Updated taxonomy of digital mental health interventions: a conceptual framework.

Most individuals at risk for or already experiencing mental disorders have no access to mental health care. Digital mental health interventions (DMHIs) can be effective in preventing and treating mental disorders. A taxonomy of digital interventions was previously proposed to organize the different types of digital tools being developed to expand mental health service delivery. This article updates that framework and presents illustrations for four types of digital interventions specific to mental health and revises their definitions. The illustrations primarily focus on studies that include populations underrepresented in the literature to highlight the potential of DMHIs to reduce health disparities. Provider administered DMHIs (Type 1) and provider administered DMHIs with blended digital adjuncts (Type 2) are offered within a healthcare system. Self-help human supported/guided DMHIs with therapeutic or technical guidance (Type 3) are offered outside a healthcare system. And self-help fully automated DMHIs (Type 4) are interventions similar to self-help books, do not involve human support and are also offered outside a healthcare system. Type 1, 2, and 3 interventions are consumable, they require human time to administer and are limited by the number of hours a health care provider or guide (to promote adherence) is available. Type 4 interventions are non-consumable because these can be used an unlimited number of times anytime anywhere in the world without human interaction. Identifying DMHIs as belonging to one of these categories can promote the development of each category, guide future reviews and help disseminate those DMHIs to as many people as possible.

Leading the charge toward a world without depression: perinatal depression can be prevented.

This manuscript is based on a keynote address presented at the 2020 Marcé Society's Conference celebrating the Society's 40th anniversary. The address described a 50-year perspective on prevention research, current evidence that perinatal depression can be prevented, and how digital tools could be used to disseminate perinatal depression prevention interventions throughout the world. We utilized the Mothers and Babies Course as a case study to illustrate these goals. The article reviews the gradual progress of depression prevention research, from the time when the state of the science was such that it was believed that the onset of major depressive episodes could not be prevented until the present day. In addition, the article recounts the three consensus reports on prevention of mental disorders published by the National Academies of Science, Engineering, and Medicine, culminating in the 2019 report, which calls on the field to implement known interventions for the prevention of depression and other mental disorders, and to scale up their administration to reduce the prevalence of these disorders in the general population. The paper presents the 2019 recommendations of the US Preventive Services Task Force, which instructs the health system to provide routine referrals to perinatal depression prevention interventions (e.g., the Mothers and Babies Course) to perinatal persons at risk for depression. We now have the knowledge to prevent approximately half of episodes of perinatal depression. It is time to implement this knowledge and begin to do research on how to prevent the remaining half.

Factors associated with smoking in low-income persons with and without chronic illness.

INTRODUCTION: Tobacco disparities persist among low-income smokers who seek care from safety-net clinics. Many of these patients suffer from chronic illnesses (CILs) that are associated with and exacerbated by smoking. The objective of the current study was to examine the differences between safety-net patients with and without CILs in terms of nicotine dependence and related factors (such as depression, anxiety) and self-efficacy regarding ability to abstain from smoking. METHODS: Sixty-four low-income smokers who thought about or intended to quit smoking were recruited from the San Francisco Health Network (SFHN) and assessed for CILs, nicotine dependence, depression, anxiety, and smoking abstinence self-efficacy. Four one-way analyses of variance were used to examine the difference between those with and without CIL on the latter four variables. RESULTS: The CIL group had significantly higher anxiety (CIL: 8.0 ± 5.35; non-CIL: 4.44 ± 3.48; p=0.02) and tended to have higher nicotine dependence (CIL: 5.40 ± 2.58; non-CIL: 3.88 ± 2.28; p=0.04). In the CIL group, nicotine dependence was positively correlated with anxiety [r(62)=0.39; p<0.01] and negatively correlated with smoking abstinence self-efficacy [r(62)= -0.38; p<0.01]. Both depression (Spearman's rho=0.39; p<0.01) and anxiety (Spearman's rho=0.29; p<0.05) were associated with total number of CIL categories. CONCLUSIONS: Safety-net patients who smoke and suffer from CILs may be suffering from higher levels of anxiety and have less confidence in their ability to quit smoking. Incorporating mood management and developing interventions that increase a sense of self-efficacy for refraining from smoking may be necessary to help low-income smokers quit smoking.

Development and usability of a Spanish/English smoking cessation website: lessons learned.

BACKGROUND: Smoking cessation Internet interventions have been shown to be comparable in effectiveness to the nicotine patch. The aim of this study was to develop a Spanish/English smoking cessation web app using input from low-income smokers, and to evaluate modifications to the online intervention in terms of its ability to engage smokers. METHODS: Three versions of a smoking cessation web app were developed and tested. Measures of engagement, such as completion of study registration, utilization of cigarette, mood, and craving trackers, and completion of follow-up assessments, were collected to determine whether changes in the website resulted in increased engagement. RESULTS: The third version of the website, which featured improved look-and-feel and fewer barriers to engagement, markedly increased tracker engagement from the first two versions. However, follow-up rates remained low across all three versions. CONCLUSIONS: The increase in engagement was attributed to the following modifications: A more inviting landing page with key intervention elements available immediately; an easily accessible dashboard with users' data; and tracking tools that were more user friendly. We conclude that in addition to adequate and functional elements, design principles are key factors in increasing engagement in online interventions.

Digital Tools for Prevention and Treatment of Depression: Lessons from the Institute for International Internet Interventions for Health / Instrumentos digitales de prevención y tratamiento de la depresión: lecciones del Instituto Internacional de Intervenciones vía Internet para la Salud

There is now substantial evidence that major depressive episodes can be prevented and treated effectively with psychological interventions administered by trained lay and professional providers. There is also evidence that depression can be prevented and treated using self-help digital interventions such as websites and apps, and that their effectiveness increases if these interventions are supported by guides or coaches. In this commentary we describe digital approaches for depression developed and tested across the world by Palo Alto University's Institute for International Internet Interventions for Health. We recommend the creation of digital apothecaries to increase access to in-person interventions by 1) training more providers, and 2) developing tools providers can use to enhance the effectiveness of these interventions, and to provide access to self-help interventions that can be used directly by anyone with 3) either guides or coaches to reduce dropout, or 4) as fully automated interventions

Existen evidencias importantes que demuestran que los episodios depresivos mayores pueden prevenirse y tratarse eficazmente con intervenciones psicológicas administradas tanto por profesionales como por no profesionales debidamente capacitados. También hay evidencia de que la depresión se puede prevenir y tratar mediante intervenciones digitales de autoayuda tales como páginas web y aplicaciones y que su eficacia aumenta si estas intervenciones son apoyadas por guías o coaches. En este comentario describimos enfoques digitales para la depresión desarrollados y probados en todo el mundo por el Instituto de Intervenciones Internacionales en Salud por Internet de la Universidad de Palo Alto. Recomendamos la creación de apotecarias digitales para aumentar el acceso a las intervenciones: 1) capacitando a más proveedores de ayuda y 2) desarrollando herramientas que estos puedan utilizar para mejorar la eficacia de estas intervenciones y para proporcionar acceso a intervenciones de autoayuda que puedan ser utilizadas directamente por cualquier persona con 3) guías o coaches con el objetivo de reducir el abandono o 4) como intervenciones totalmente automatizadas

A Meta-analytic Review: Psychological Treatment of Subthreshold Depression in Children and Adolescents.

OBJECTIVE: Subthreshold depression has been found to be associated with considerable impairment and an increased risk of developing major depression. Although several randomized trials have examined the effects of psychological interventions for subthreshold depression in children and adolescents, no meta-analysis has integrated the results of these trials. METHOD: We searched 4 bibliographic databases and included randomized trials comparing psychological interventions with control conditions in children and adolescents scoring above a cut-off of a depression questionnaire but not meeting diagnostic criteria for major depression (or persistent depressive disorder) according to a diagnostic interview. Effect sizes and incidence rates of major depression were pooled with random effects meta-analyses. RESULTS: A total of 12 trials with 1,576 children and adolescents met inclusion criteria. The overall effect size indicating the difference between treatment and control at post-test was g = 0.38 (95% CI = 0.14-0.63), which corresponds to a number-needed-to-treat (NNT) of 8.4. Heterogeneity was moderate to high (I2 = 61; 95% CI = 28-79), and there was significant risk of publication bias (p < .04). The 2 studies in children less than 12 years of age showed nonsignificant effects (g = 0.01; 95% CI = -1.16 to 1.18). We found no significant effect on the incidence of major depression at follow-up (relative risk = 0.52; 95% CI = 0.25-1.08), although this may be related to low statistical power. CONCLUSION: Interventions for subthreshold depression may have positive acute effects in adolescents. There is currently insufficient evidence, however, that these interventions are effective in children less than 12 years of age, or that they prevent the onset of major depression at follow-up.

Who comes to a self-help depression prevention website? Characteristics of Spanish- and English-speaking visitors.

OBJECTIVE: To describe demographic and clinical characteristics of Spanish- and English-speaking visitors to a "Healthy Mood" website. METHODS: An online study intended to prevent depression by teaching users mood management skills recruited participants globally using primarily Google Ads. Those who consented responded to the Patient Health Questionnaire (PHQ-9) and the MDE Screener (Muñoz, 1998) upon entry into the study. RESULTS: 1423 participants consented, 437 English speakers and 986 Spanish speakers. Of the 1271 participants with sufficient depression symptom data, 65% screened positive for a current major depressive episode, 30% were at high risk for onset of a major depressive episode, and 5% were in the low-risk category. CONCLUSION: Websites intended to be preventive appear to attract primarily individuals who are currently experiencing enough symptoms to screen positive for a major depressive episode. Only 30% of participants were appropriate for a depression prevention intervention. Therefore, such sites must be ready to encourage those with current depression to obtain professional help as well as ensure that the online self-help interventions are appropriate for participants who could benefit from both preventive and treatment interventions.

Psychological interventions to prevent the onset of depressive disorders: A meta-analysis of randomized controlled trials.

PURPOSE: Depressive disorders are common and have a considerable impact on patients and societies. Several treatments are available, but their effects are modest and reduce the burden only to a limited extent. Preventing the onset of depressive disorders may be one option to further reduce the global disease burden. METHODS: We conducted a meta-analysis of randomized controlled trials in participants without a diagnosis of depression at baseline, who were assigned to a preventive psychological intervention, or a care-as-usual, or comparable control group and in which incident cases of depression at follow-up were ascertained with a diagnostic interview. RESULTS: Our systematic searches resulted in 50 trials (14,665 participants) with relatively high quality, in high risk groups of all ages. The psychological interventions were mostly based on cognitive behavioral interventions. One year after the preventive interventions, the relative risk of developing a depressive disorder was RR = 0.81 (95% CI: 0.72-0.91), indicating that those who had received the intervention had 19% less chance to develop a depressive disorder. Given the average control event rate of 30%, twenty-one people had to participate in the intervention to prevent one depressive disorder compared to people in the control conditions. CONCLUSIONS: Prevention is a promising approach to reduce the global disease burden of depression in addition to treatments.

Artificial Intelligence Chatbot for Depression: Descriptive Study of Usage.

BACKGROUND: Chatbots could be a scalable solution that provides an interactive means of engaging users in behavioral health interventions driven by artificial intelligence. Although some chatbots have shown promising early efficacy results, there is limited information about how people use these chatbots. Understanding the usage patterns of chatbots for depression represents a crucial step toward improving chatbot design and providing information about the strengths and limitations of the chatbots. OBJECTIVE: This study aims to understand how users engage and are redirected through a chatbot for depression (Tess) to provide design recommendations. METHODS: Interactions of 354 users with the Tess depression modules were analyzed to understand chatbot usage across and within modules. Descriptive statistics were used to analyze participant flow through each depression module, including characters per message, completion rate, and time spent per module. Slide plots were also used to analyze the flow across and within modules. RESULTS: Users sent a total of 6220 messages, with a total of 86,298 characters, and, on average, they engaged with Tess depression modules for 46 days. There was large heterogeneity in user engagement across different modules, which appeared to be affected by the length, complexity, content, and style of questions within the modules and the routing between modules. CONCLUSIONS: Overall, participants engaged with Tess; however, there was a heterogeneous usage pattern because of varying module designs. Major implications for future chatbot design and evaluation are discussed in the paper.

Indigeneity, diversity, and equity in Internet interventions: Could ISRII contribute to making health care a universal human right?

This article is a partially revised version of a keynote address presented at the 10th Scientific Meeting of the International Society for Research on Internet Interventions (ISRII) in Auckland, New Zealand. It addresses six points: 1) the meanings of indigeneity, diversity, and equity, 2) the strong emotional reactions elicited by the inequities experienced by indigenous groups throughout the world, 3) the aspirations of members of ISRII in terms of what we would like our field to accomplish to address these inequities, 4) the United Nations goal of making health care a universal human right, 5) the difficulties encountered by other health sciences in attempting to include diverse populations into major studies, and 6) ways in which the Internet interventions and digital health field could include indigeneity, diversity, and equity in our work, and by doing so, contribute to the United Nations goal of making health care a universal human right. The authors suggest that providing access to health care to all people, no matter where they are on the socioeconomic continuum, is a key strategy to pursue. The field of Internet interventions could contribute by creating digital apothecaries that would develop, evaluate, and disseminate evidence-based Massive Open Online Interventions to anyone in the world who needs them.

Octavo informe del grupo de estudios sobre cáncer del aparato digestivo / The eight inform from the gastrointestinal cancer group

De acuerdo con este estudio de 8 años, podemos apreciar que la frecuencia del carcinoma colo-rectal ha aumentado y en el INNSZ ocupó el primer lugar. En el Hospital General de la SS ocupa un segundo lugar después del carcinoma gástrico y en el Español continua en primer lugar. El carcinoma gástrico continua siendo el primer cáncer en los Hospitales Generales de la SS y 20 de Noviembre del ISSSTE, en cambio en el hospital Juárez de la SS el primer lugar en frecuencia es ocupado por el carcinoma de vesícula y vías biliares en segundo lugar el gástrico y en tercer el de colon. En términos generales no encontramos una explicación para el aumento de cáncer colo-rectal en las instituciones estudiadas. En relación a la dieta, se observó que en los pacientes con carcinoma gástrico la misma era baja en proteínas y en grasas así como en vitaminas A y C, y normal o alta en residuo; mientras que en los pacientes con carcinoma colo-rectal era alta en grasas y en proteínas, baja en residuos y normal en vitaminas. En el Hospital Juárez se encontró que el grupo sanguíneo O era alto en proporción significativa entre los pacientes con carcinoma de vesícula y vías biliares, en comparación con el INNSZ que tuvo una proporción intermedia y el Español que la tuvo baja. En estudios previos realizados por Lisker en el INNSZ se demostró que en los grupos sanguíneos el O predominaba entre los indígenas es un 80 a 90%. Se considera que la raza, el sexo, la edad y los factores dietéticos tienen influencia en la mayor f