a high likelihood of symptom recurrence or chronicity. Thus, in the vulnerable post-discharge phase, aftercare and follow-up aim at stabilising treatment effects, promoting functionality and preventing relapse or readmission. Internet- and mobile-based interventions may represent low threshold and effective extensions to aftercare in tertiary prevention of mental disorders. OBJECTIVES: The planned systematic review and meta-analysis aims to synthesise and analyse existing evidence on the effectiveness of psychological internet- and mobile-based aftercare or follow-up in maintaining treatment effects and/or preventing recurrence in adults with mental disorders. METHODS AND ANALYSIS: Electronic databases (PsycInfo, MEDLINE and Cochrane Central Register of Controlled trials) will be searched systematically, complemented by a hand-search of ongoing trials and reference lists of selected studies. Data extraction and evaluation will be conducted by two independent researchersand quality will be assessed with the Cochrane risk of bias tool. Eligibility criteria for selecting studies will be: randomised controlled trials of internet-based and mobile-based, psychological aftercare and follow-up for the tertiary prevention of mental disorders in an adult population. Primary outcome will be symptom severity. Secondary outcomes will be symptom or disorder recurrence rate, rehospitalisation rate, functionality, quality of life or adherence to primary treatment. Further data items to be extracted will be: study design, intervention and technical characteristics, type of mental disorder or clinical symptom to be treated, target population items, setting, treatment engagement and assessment of additional outcome variables. Meta-analytic pooling will be conducted when data of included studies are comparable in terms of study design, intervention type, endpoints, assessments and target mental disorder. Cumulative evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework. ETHICS AND DISSEMINATION: Ethics approval is not required. Results from this review will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER: PROSPERO CRD42017055289.