Connected Mental Health Solutions: Global Attitudes, Preferences, and Concerns.

Background: Connected mental health (CMH) presents several technology-based solutions, which can help overcome many mental care delivery barriers. However, attitudes toward the use of CMH are diverse and differ from a cohort to another. Objective: The purpose of this study is to investigate the global attitudes toward CMH use and assess the use of technology for mental care. Methods: This study presents a synthesis of literature available in Scopus, Science Direct, and PubMed digital libraries, investigating attitudes toward CMH in different cohorts from different countries, based on a systematic review of relevant publications. This study also analyzes technology use patterns of the cohorts investigated, the reported preferred criteria that should be considered in CMH, and issues and concerns regarding CMH use. Results: One hundred and one publications were selected and analyzed. These publications were originated from different countries, with the majority (n = 23) being conducted in Australia. These studies reported positive attitudes of investigated cohorts toward CMH use and high technology use and ownership. Several preferred criteria were reported, mainly revolving around providing blended care functionalities, educational content, and mental health professionals (MHPs) support. Whereas concerns and issues related to CMH use addressed technical problems related to access to technology and to CMH solutions, the digital divide, lack of knowledge and use of CMH, and general reservations to use CMH. Concerns related to institutional and work barriers were also identified. Conclusions: Attitudes toward CMH show promising results from users and MHP views. However, factors such as providing blended care options and considering technical concerns should be taken into consideration for the successful adoption of CMH.

A Conceptual Framework to Design Connected Mental Health Solutions in the United Arab Emirates: Questionnaire Study.

BACKGROUND: Connected mental health (CMH) is a field presenting information and communications technology-based mental care interventions that could help overcome many mental care delivery barriers. Culture and background influence people's attitudes, preferences, and acceptance of such solutions. Therefore, the suitability of CMH solutions to the targeted population is an important factor in their successful adoption. OBJECTIVE: The aim of this study is to develop a framework for the design and creation of CMH solutions suitable for the UAE context. The framework is based on investigating enablers and barriers of CMH adoption in the United Arab Emirates, from the mental health professional's (MHP) perspective and from related literature. METHODS: A survey of literature on relevant studies addressing the use of technology for mental care in Arab countries, and a web-based questionnaire-based survey with 17 MHPs practicing in the United Arab Emirates investigating their attitudes and views toward CMH was conducted. Results from the questionnaire and from related studies were analyzed to develop the design framework. RESULTS: On the basis of findings from the literature survey and analyzing MHP answers to the web-based survey, a framework for the design of CMH solutions for the UAE population was developed. The framework presents four types of recommendation categories: favorable criteria, which included blended care, anonymity, and ease of use; cultural factors including availability in multiple languages, mainly Arabic and English, in addition to religious and cultural considerations; technical considerations, including good-quality communication, availability in formats compatible with mobile phones, and providing technical support; and users' health and data safety considerations, including users' suitability testing, confidentiality, and ensuring MHP integrity. CONCLUSIONS: CMH has the potential to help overcome many mental care barriers in the United Arab Emirates in particular and in the Arab world in general. CMH adoption in the United Arab Emirates has a potential for success. However, many factors should be taken into account, mainly cultural, religious, and linguistic aspects.

Biofeedback-Based Connected Mental Health Interventions for Anxiety: Systematic Literature Review.

BACKGROUND: Connected mental health, which refers to the use of technology for mental health care and technology-based therapeutic solutions, has become an established field of research. Biofeedback is one of the approaches used in connected mental health solutions, which is mainly based on the analysis of physiological indicators for the assessment and management of the psychological state. Biofeedback is recommended by many therapists and has been used for conditions including depression, insomnia, and anxiety. Anxiety is associated with several physiological symptoms, including muscle tension and breathing issues, which makes the inclusion of biofeedback useful for anxiety detection and management. OBJECTIVE: The aim of this study was to identify interventions using biofeedback as a part of their process for anxiety management and investigate their perceived effectiveness. METHODS: A systematic literature review of publications presenting empirically evaluated biofeedback-based interventions for anxiety was conducted. The systematic literature review was based on publications retrieved from IEEE Digital Library, PubMed, ScienceDirect, and Scopus. A preliminary selection of papers was identified, examined, and filtered to include only relevant publications. Studies in the final selection were classified and analyzed to extract the modalities of use of biofeedback in the identified interventions, the types of physiological data that were collected and analyzed and the sensors used to collect them. Processes and outcomes of the empirical evaluations were also extracted. RESULTS: After final selection, 13 publications presenting different interventions were investigated. The interventions addressed either primarily anxiety disorders or anxiety associated with health issues such as migraine, Parkinson disease, and rheumatology. Solutions combined biofeedback with other techniques including virtual reality, music therapy, games, and relaxation practices and used different sensors including cardiovascular belts, wrist sensors, or stretch sensors to collect physiological data such as heart rate, respiration indicators, and movement information. The interventions targeted different cohorts including children, students, and patients. Overall, outcomes from the empirical evaluations yielded positive results and emphasized the effectiveness of connected mental health solutions using biofeedback for anxiety; however, certain unfavorable outcomes, such as interventions not having an effect on anxiety and patients' preferring traditional therapy, were reported in studies addressing patients with specific physical health issues. CONCLUSIONS: The use of biofeedback in connected mental health interventions for the treatment and management of anxiety allows better screening and understanding of both psychological and physiological patient information, as well as of the association between the two. The inclusion of biofeedback could improve the outcome of interventions and boost their effectiveness; however, when used with patients suffering from certain physical health issues, suitability investigations are needed.

Impact of COVID-19 on the psychological health of university students in Spain and their attitudes toward Mobile mental health solutions.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had an impact on several aspects of life, including university students' mental health. Mobile mental care applications (apps) comprise a form of online mental care that enables the delivery of remote mental care. OBJECTIVES: This study aimed to explore the impact of COVID-19 on the mental health of university students in Spain and to explore their attitudes toward the use of mobile mental care apps. METHOD: Respondents answered a survey, which comprised two sections. The first included the 12-item General Health Questionnaire (GHQ-12) that was employed to assess the students' mental health. The second section included six questions developed by the authors to explore the students' attitudes toward mental care apps. RESULTS: The results showed that the students suffered from anxiety and depression as well as social dysfunction. Further, 91.3 % of the students had never used a mobile app for mental health, 36.3 % were unaware of such apps, and 79.2 % were willing to use them in the future. CONCLUSIONS: The COVID-19 pandemic had a significant impact on the psychological health of university students. Mobile mental care apps may be an effective and efficient way to access mental care, particularly during a pandemic.

A Systematic Literature Review on e-Mental Health Solutions to Assist Health Care Workers During COVID-19.

Background: e-Mental health is an established field of exploiting information and communication technologies for mental health care. It offers different solutions and has shown effectiveness in managing many psychological issues. Introduction: The coronavirus disease 2019 (COVID-19) pandemic has critically influenced health care systems and health care workers (HCWs). HCWs are working under hard conditions, and are suffering from different psychological issues, including anxiety, stress, and depression. Consequently, there is an undeniable need of mental care interventions for HCWs. Under the circumstances caused by COVID-19, e-health interventions can be used as tools to assist HCWs with their mental health. These solutions can provide mental health care support remotely, respecting the recommended safety measures. Materials and Methods: This study aims to identify e-mental health interventions, reported in the literature, that are developed for HCWs during the COVID-19 pandemic. A systematic literature review was conducted following the PRISMA protocol by searching the following digital libraries: IEEE, ACM, ScienceDirect, Scopus, and PubMed. Results and Discussion: Eleven publications were selected. The identified e-mental health interventions consisted of social media platforms, e-learning content, online resources and mobile applications. Only 27% of the studies included empirical evaluation of the reported interventions, 55% listed challenges and limitations related to the adoption of the reported interventions. And 45% presented interventions developed specifically for HCWs in China. The overall feedback on the identified interventions was positive, yet a lack of empirical evaluation was identified, especially regarding qualitative evidence. Conclusions: The COVID-19 pandemic has highlighted the importance and need for e-mental health solutions for HCWs.

Investigating the Impact of COVID-19 Lockdown on the Psychological Health of University Students and Their Attitudes Toward Mobile Mental Health Solutions: Two-Part Questionnaire Study.

BACKGROUND: The COVID-19 outbreak was first reported to the World Health Organization on December 31, 2019, and it was officially declared a public health emergency of international concern on January 30, 2020. The COVID-19 outbreak and the safety measures taken to control it caused many psychological issues in populations worldwide, such as depression, anxiety, and stress. OBJECTIVE: The objectives of this study were to assess the psychological effects of the lockdown due to the COVID-19 outbreak on university students in the United Arab Emirates (UAE) and to investigate the students' awareness of mobile mental health care apps as well as their attitudes toward the use of these apps. METHODS: A two-part self-administered web-based questionnaire was delivered to students at United Arab Emirates University. The first part of the questionnaire assessed the mental state of the participants using the 12-item General Health Questionnaire (GHQ-12), while the second part contained questions investigating the participants' awareness of and attitudes toward mental health care apps. Students were invited to fill out the web-based questionnaire via social media and mailing lists. RESULTS: A total of 154 students participated in the survey, and the majority were female. The results of the GHQ-12 analysis showed that the students were experiencing psychological issues related to depression and anxiety as well as social dysfunction. The results also revealed a lack of awareness of mental health care apps and uncertainty regarding the use of such apps. Approximately one-third of the participants (44/154, 28.6%) suggested preferred functionalities and characteristics of mobile mental health care apps, such as affordable price, simple design, ease of use, web-based therapy, communication with others experiencing the same issues, and tracking of mental status. CONCLUSIONS: Like many groups of people worldwide, university students in the UAE were psychologically affected by the lockdown due to the COVID-19 outbreak. Although apps can be useful tools for mental health care delivery, especially in circumstances such as those produced by the outbreak, the students in this study showed a lack of awareness of these apps and mixed attitudes toward them. Improving the digital health literacy of university students in the UAE by increasing their awareness of mental health care apps and the treatment methods and benefits of the apps, as well as involving students in the app creation process, may encourage students to use these tools for mental health care.

An analysis on self-management and treatment-related functionality and characteristics of highly rated anxiety apps.

BACKGROUND AND OBJECTIVE: Anxiety is a common emotion that people often feel in certain situations. But when the feeling of anxiety is persistent and interferes with a person's day to day life then this may likely be an anxiety disorder. Anxiety disorders are a common issue worldwide and can fall under general anxiety, panic attacks, and social anxiety among others. They can be disabling and can impact all aspects of an individual's life, including work, education, and personal relationships. It is important that people with anxiety receive appropriate care, which in some cases may prove difficult due to mental health care delivery barriers such as cost, stigma, or distance from mental health services. A potential solution to this could be mobile mental health applications. These can serve as effective and promising tools to assist in the management of anxiety and to overcome some of the aforementioned barriers. The objective of this study is to provide an analysis of treatment and management-related functionality and characteristics of high-rated mobile applications (apps) for anxiety, which are available for Android and iOS systems. METHOD: A broad search was performed in the Google Play Store and App Store following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol to identify existing apps for anxiety. A set of free and highly rated apps for anxiety were identified and the selected apps were then installed and analyzed according to a predefined data extraction strategy. RESULTS: A total of 167 anxiety apps were selected (123 Android apps and 44 iOS apps). Besides anxiety, the selected apps addressed several health issues including stress, depression, sleep issues, and eating disorders. The apps adopted various treatment and management approaches such as meditation, breathing exercises, mindfulness and cognitive behavioral therapy. Results also showed that 51% of the selected apps used various gamification features to motivate users to keep using them, 32% provided social features including chat, communication with others and links to sources of help; 46% offered offline availability; and only 19% reported involvement of mental health professionals in their design. CONCLUSIONS: Anxiety apps incorporate various mental health care management methods and approaches. Apps can serve as promising tools to assist large numbers of people suffering from general anxiety or from anxiety disorders, anytime, anywhere, and particularly in the current COVID-19 pandemic.

Connected Mental Health: Systematic Mapping Study.

BACKGROUND: Although mental health issues constitute an increasing global burden affecting a large number of people, the mental health care industry is still facing several care delivery barriers such as stigma, education, and cost. Connected mental health (CMH), which refers to the use of information and communication technologies in mental health care, can assist in overcoming these barriers. OBJECTIVE: The aim of this systematic mapping study is to provide an overview and a structured understanding of CMH literature available in the Scopus database. METHODS: A total of 289 selected publications were analyzed based on 8 classification criteria: publication year, publication source, research type, contribution type, empirical type, mental health issues, targeted cohort groups, and countries where the empirically evaluated studies were conducted. RESULTS: The results showed that there was an increasing interest in CMH publications; journals were the main publication channels of the selected papers; exploratory research was the dominant research type; advantages and challenges of the use of technology for mental health care were the most investigated subjects; most of the selected studies had not been evaluated empirically; depression and anxiety were the most addressed mental disorders; young people were the most targeted cohort groups in the selected publications; and Australia, followed by the United States, was the country where most empirically evaluated studies were conducted. CONCLUSIONS: CMH is a promising research field to present novel approaches to assist in the management, treatment, and diagnosis of mental health issues that can help overcome existing mental health care delivery barriers. Future research should be shifted toward providing evidence-based studies to examine the effectiveness of CMH solutions and identify related issues.

Mobile Apps for Post Traumatic Stress Disorder.

Post Traumatic Stress Disorder (PTSD) is a serious mental disorder that is caused by exposure to traumatic stress and not being able to recover from it. PTSD often results in a severe reduction of the quality of life, and is significantly associated with the risk of suicide. This paper identifies the current list of free mobile applications (apps) available in Android platform for smartphone users with PTSD. This paper also assesses the functionalities of the apps selected. The result of this study may assist PTSD apps seekers for self-support, and serve as a reference for researchers and developers, who intend proposing stress management apps.