The Effect of Digital Mental Health Literacy Interventions on Mental Health: Systematic Review and Meta-Analysis.

BACKGROUND: Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions. OBJECTIVE: This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health. METHODS: We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health. RESULTS: Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI -0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults. CONCLUSIONS: For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995.

Mother-child and father-child "serve and return" interactions at 9 months: Associations with children's language skills at 18 and 24 months.

Infants learn language through the back-and-forth interactions with their parents where they "serve" by uttering sounds, gesturing, or looking and parents "return" in prompt (i.e., close in time) and meaningful (i.e., semantically relevant to the object of interest) ways. In a sample of 9-month-old infants (n = 148) and their mothers and fathers (n = 296 parents) from ethnically and socioeconomically diverse backgrounds, we examined the associations between "serve and return" (SR) parent-child interactions and children's language skills at 18 and 24 months. We also examined the moderation effects between maternal and paternal SR interactions on language outcomes. SR interactions were transcribed and coded from videotaped parent-child toy play activities during home visits. We report three findings. First, mothers who provided more meaningful responses to their child's serves at 9 months had children with higher expressive language scores at 18 months. Second, fathers' prompt responses (i.e., within 3 s) at 9 months were associated with higher receptive language scores at 18 months, but their meaningful responses were negatively associated with receptive language scores at 24 months. Third, the negative association between fathers' meaningful responses and children's receptive language scores was reduced (compensated) when mothers' meaningful responses were high. Findings show that infants in ethnically and socioeconomically diverse families engage in frequent SR interactions with both mothers and fathers, who make unique contributions to infants' language development. We discuss implications for programs and policies that aim to promote early language development and reduce gaps in school readiness.

Consideration of Developmental Stage and the Debate on the Effects of Screens Use-Not All Things Are Created Equal.

This Viewpoint discusses the role of childhood developmental stage in research evaluating the effects of screen use among youth and its application to practice, policy, and the public.

Applying a family stress model to understand U.S. families' patterns of stress, media use, and child behavior during the COVID-19 pandemic.

The COVID-19 pandemic has greatly altered family life, and research among adults and families is finding increases in financial stress, mental health problems, screen time, parental conflict, and child behavior problems. Given these patterns, we sought to replicate these findings with a younger and largely non-white sample and consider how these constructs might relate to each other by using the Family Stress Model. From surveys of 247 predominately Latine mothers and fathers of children under 4 years in the U.S., we found that financial strain was related to children's media exposure and use, largely through impacts on parents' mental health and coparenting relationship. Interestingly, only use of television in the background and during mealtimes were associated with increases in children's behavior problems. Such findings better capture how stress may operate in a family system and offer a way to counsel parents about healthier media habits for children.

Caregivers' Experiences During the COVID-19 Pandemic and Their Children's Behavior.

The COVID-19 pandemic has financial and emotional impacts on families. We explored how caregivers' financial strain and mental health are associated with changes in their young children's behavior during the pandemic. We additionally considered whether having a sense of purpose moderated these associations. Caregivers (n = 300) in the emergency department of a children's hospital were surveyed anonymously about changes to their employment (e.g., reduced/increased hours and job loss), ability to pay for expenses and whether their child's behavior had changed. Aligned with the Family Stress Model, caregivers' financial strain was associated with poor mental health, inconsistent sleep routines, and changes in children's problematic and prosocial behaviors. A sense of purpose buffered some of these relationships. Families are differently affected by the pandemic and our findings underscore the need for supporting caregivers' mental health and connecting them with resources.

Pregnant in a Pandemic: Connecting Perceptions of Uplifts and Hassles to Mental Health.

How women experience pregnancy as uplifting or a hassle is related to their mental and physical health and birth outcomes. Pregnancy during a pandemic introduces new hassles, but may offer benefits that could affect how women perceive their pregnancy. Surveying 118 ethnically and racially diverse pregnant women, we explore (1) women's traditional and pandemic-related pregnancy uplifts and hassles and (2) how these experiences of pregnancy relate to their feelings of loneliness, positivity, depression, and anxiety. Regressions show that women who experience more intense feelings of uplifts than hassles also feel more positive, less lonely, and have better mental health. Findings suggest that focusing on positive aspects of being pregnant, in general and during a pandemic, might be beneficial for pregnant women's mental health.

Risks and Protective Factors of Hispanic Families and Their Young Children during the COVID-19 Pandemic.

This study examines the risk-related factors during the pandemic and protective factors that might reduce its effects on family functioning in a sample of 161 low-income Hispanic parents in the United States, recruited from an ongoing longitudinal intervention study. They were surveyed about family functioning six months into the pandemic. We focused on the associations between social (e.g., exposure to the virus) and economic (e.g., job loss) pandemic-related risks on parental stress, parenting, and children's socioemotional problems and skills, as well as the degree to which coparenting support, parents' positivity, economic support, and access to services and information mitigated (protected) the negative effects of these stressors on family functioning. We found that increases in economic risk were associated with more child competence skills, whereas increases in social risk were associated with less parental engagement. Positivity and economic support moderated the effects of economic risk on parental stress and engagement. These findings show that to intervene effectively with low-income Hispanic families, we need to strengthen and support the resources for coping with adversity.

Challenging Parenting Behaviors in Ethnically Diverse Two-Parent Families in the United States: Association with Infants' Social Competence and Behavior Problems.

We used data from a sample of ethnically diverse first-time parents (N = 186) in the United States to examine differences between mothers' and fathers' challenging parenting behaviors (CPB) when infants were 9 months old as well as covariates of CPB. We also examined associations between CPB and infants' social competence and behavior problems when they were 12 months old. Results showed no differences between mothers and fathers in the level of CPB with their infants. Mothers with more depressive symptoms engaged in more CPB. Over and above the contributions of infants' gender and temperament and parents' education, mothers' and fathers' CPB was not associated with infants' social competence and behavior problems. This study expands our understanding of the universality of CPB and whether it is associated with social competence in ethnically diverse families.

Personalized Stress Monitoring using Wearable Sensors in Everyday Settings.

Since stress contributes to a broad range of mental and physical health problems, the objective assessment of stress is essential for behavioral and physiological studies. Although several studies have evaluated stress levels in controlled settings, objective stress assessment in everyday settings is still largely under-explored due to challenges arising from confounding contextual factors and limited adherence for self-reports. In this paper, we explore the objective prediction of stress levels in everyday settings based on heart rate (HR) and heart rate variability (HRV) captured via low-cost and easy-to-wear photoplethysmography (PPG) sensors that are widely available on newer smart wearable devices. We present a layered system architecture for personalized stress monitoring that supports a tunable collection of data samples for labeling, and present a method for selecting informative samples from the stream of real-time data for labeling. We captured the stress levels of fourteen volunteers through self-reported questionnaires over periods of between 1-3 months, and explored binary stress detection based on HR and HRV using Machine Learning methods. We observe promising preliminary results given that the dataset is collected in the challenging environments of everyday settings. The binary stress detector is fairly accurate and can detect stressful vs non-stressful samples with a macroF1 score of up to %76. Our study lays the groundwork for more sophisticated labeling strategies that generate context-aware, personalized models that will empower health professionals to provide personalized interventions.

Family Functioning in the Time of COVID-19 Among Economically Vulnerable Families: Risks and Protective Factors.

The ongoing COVID-19 crisis has been particularly harmful to economically vulnerable families with young children. We surveyed 247 low-income mothers and fathers from 142 families in the United States about changes in their family life following the economic and social restrictions imposed by the pandemic. We examined the associations between pandemic-related risk factors such as economic stressors (e.g., loss of job) and social stressors (e.g., exposure to the virus) on family functioning (e.g., parents' mental health, parent engagement, and children's socioemotional behaviors) and the degree to which coparenting support and parents' positivity protected families from the negative effects of these stressors on their wellbeing. We found both positive and negative associations. Mothers and fathers who reported more economic stressors since the pandemic also observed that their children behaved more prosocially and that fathers experienced more mental health difficulties during the pandemic. Mothers and fathers who reported more social stressors reported that they were less engaged with their children and their children exhibited more behavior problems compared to before the pandemic. We also found that mothers and fathers who reported feeling more positive also reported feeling less depressed and stressed during the pandemic and observed that their children had more prosocial behaviors compared to before the pandemic. Compared to before the pandemic, mothers and fathers who reported a more supportive coparenting relationship also reported more parent engagement and observed more prosocial behaviors in their children. In terms of protective factors, high levels of parent positivity during the pandemic protected mothers (less mental health difficulties) whereas high levels of coparenting support protected fathers (less mental health difficulties) from the negative effects of economic stress on their mental health during the pandemic. These findings highlight family processes that could promote resilience in mothers and fathers in the face of pandemic-related economic and social stressors.

The Protective Effects of Maternal and Paternal Factors on Children's Social Development.

The goal of this study is to examine associations among family and child protective factors, maternal and paternal levels of distress, and children's social competence in a sample of 156 ethnically and socioeconomically diverse first-time mothers, fathers, and their children, followed from 9 months to 30 months of age. Using multiple linear regression modeling, our results indicate that dyadic synchrony and children's positive temperament during infancy are significantly associated with fewer behavior problems and paternal optimism with high levels of social competence at 21 months (main effects). Father optimism and child positive temperament are only significantly related to higher levels of social competence and fewer behavioral problems, respectively, in the context of low levels of paternal distress (interaction effects). These results suggest that in our sample maternal dyadic synchrony operates in the same way across levels of maternal distress as it relates to children's behavior problems, with the exception of paternal optimism and children's positive temperament. Results also suggest that protective factors are different for mothers, fathers, and children.

A Randomized Control Trial of Using Baby Books to Reduce New Mothers' Feelings of Stress and Depression.

OBJECTIVE: To determine whether embedding educational information about child development and optimal parenting practices from the Bright Futures Guidelines for Health Supervision into baby books can reduce women's depressive symptoms and parenting stress during the first 18 months of motherhood. METHODS: A sample of 167 low-income, primarily African-American, first-time mothers were randomized into three conditions while pregnant: an educational book group, a non-educational book group, or a no-book group. Depressive symptoms and parenting stress were assessed using two questionnaires during home visits when women were in their third trimester of pregnancy (baseline) and when their child was 2, 4, 6, 9, 12, and 18 months of age. RESULTS: Hierarchical Linear Models showed that women who received books with educational information shed depressive symptoms and parenting stress at a faster rate than women who received similar books without educational information and women who did not receive books. CONCLUSIONS: These findings indicate that providing women with child development and parenting information via baby books can be an effective strategy for promoting new mothers' emotional wellbeing. Since feelings of sadness and stress are risky for both mothers and their infants, this easy to implement intervention holds great promise.

Coping With Stress Through Texting: An Experimental Study.

PURPOSE: Texting is used by many adolescents and has the potential to improve well-being, as youth can reach out for support immediately after experiencing a stressful situation. Many studies have examined whether texting is associated with well-being, but few have used experimental designs, preventing causal claims. METHODS: In this experimental study, 130 adolescents (Mage = 12.41) participated with a same-gender friend whom they texted regularly. Both adolescents completed a task that elicited stress and then engaged in one of the following randomly assigned activities: texting their friend, watching a video on a cellphone (passive-phone condition), or sitting quietly (no activity condition). Participants reported their mood and stress levels after the stress task and again after the activity. Heart rate variability was measured throughout. RESULTS: Participants who texted their friend reported higher moods (b = -.80, standard error [SE] = .24, p < .001, ηp2 = .09) and lower stress at the end of the study than those in the no activity condition (b = .51, SE = .25, p = .046, ηp2 = .04) and higher moods than adolescents in the passive-phone condition (b = -.74, SE = .25, p = .004, ηp2 = .08). No differences were noted between the passive-phone and no activity conditions. There were no differences in heart rate variability between the three conditions. The effects of texting on mood, self-reported stress, and heart rate variability did not differ by gender. CONCLUSIONS: Both boys and girls may benefit from texting a friend after experiencing a stressful event.

The Observed Quality of Caregiver-Child Interactions With and Without a Mobile Screen Device.

OBJECTIVE: This study investigated how caregivers' mobile device use influenced the quality of their interactions with their children. The associations between quality of interactions and the type of activity (eg, typing/swiping, looking at screen), setting, caregiver-child proximity, and child behaviors were also examined. METHOD: Researchers anonymously and systematically observed and coded the behavior of 98 caregiver-child dyads in public settings (eg, parks, food courts) during real-time, naturally occurring interactions using time sampling. RESULTS: Caregivers who used a mobile device for the entire observation engaged in less joint attention and were less responsive than caregivers who used the device some of the time. When looking at patterns within caregivers who used the device intermittently, the probability that they would engage in joint attention, initiate interactions with their child, talk, and display positive emotions was lower when they used a mobile device than when they did not. Child talking and positive affect were unrelated to caregiver device use. Activity type with the device, caregiver-child proximity and setting also related to interaction quality. CONCLUSIONS: Caregiver device use was negatively associated with adult behaviors that are key components of high-quality caregiver-child interactions. Additionally, setting, activity type, and caregiver-child proximity are factors that should be considered because they relate to the quality of caregiver-child interactions in the context of mobile screen technologies.

Parents' Beliefs About the Benefits and Detriments of Mobile Screen Technologies for Their Young Children's Learning: A Focus on Diverse Latine Mothers and Fathers.

Young children's use of mobile screens is increasing despite the American Academy of Pediatrics' recommendations to limit screen use. Research on TV has found that maternal beliefs about the effects of screens on children's learning and parental socioeconomic status influence children's media consumption. However, few studies have explored parents' beliefs about mobile screens and whether there are differences in beliefs by socioeconomic status, particularly within the largest ethnic minoritized group - Latines. Because Latines are a socioeconomically and linguistically heterogenous group, but are often represented by low-income mothers in research, it is important to understand whether there are socioeconomic and linguistic differences on how and why Latine mothers AND fathers permit their children to use mobile screens. This study used in-depth, semi-structured interviews to understand how and why Latine mothers (low-income = 10, middle-to-high income = 10) and fathers (low-income = 10, middle-to-high income = 10) permitted their children (0-4 years) to use mobile screens. Specifically, we discussed their beliefs about how mobile screens support and hinder their children's learning and how their children used them. Results from qualitative content analysis showed that mothers and fathers, across income, education levels, and language use, believed that they, as parents, were the key decision-makers in determining the extent to which mobile screens supported and hindered their young children's learning. They described mediation strategies of selecting appropriate content, setting time limits, and monitoring use, to ensure that their children primarily benefited from device use. However, two distinctions were noted. Parents with a high school diploma or beyond stressed the importance of co-using devices with their children. This was not mentioned by less formally educated parents. Additionally, low-income parents with diverse educational levels, mentioned the importance of continuously monitoring device use to avoid their children encountering inappropriate content. Findings can inform work seeking to promote optimal media habits among Latine families.

Pregnancy posting: exploring characteristics of social media posts around pregnancy and user engagement.

BACKGROUND: Pregnant women use the Internet and social networking sites to meet a variety of pregnancy-related needs as well as to help make decisions regarding their pregnancy and/or parenting. Knowing more about the current landscape of social networking sites as it relates to pregnancy can inform future work that wants to leverage social media for education or support. METHODS: Across a 7-day period, we conducted a content analysis of 4 Facebook pregnancy-related groups and 4 Instagram pregnancy-related channels. The posts were coded based on the nature, content, and purpose of each post as well as the number of likes, shares, and comments for each. After establishing inter-rater reliability, univariate statistics were used to describe the nature, characteristics, and popularity of the posts for each group or channel. We then used logistic regressions to predict which characteristics were associated with being popular or unpopular with users. RESULTS: There were 288 eligible posts within the 7-day window. Only a small proportion of the large (182,000 to 2,527,712) amount of followers responded with likes or comments (comments: mean =0.02%, SD =0.04%; likes: mean =0.36%, SD =0.89%). Facebook posts tended to give more general pregnancy-related information or opportunities for personal sharing while Instagram posts often had emotional support themes or posts meant to make pregnancy relatable. Popular posts tended to try to make pregnancy more relatable (OR =4.21, P<0.01) or offer emotional support (OR =4.62, P<0.01), while unpopular posts tended to provide general pregnancy-related information (OR= 2.17, P<0.05). CONCLUSIONS: In general, there were clear characteristics that differentiated the two social networking site posts that garner user attention or not. This can inform how to provide health information and social support via social media to maximize its influence. This work suggests which features are desirable for followers and can help those interested in leveraging Instagram and Facebook to provide pregnancy-related health information.

Disparities in Caregivers' Experiences at the Dentist With Their Young Child.

OBJECTIVE: To understand the experiences of diverse families when taking their young children to the dentist and to document their prevalence. METHODS: An exploratory sequential design was used. First, 4 focus groups (N = 33) comprised of low-income female caregivers of children under 6 years of age were conducted in English and Spanish. Discussions centered around facilitators and barriers to taking children to the dentist. Themes derived from the groups were then used to create a survey that was given to 1184 caregivers in English, Spanish, or Vietnamese. RESULTS: Thematic coding of focus groups found little support for typically reported barriers to pediatric oral health care utilization (eg, transportation, cost, knowledge); instead, caregivers reported negative experiences (eg, restraint, separation) as barriers. In the surveys, 66% of caregivers reported being separated from their children, 25% reported that their children were restrained (53.7% for cleanings), 26% of children were given sedating medication for cleanings, and 22% of the caregivers reported experiences that made them not want to return to the dentist. The prevalence of these experiences differed significantly among Latino, Asian, and Caucasian families and for annual incomes under or above $50,000. CONCLUSIONS: Families with lower incomes and/or from ethnic and linguistic minority groups were more likely to report negative experiences at the dentist than higher income and Caucasian families. These data document the high prevalence of negative experiences and suggest ethnic, financial, and linguistic disparities in the quality of experiences. More research is needed on the role of dentists in facilitating or hindering oral health care utilization among diverse families.

"It's Just a Lot of Work": Adolescents' Self-Presentation Norms and Practices on Facebook and Instagram.

We explored adolescents' (12- to 18-year-olds; n = 51) awareness of their audience and subsequent self-presentation practices on Facebook and Instagram through focus group discussions. Findings suggest that teens, who are developmentally able to perceive a situation from the third-person perspective and who value peer approval, purposefully share content to appear interesting, well liked, and attractive. Some teens invested great effort into posting by these norms, even asking their friends to help; however, this was more common among girls. Older teens especially discussed taking the perspective of their audience when deciding what to post, which is consistent with the finding that perspective taking continues to develop throughout adolescence. These findings suggest that perspective taking skills and need for peer approval influence self-presentation online.

Parenting and Digital Media.

Understanding the family dynamic surrounding media use is crucial to our understanding of media effects, policy development, and the targeting of individuals and families for interventions to benefit child health and development. The Families, Parenting, and Media Workgroup reviewed the relevant research from the past few decades. We find that child characteristics, the parent-child relationship, parental mediation practices, and parents' own use of media all can influence children's media use, their attitudes regarding media, and the effects of media on children. However, gaps remain. First, more research is needed on best practices of parental mediation for both traditional and new media. Ideally, this research will involve large-scale, longitudinal studies that manage children from infancy to adulthood. Second, we need to better understand the relationship between parent media use and child media use and specifically how media may interfere with or strengthen parent-child relationships. Finally, longitudinal research on how developmental processes and individual child characteristics influence the intersection between media and family life is needed. The majority of children's media use takes place within a wider family dynamic. An understanding of this dynamic is crucial to understanding child media use as a whole.

Positive feelings during pregnancy, early feeding practices, and infant health.

BACKGROUND: Early parenting practices, such as infant feeding, can affect children's physical health. Additionally, negative prenatal maternal affect can influence feeding choices, such as breast-feeding, and can have a detrimental effect on children's health. Little is known, however, about the contribution of positive maternal affect during pregnancy on feeding practices and children's health. METHODS: This study explored whether positive prenatal feelings influenced children's health during the first 18 months, and whether early feeding practices mediated the relationship between these two variables. Low-income, ethnically diverse, primiparous women (n = 114) reported their feelings of pregnancy uplifts and hassles during their third trimester. These women were interviewed again at 2, 4, 6, 9, 12, and 18 months post-partum about their feeding practices. A retrospective audit of their infants' medical charts was completed from birth to 18 months. RESULTS: Using structural equation modeling, having more uplifts than hassles during pregnancy was associated with longer breast-feeding duration and greater adherence to recommended schedules for introducing fruits and vegetables, solids, and baby cereal. These feeding practices were linked to better child health outcomes, including reduced risk of upper respiratory tract infections, conjunctivitis, otitis media, and thrush. CONCLUSIONS: Positive maternal feelings during pregnancy were associated with better feeding practices, and these better feeding practices were associated with fewer common childhood illnesses. Helping expectant women focus on the positive aspects of their pregnancy may lead to postnatal care methods that are fiscally advantageous, preventive of detrimental postnatal choices, and medically beneficial for children.