Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis.

BACKGROUND: The prevalence of mental illness increased in children, adolescents, and young adults during the COVID-19 pandemic, while at the same time, access to treatment facilities has been restricted, resulting in a need for the quick implementation of remote or online interventions. OBJECTIVE: This study aimed to give an overview of randomized controlled studies examining remote or online interventions for mental health in children, adolescents, and young adults and to explore the overall effectiveness of these interventions regarding different symptoms. METHODS: A systematic literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, PsycInfo, Psyndex, Embase, and Google Scholar. A meta-analysis was conducted using a random effects model to calculate overall effect sizes for interventions using standardized mean differences (SMDs) for postintervention scores. RESULTS: We identified 17 articles with 8732 participants in the final sample, and 13 were included in the quantitative analysis. The studies examined different digital interventions for several outcomes, showing better outcomes than the control in some studies. Meta-analyses revealed significant medium overall effects for anxiety (SMD=0.44, 95% CI 0.20 to 0.67) and social functioning (SMD=0.42, 95% CI -0.68 to -0.17) and a large significant effect for depression (SMD=1.31, 95% CI 0.34 to 2.95). In contrast, no significant overall treatment effects for well-being, psychological distress, disordered eating, and COVID-19-related symptoms were found. CONCLUSIONS: The qualitative and quantitative analyses of the included studies show promising results regarding the effectiveness of online interventions, especially for symptoms of anxiety and depression and for training of social functioning. However, the effectiveness needs to be further investigated for other groups of symptoms in the future. All in all, more research with high-quality studies is required.

Machine Learning Based Linking of Patient Reported Outcome Measures to WHO International Classification of Functioning, Disability, and Health Activity/Participation Categories.

BACKGROUND: In the primary and secondary medical health sector, patient reported outcome measures (PROMs) are widely used to assess a patient's disease-related functional health state. However, the World Health Organization (WHO), in its recently adopted resolution on "strengthening rehabilitation in all health systems", encourages that all health sectors, not only the rehabilitation sector, classify a patient's functioning and health state according to the International Classification of Functioning, Disability and Health (ICF). AIM: This research sought to optimize machine learning (ML) methods that fully and automatically link information collected from PROMs in persons with unspecific chronic low back pain (cLBP) to limitations in activities and restrictions in participation that are listed in the WHO core set categories for LBP. The study also aimed to identify the minimal set of PROMs necessary for linking without compromising performance. METHODS: A total of 806 patients with cLBP completed a comprehensive set of validated PROMs and were interviewed by clinical psychologists who assessed patients' performance in activity limitations and restrictions in participation according to the ICF brief core set for low back pain (LBP). The information collected was then utilized to further develop random forest (RF) methods that classified the presence or absence of a problem within each of the activity participation ICF categories of the ICF core set for LBP. Further analyses identified those PROM items relevant to the linking process and validated the respective linking performance that utilized a minimal subset of items. RESULTS: Compared to a recently developed ML linking method, receiver operating characteristic curve (ROC-AUC) values for the novel RF methods showed overall improved performance, with AUC values ranging from 0.73 for the ICF category d850 to 0.81 for the ICF category d540. Variable importance measurements revealed that minimal subsets of either 24 or 15 important PROM variables (out of 80 items included in full set of PROMs) would show similar linking performance. CONCLUSIONS: Findings suggest that our optimized ML based methods more accurately predict the presence or absence of limitations and restrictions listed in ICF core categories for cLBP. In addition, this accurate performance would not suffer if the list of PROM items was reduced to a minimum of 15 out of 80 items assessed.

Do the WHO-ICF personal factors "age" and "sex" impact limited activity and restricted participation category profiles differently between younger and older women and men in multimodal chronic back pain rehabilitation?

PURPOSE: To investigate if the International Classification of Functioning and Health (ICF) context factors "age" and "sex" would impact the disablement and respective improvement with rehabilitation defined with the ICF core set for chronic low back pain (cLBP). Furthermore, associations between limitations/restrictions and measures of body function or quality of life were of interest. MATERIALS AND METHODS: One thousand five hundred and twelve employed cLBP patients who completed 6 months of outpatient rehabilitation and for whom complete assessments were available before and after rehabilitation. Rehabilitation comprised of progressive resistance training, psychological counseling, and educational sessions. Main outcome measures were the ICF-activity/participation core categories automatically predicted from random forests and utilizing information from the Roland Morris Disability Questionnaire and Pain Disability Index. RESULTS: Generalized linear-mixed models revealed that upon completion of rehabilitation the presence of a limitation within the ICF activity "walking" significantly decreased with significant between-group differences. The category "doing housework" demonstrated gender-specific differences, and both gender- and age-specific differences were observed for work-related participation categories. There were no meaningful associations between ICF limitation/restriction categories and body function measures (point-biserial/Spearman's correlations). CONCLUSIONS: The personal factors "age" and "sex" impact some ICF limitation/restriction categories in cLBP; appropriately addressing these personal features could further improve phase III rehabilitation outcome.Implications for rehabilitationConsistent with calls to explore the age and sex/gender influence on health and disease, little is known how these factors affect the disablement of individuals with chronic back pain.The factors "age" and "sex" drive differences in some categories within the ICF activity/restriction categories.If age- and gender-specific features in activities and participation are not appropriately addressed through interventions, rehabilitation outcome may remain suboptimal in cLBP.

Perceived psychosocial stressors and coping resources in chronic low back pain patients as classified by the avoidance-endurance model.

Objectives: The Avoidance-Endurance Model distinguishes between subgroups of low back pain (LBP) patients with three maladaptive styles of coping with pain: fear-avoidance (FAR), distress-endurance (DER), eustress-endurance (EER), and one adaptive coping style (AR). This study aimed to compare the quantity of patients' perceived psychosocial stressors and coping resources across these subgroups. Materials and methods: This cross-sectional study was conducted at an outpatient rehabilitation center for patients with chronic musculoskeletal pain. One hundred and thirty-seven patients (69 women/68 men) with chronic LBP were assessed using the following: a demographic checklist, the visual analogue scale, Avoidance-Endurance Questionnaire, Roland-Morris Disability Questionnaire, Pain Disability Index, and 36-Item Short Form. Subsequently, patients participated in semi-structured interviews led by clinical psychologists, which were intended to identify their perception of stressors and coping resources. The quantity of psychosocial stressors and coping resources were analyzed using deductive and inductive content analyses and then compared between subgroups using chi-square-tests. Results: FARs experienced significantly higher levels of "mental suffering" (p = <0.001) and "other workplace problems" compared to ARs and EERs (p = <0.001). DERs reported significantly higher levels of "mental suffering" (p = <0.001), "job stress" (p = 0.022), and "familial losses" (p = 0.029) compared to ARs, whereas the AR group demonstrated significantly more "coping resources" (p = 0.001) compared to FARs. Conclusion: AEM-subgroups differed in the quantity of perceived psychosocial stressors and coping resources with AR, who demonstrated a lower risk for pain chronicity and reported the highest quantity of resources. The variability across subgroups may imply differences in patients needs regarding therapeutic interventions and suggests that a resource-centered approach to cope with stress and pain may be beneficial.

Comorbidities of bladder pain syndrome in the context of the HITOP distress category: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: The aim of this systematic review and meta-analysis is, looking at different care settings, to examine prevalence rates of psychological distress-level comorbidities in female interstitial cystitis/bladder pain syndrome (IC/BPS) patients, their impact on Quality of Life (QoL), and the correlation between such comorbidities and symptom severity. METHODS: A systematic literature search according to PRISMA guidelines was conducted in PubMed, PsycInfo, Web of Science, Science Direct, and Google Scholar. RESULTS: Twenty-nine studies were found that met inclusion criteria. Prevalence rates of depression and anxiety are higher in IC/BPS patients compared to the general population; however, due to a wide array of measurements, statistical comparisons between care settings were only possible in two cases showing mixed results. No studies meeting inclusion criteria exist that examine PTSD and borderline personality disorder, though rates of past traumatic experiences seem to be higher in patients than in healthy controls. Psychological comorbidities of the distress category, especially depression, are found in most studies to be related to symptom severity, also yielding statistically significant associations. CONCLUSIONS: While there is still need for studies focused on some of the comorbidities as well as on different care settings, the data already show that psychological comorbidities of the distress category play an important role in IC/BPS patients regarding suffering, QoL, and symptom severity, thus emphasizing the need for highly specialized interdisciplinary treatment.

The impact of problematic smartphone use on children's and adolescents' quality of life: A systematic review.

AIM: To provide a systematic review on studies examining problematic smartphone (PSU) use in children and adolescents, and its impact on quality of life, life satisfaction, and well-being. METHODS: An extensive literature search was conducted in Google Scholar, Scopus and Pubmed. RESULTS: The search yielded k = 9 articles for which inclusion criteria were met. Five studies examined health-related or overall quality of life, two assessed life satisfaction, and two evaluated well-being in relation to PSU. Negative associations between PSU and the outcome variables were reported almost consistently, with one study yielding only a trend for a negative correlation of PSU with life satisfaction, and one study finding no significant correlation regarding quality of life. Comparability between studies was impeded by the scarcity of studies which met inclusion criteria and by the use of different measures. CONCLUSION: More research is needed regarding PSU and the outcome variables in children and adolescents. Also, a distinct and consistent theoretical conceptualisation of PSU is required to replicate findings, and to enhance comparability between studies. Based on the trend reported here, the development of customised, early on interventions for children and adolescents at risk of PSU is warranted.

In-depth analysis of life values and their corresponding inhibitors and facilitators in chronic low back pain patients: A mixed-method approach.

BACKGROUND: The struggle with pain often interferes with the ability of chronic low back pain (CLBP) patients to pursue important life values due to psychological inflexibility. OBJECTIVE: This research examined life values, related inhibitors and facilitators relevant to personalized therapy planning. METHODS: Two hundred and forty-four CLBP patients completed the Chronic Pain Values Inventory (CPVI). Of these, 68 patients were interviewed to assess inhibitors and facilitators related to life values. Mixed-effects models quantitatively examined differences in the values, structuring content analysis served to qualitatively analyze the interviews. RESULTS: Participants rated the value "family" as being of highest importance and success. The largest discrepancy between importance and success was found for "health". Content analyses revealed a broad range of inhibitors and facilitators related to the examined life values with the highest number of inhibitors related to "work". Facilitators were also found to be of relevance to all life values, but to a lower extent than inhibitors. CONCLUSIONS: The perceived importance and success of life values and their related inhibitors and facilitators may differentially affect CLBP patients. Considering such individual aspects is therefore of utmost importance to improve patient care, as they enable treatment goals and the therapeutic strategies to be adapted accordingly.

Mapping patient reported outcome measures for low back pain to the International Classification of Functioning, Disability and Health using random forests.

BACKGROUND: There is need for feasible and efficient concepts to document patients functioning impairment according to the International Classification of Functioning, Disability and Health (ICF) without imposing additional burden to clinical practice. AIM: The aim of this study was to develop and validate an automatic linking approach that translates information derived from patient reported outcome measures (PROMs) into the ICF. DESIGN: Proof-of-concept study. SETTING: Participants completed both the Roland-Morris disability questionnaire and the Pain Disability Index and were interviewed using the activity and participation component of the ICF brief core set for low back pain. POPULATION: A total of 244 patients with light to moderate chronic low back pain (cLBP); additionally, 19 patients with higher levels of pain were recruited and assessed for validation purposes. METHODS: Based on information extracted from the PROMs and considering the factors age and gender, random forest models that predicted the presence or absence of an impairment at the specific ICF category were computed and validated. RESULTS: Accuracy of the models was found to be acceptable for the most relevant ICF brief core set categories for low back pain if applied at the population level. CONCLUSIONS: The presented approach can be assumed valid if applied at large on population level. The results are of relevance for the further development of automatic linking programs that would allow the ICF-based classification of functioning properties within the International Classification of Diseases (ICD-11) for any health condition. CLINICAL REHABILITATION IMPACT: The presented approach eases the documentation of patients' functioning impairment according to the standardized ICF.

Risk factors for problematic smartphone use in children and adolescents: a review of existing literature.

BACKGROUND: The percentage of smartphone users-especially among minors-is growing, and so is the body of literature hinting at increasing rates of problematic smartphone use in children and adolescents. However, comprehensive reviews regarding this issue are still scarce. OBJECTIVE: The main aim of this review was to provide an overview of studies focusing on specific risk factors predicting problematic smartphone use in children and adolescents. METHODS: A literature search was conducted in Google Scholar and PubMed. RESULTS: The search yielded 38 articles that met the criteria for inclusion in this review. Research regarding influencing factors such as gender, age, and social, family, and personality factors, as well as duration of use and use patterns, could be found. Results seem to cautiously suggest that using a smartphone for gaming and social networking might be risk factors, whereas having good friendships might constitute a protective factor. Also, female adolescents seem to be prone to a higher smartphone addiction risk than male adolescents. For family, school, and personality factors, results are still scarce, and more research is needed. Nevertheless, strict parenting, low self-control, and low self-esteem seem to increase risks for problematic use, whereas academic motivation and school success might decrease this risk. CONCLUSION: A concise theoretical conceptualization of problematic smartphone use and corresponding standardized measures are needed to increase comparability of future studies and to thereby add to a clearer understanding of this contested concept.