User-Friendly Chatbot to Mitigate the Psychological Stress of Older Adults During the COVID-19 Pandemic: Development and Usability Study.

BACKGROUND: To safeguard the most vulnerable individuals during the COVID-19 pandemic, numerous governments enforced measures such as stay-at-home orders, social distancing, and self-isolation. These social restrictions had a particularly negative effect on older adults, as they are more vulnerable and experience increased loneliness, which has various adverse effects, including increasing the risk of mental health problems and mortality. Chatbots can potentially reduce loneliness and provide companionship during a pandemic. However, existing chatbots do not cater to the specific needs of older adult populations. OBJECTIVE: We aimed to develop a user-friendly chatbot tailored to the specific needs of older adults with anxiety or depressive disorders during the COVID-19 pandemic and to examine their perspectives on mental health chatbot use. The primary research objective was to investigate whether chatbots can mitigate the psychological stress of older adults during COVID-19. METHODS: Participants were older adults belonging to two age groups (≥65 years and <65 years) from a psychiatric outpatient department who had been diagnosed with depressive or anxiety disorders by certified psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. The participants were required to use mobile phones, have internet access, and possess literacy skills. The chatbot's content includes monitoring and tracking health data and providing health information. Participants had access to the chatbot for at least 4 weeks. Self-report questionnaires for loneliness, depression, and anxiety were administered before and after chatbot use. The participants also rated their attitudes toward the chatbot. RESULTS: A total of 35 participants (mean age 65.21, SD 7.51 years) were enrolled in the trial, comprising 74% (n=26) female and 26% (n=9) male participants. The participants demonstrated a high utilization rate during the intervention, with over 82% engaging with the chatbot daily. Loneliness significantly improved in the older group ≥65 years. This group also responded positively to the chatbot, as evidenced by changes in University of California Los Angeles Loneliness Scale scores, suggesting that this demographic can derive benefits from chatbot interaction. Conversely, the younger group, <65 years, exhibited no significant changes in loneliness after the intervention. Both the older and younger age groups provided good scores in relation to chatbot design with respect to usability (mean scores of 6.33 and 6.05, respectively) and satisfaction (mean scores of 5.33 and 5.15, respectively), rated on a 7-point Likert scale. CONCLUSIONS: The chatbot interface was found to be user-friendly and demonstrated promising results among participants 65 years and older who were receiving care at psychiatric outpatient clinics and experiencing relatively stable symptoms of depression and anxiety. The chatbot not only provided caring companionship but also showed the potential to alleviate loneliness during the challenging circumstances of a pandemic.

Potential Mobile Health Applications for Improving the Mental Health of the Elderly: A Systematic Review.

The rapid aging of the global population presents challenges in providing mental health care resources for older adults aged 65 and above. The COVID-19 pandemic has further exacerbated the global population's psychological distress due to social isolation and distancing. Thus, there is an urgent need to update scholarly knowledge on the effectiveness of mHealth applications to improve older people's mental health. This systematic review summarizes recent literature on chatbots aimed at enhancing mental health and well-being. Sixteen papers describing six apps or prototypes were reviewed, indicating the practicality, feasibility, and acceptance of chatbots for promoting mental health in older adults. Engaging with chatbots led to improvements in well-being and stress reduction, as well as a decrement in depressive symptoms. Mobile health applications addressing these studies are categorized for reference.

Subjective and objective assessments of sleep problems in children with attention deficit/hyperactivity disorder and the effects of methylphenidate treatment.

BACKGROUND: to investigate the sleep problems in children with different ADHD presentations and effects of methylphenidate (MPH) on the sleep problems of children with ADHD by both subjective and objective measurements. METHODS: 71 children with ADHD and 30 controls were included. 35 had ADHD with predominantly inattentive presentation (ADHD-I) and 36 with predominantly hyperactive/impulsive or combined presentation (ADHD-C). We used the pediatric sleep questionnaire (PSQ) and a nocturnal polysomnography (PSG) to assess the sleep problems in children with ADHD before and 6 months after being treated with methylphenidate (0.3-0.7 mg/kg/dose). RESULTS: PSG showed significantly higher apnea-hypopnea index and hypopnea counts, and lower slow-wave sleep percentage in children with ADHD. The results of PSQ reported by parents showed significantly higher rates of delay initiation of sleep, sleep onset latency, sleep fragment, daytime sleepiness, enuresis, bruxism, nightmares, periodic limb movement disorder (PLMD), and snoring in children with ADHD compared to normal controls. Comparisons of ADHD presentations revealed no significant difference between ADHD-I and ADHD-C by either PSG or PSQ measurements. After 6-month MPH treatment, the PSG showed significantly increased total sleep time and reduced periodic limb movement index (PLMI). The PSQ indicated significant reduction in bruxism and snoring in ADHD-I, as well as nightmares in ADHD-C, and both subgroups showed significant reduction in PLMD. CONCLUSION: subjective and objective approaches produced inconsistent findings regarding the sleep problems in children with ADHD. Besides, MPH didn't worsen the sleep problems in children with ADHD.

Dimensionality of the Chinese hospital anxiety depression scale in psychiatric outpatients: Mokken scale and factor analyses.

OBJECTIVE: The hospital anxiety and depression scale (HADS) is a widely used scale of anxiety and depression. However, recent studies have challenged the bi-dimensional scoring of the HADS. The present study was to examine the dimensionality of the Chinese HADS. METHODS: We recruited a convenience sample of 214 adult psychiatric outpatients at a medical centre in Taiwan, and they completed the Chinese HADS. We used Mokken scale analysis (MSA), exploratory factor analysis (EFA), exploratory bifactor analysis (EBA) and confirmatory factor analysis (CFA) to examine the dimensionality of the Chinese HADS. RESULTS: The Chinese HADS was a moderate Mokken scale (Hs = 0.44), and had a two-factor structure. EBA showed that one general factor, emotional distress, explained 68% of the common variance of the Chinese HADS. CFA confirmed that the bifactor model had the best fit statistics. The items 5 and 7 of the Chinese HADS contributed to structural ambiguity in the Chinese HADS subscales. CONCLUSIONS: The sum scores of the Chinese HADS were a reliable and valid unidimensional measure of emotional distress. The Chinese HADS subscales were incapable of differentiating between anxiety and depression. Clinicians and researchers should choose other scales that are specifically designed for measuring anxiety and depression.

Construct validity of the Depression and Somatic Symptoms Scale: evaluation by Mokken scale analysis.

OBJECTIVE: Previous studies of the Depression and Somatic Symptoms Scale (DSSS), a free scale, have been based on the classical test theory, and the construct validity and dimensionality of the DSSS are as yet uncertain. The aim of this study was to use Mokken scale analysis (MSA) to assess the dimensionality of the DSSS. METHODS: A sample of 214 psychiatric outpatients with mood and anxiety disorders were enrolled at a medical center in Taiwan (age: mean [SD] =38.3 [10.5] years; 63.1% female) and asked to complete the DSSS. MSA was used to assess the dimensionality of the DSSS. RESULTS: All 22 items of the DSSS formed a moderate unidimensional scale (Hs =0.403), supporting its construct validity. The DSSS was divided into 4 subscales (Hs ranged from 0.35 to 0.67), including a general somatic scale (GSS), melancholic scale (MS), muscular pain scale (MPS), and chest symptom scale (CSS). The GSS is a weak reliable Mokken scale; the other 3 scales are strong reliable Mokken scales. CONCLUSION: The DSSS is a psychometrically sound measure of depression and somatic symptoms in adult psychiatric outpatients with depression or anxiety. The summed score of the DSSS and its 4 subscales are valid statistics. Further research is required for replication of the 4 subscales of the DSSS.

Effects of naphthalene quinonoids on the induction of oxidative DNA damage and cytotoxicity in calf thymus DNA and in human cultured cells.

The purpose of this study was to examine the differences in the induction of DNA damage and cytotoxic effects by quinonoid derivatives of naphthalene in calf thymus DNA (ct-DNA) and in human T47D breast cancer cells. Results indicated that copper(II) and NADPH were essential for causing oxidant-mediated aldehydic DNA lesions (ADLs), including abasic sites and aldehydic base/sugar lesions, in ct-DNA exposed to 1,2-naphthalenediol (NCAT), 1,4-naphthalenediol (NHQ), 1,2-naphthoquinone (1,2-NQ), and 1,4-naphthoquinone (1,4-NQ). The ADLs induced by naphthalene quinonoids in ct-DNA decrease in the rank order NCAT congruent with 1,2-NQ > NHQ >> 1,4-NQ. Results from the analyses in cells indicated that after 1.5-5 h of exposure all naphthalene quinonoids induced a cytotoxic response in T47D cells at concentrations 10-100 microM or above, where NHQ and 1,4-NQ were approximately 5-10 times more efficient than NCAT and 1,2-NQ in the induction of cell death. In addition, NHQ, 1,2-NQ, and 1,4-NQ were not able to produce measurable levels of ADLs in cells at concentrations up to 1.25 mM, whereas NCAT (0.75-1.25 mM) induced a significant increase in the number of ADLs in T47D cells after 1.5 h of exposure when compared to control. The specific type of ADLs induced by NCAT is resistant to cellular excision repair pathway. Results from the measurements of reactive oxygen species (ROS) indicated that all naphthalene quinonoids induced increases in ROS formation in T47D cells. The induction of ROS formation in cells by naphthalene quinonoids decreases in the rank order 1,4-NQ congruent with 1,2-NQ > NHQ > NCAT. Overall, results from our investigation suggest that naphthalene quinonoids cause cell death at concentrations well below the concentrations at which they induce the formation of ADLs, perhaps by altering intracellular redox status.