Accessibility and Digital Mental Health: Considerations for More Accessible and Equitable Mental Health Apps.

Digital mental health is often touted as a solution to issues of access to mental health care. However, there has been little research done to understand the accessibility of digital mental health, especially for those with disabilities. In this piece, we define accessibility as it relates to mental health apps, describe the current state of accessibility in the digital world broadly and in mental health apps more specifically, outline why accessibility matters in mental health apps, and identify future steps to better incorporate accessibility into research and development of mental health apps.

Designing Mental Health Technologies that Support the Social Ecosystem of College Students.

The last decade has seen increased reports of mental health problems among college students, with college counseling centers struggling to keep up with the demand for services. Digital mental health tools offer a potential solution to expand the reach of mental health services for college students. In this paper, we present findings from a series of design activities conducted with college students and counseling center staff aimed at identifying needs and preferences for digital mental health tools. Results emphasize the social ecosystems and social support networks in a college student's life. Our findings highlight the predominant role of known peers, and the ancillary roles of unknown peers and non-peers (e.g., faculty, family) in influencing the types of digital mental health tools students desire, and the ways in which they want to learn about mental health tools. We identify considerations for designing digital mental health tools for college students that take into account the identified social factors and roles.

A Place to Play: The (Dis)Abled Embodied Experience for Autistic Children in Online Spaces.

Play is the work of children-but access to play is not equal from child to child. Having access to a place to play is a challenge for marginalized children, such as children with disabilities. For autistic children, playing with other children in the physical world may be uncomfortable or even painful. Yet, having practice in the social skills play provides is essential for childhood development. In this ethnographic work, I explore how one community uses the sense of place and the digital embodied experience in a virtual world specifically to give autistic children access to play with their peers. The contribution of this work is twofold. First, I demonstrate how various physical and virtual spaces work together to make play possible. Second, I demonstrate these spaces, though some of them are digital, are no more or less "real" than the physical spaces making up a schoolyard or playground.

"Autsome": Fostering an Autistic Identity in an Online Minecraft Community for Youth with Autism.

Autism is a medical diagnosis that has attracted much attention in recent decades, particularly due to an increase in the numbers of children being diagnosed and the changing requirements for getting the diagnosis. In parallel online communities around autism-both those supporting individuals, families seeking treatment and those supporting embracing the autism identity-have grown. Previous literature has shown the positive impact support groups can have for those encountering hardship in their lives, such as depression. In this qualitative study of an online community for autistic children centered around a virtual world, I explore how the label "autism" can be not only a source of disenfranchisement, leading to harassment and violence-in both the virtual and physical world-but also a source of empowerment and identity. I illuminate the tension in claiming the autistic identity within this community-having a sense of identity in the community, but, in doing so, also "othering" those with autism further. The walls of the community work to keep community members safe, but also set them apart from others on the internet. I see that the Autcraft community goes beyond being a support group for victims of targeted violence, to one that redefines and helps community members embrace their own autistic identities.

Understanding Mental Ill-health as Psychosocial Disability: Implications for Assistive Technology.

Psychosocial disability involves actual or perceived impairment due to a diversity of mental, emotional, or cognitive experiences. While assistive technology for psychosocial disabilities has been understudied in communities such as ASSETS, advances in computing have opened up a number of new avenues for assisting those with psychosocial disabilities beyond the clinic. However, these tools continue to emerge primarily within the framework of "treatment," emphasizing resolution or improvement of mental health symptoms. This work considers what it means to adopt a social model lens from disability studies and incorporate the expertise of assistive technology researchers in relation to mental health. Our investigation draws on interviews conducted with 18 individuals who have complex health needs that include mental health symptoms. This work highlights the potential role for assistive technology in supporting psychosocial disability outside of a clinical or medical framework.

Stepping Up: Predictors of 'Stepping' within an iCBT Stepped-Care Intervention for Depression.

Internet-based cognitive behavioral therapy (iCBT) may overcome barriers to mental health care and has proven efficacious. However, this approach currently exists outside the existing mental health care delivery system. Stepped care is a proposed framework for integrating digital mental health (DMH) into health systems by initiating iCBT and "stepping up" care to a more intensive intervention should iCBT prove ineffective. This study explores pre-treatment factors associated with reaching stepping criteria among patients receiving iCBT. This exploratory analysis of a stepped care arm of a larger randomized trial examined participants who were stepped to a more intensive intervention if they did not respond to iCBT. The association of pre-treatment factors on stepping were examined using Kruskal-Wallis and Chi-square tests. One-fifth of the 151 participants met criteria for stepping within the 20-week treatment period. Only pre-treatment depression severity and treatment preference were associated with increased likelihood of stepping (p = 0.049 and 0.048, respectively). The low number of individuals who stepped provides support for iCBT as an effective, low intensity treatment for depression. The modest association of pre-treatment depression and preference to not receive iCBT may be useful in identifying patients who are less likely to respond.

"I think people are powerful": The Sociality of Individuals Managing Depression.

Millions of Americans struggle with depression, a condition characterized by feelings of sadness and motivation loss. To understand how individuals managing depression conceptualize their self-management activities, we conducted visual elicitations and semi-structured interviews with 30 participants managing depression in a large city in the U.S. Midwest. Many depression support tools are focused on the individual user and do not often incorporate social features. However, our analysis showed the key importance of sociality for self-management of depression. We describe how individuals connect with specific others to achieve expected support and how these interactions are mediated through locations and communication channels. We discuss factors influencing participants' sociality including relationship roles and expectations, mood state and communication channels, location and privacy, and culture and society. We broaden our understanding of sociality in CSCW through discussing diffuse sociality (being proximate to others but not interacting directly) as an important activity to support depression self-management.