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Our range of Digital Interventions offer support for those experiencing mild to moderate Mental Health conditions

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Statement of Significance Sleep problems are highly prevalent among university students and are associated with poor mental health, functioning, and academ

Background: Physical activity (PA) in older adults can prevent, treat, or offset symptoms and deterioration from various health conditions and help maintain independence. However, most older adults are insufficiently active. Digital interventions have the potential for high reach at low cost. Objective: This paper reports on the implementation of ‘Active Lives’, a digital intervention developed specifically for older adults. Methods: This study had a qualitative design. The implementation team approached a range of National Health Service (NHS), public health, community, and third-sector organisations in the UK to offer Active Lives to as large and diverse a group of older adults as possible. Alongside real-world implementation activities, research was conducted to explore what supports and inhibits the implementation of a digital intervention for PA in older adults. Data collection involved interviews with implementation partners (n=15) and the implementation team (n=3) plus extensive field notes from stakeholder communications. Inductive thematic analysis was used to analyse the data. Results: Five broad themes were developed, capturing implementation barriers and facilitators. These were: I) Complex and opaque networks and influencers, II) Forming an understanding of Active Lives and its fit, III) A landscape of competition and conflicting interests, IV) Navigating unclear approval processes, and V) Shifting strategies: small and effortful to high reach and passive. Identifying key decision-makers proved arduous, consuming significant time and resources, and proposals from enthusiastic implementation partners often proved impractical or overly burdensome. Healthcare professionals demonstrated a comprehensive understanding of the potential benefits of digital interventions in alleviating operational burdens and improving patient care. However, stakeholders from disparate sectors held reservations about digital intervention and had different views on the best approaches to supporting physical activity among older adults. This discord was exacerbated by conflicts with existing local initiatives, such as group exercise programs, which occasionally hindered the implementation of Active Lives. Furthermore, bureaucratic hurdles within NHS trust approval processes acted as formidable obstacles, dampening progress, and resolve, highlighting the need for guidance in identifying sustainable and scalable practices. Conclusions: The findings highlight important implementation challenges to digital physical activity interventions for older adults such as bureaucratic barriers and alignment with ongoing initiatives. This research emphasises the necessity for strategic direction and multi-level guidance to efficiently implement digital interventions for physical activity among community-dwelling older adults.

Background: Testimonials from credible sources are an evidence-based strategy for behavior change. Behavioral health interventions have used testimonials to promote health behaviors (e.g., physical activity, healthy eating). Integrating testimonials into eating disorder (ED) interventions poses a nuanced challenge because ED testimonials can promote ED behaviors. Testimonials in ED interventions must therefore be designed carefully. Some optimal design elements of testimonials are known, but questions remain about testimonial speakers, messaging, and delivery, especially for ED interventions. Objective: We sought to learn how to design and deliver testimonials focused on positive behavior change strategies within our multi-session digital binge eating intervention. Methods: We applied human-centered design methods to learn users’ preferences for testimonial speakers, messaging, and delivery (modalities, over time, and as “nudges” for selecting positive behavior change strategies they could practice). We recruited target users of our multi-session intervention to complete design sessions. Adults (N=22, 64% self-identified as female; 32% as non-Hispanic Black, 41% as non-Hispanic White, 27% as Hispanic) with recurrent binge eating and obesity completed individual interviews. Data were analyzed using methods from thematic analysis. Results: Most participants preferred designs with testimonials (versus without) for their motivation and validation of the intervention’s efficacy. A few distrusted testimonials for appearing too “commercial” or personally irrelevant. For speakers, participants preferred sociodemographically tailored testimonials and were willing to report personal data in the intervention to facilitate tailoring. For messaging, some preferred testimonials with “how-to” advice, whereas others preferred “big picture” success stories. For delivery interface, participants were interested in text, video, and multimedia testimonials. For delivery over time, participants preferred testimonials from new speakers to promote engagement. When the intervention allows users to choose between actions (e.g., behavioral strategies), participants preferred testimonials be available across all actions, but said that selectively delivering a testimonial with one action could “nudge” them to select it. Conclusions: Results indicated that intervention users were interested in testimonials. While participants preferred sociodemographically tailored testimonials, they said different characteristics mattered to them, indicating that interventions should assess users’ most pertinent identities and tailor testimonials accordingly. Likewise, users’ divided preferences for testimonial messaging (i.e., “big picture” versus “how-to”) suggest that optimal messaging may differ by user. To improve the credibility of testimonials, which some participants distrusted, interventions could invite current users to submit testimonials for future integration in the intervention. Aligned with nudge theory, our findings indicate testimonials could be used as “nudges” within interventions—a ripe area for further inquiry—though future work should test if delivering a testimonial only with the nudged choice improves its uptake. Further research is needed to validate these design ideas in practice, including evaluating their impact on behavior change toward improving ED behaviors.

Background: Health care professionals are exposed to high levels of occupational stress, emotional exhaustion, and anxiety-depressive symptoms. Digital interventions using mindfulness- and acceptance-based approaches have shown promising results in improving psychological well-being in this population. The MINDxYOU program is a self-guided digital intervention designed to reduce perceived stress and enhance emotional regulation, resilience, and psychological flexibility. Although its effectiveness has been demonstrated, treatment response may vary substantially between individuals. Objective: The aims of this study are to explore the sociodemographic, occupational, and psychological moderators of the effectiveness of the digital MINDxYOU program on perceived stress among health care professionals and to identify differential response profiles. Methods: This study is a secondary analysis of a stepped-wedge cluster randomized trial including 347 health care professionals from 6 clusters allocated to 3 intervention start sequences. The intervention (MINDxYOU) is a self-guided, web-based program designed to be completed over 8 weeks, grounded in third-wave psychological approaches and incorporating mindfulness-, compassion-, and acceptance-based components. Weekly support was provided via WhatsApp Messenger (Meta Platforms Inc), phone calls, or email to promote adherence. Assessments were conducted every 8 weeks across 5 measurement waves. Linear mixed-effects models were used to evaluate moderation effects by testing condition × moderator interactions, accounting for repeated measures within participants and clustering effects. Results: Moderation analyses showed greater reductions in perceived stress among participants with higher baseline depressive symptom scores (9-item Patient Health Questionnaire [PHQ-9]; B=−0.22, SE 0.08; =.004) and those with higher scores in the observing facet of mindfulness (15-item Five Facet Mindfulness Questionnaire [FFMQ-15]; B=−0.86, SE 0.41; =.04). In addition, #nursing staff exhibited greater reductions in perceived stress compared with physicians (B=1.92, SE 0.81; =.02) and other health care professionals (B=1.80, SE 0.90; =.04). Conclusions: The results suggest that baseline psychological and occupational characteristics may contribute to differences in the effectiveness of the MINDxYOU program in reducing perceived stress. These findings provide preliminary evidence regarding potential response profiles in digital mental health interventions and support the development of more personalized and targeted approaches to stress management in health care settings. Trial Registration: ClinicalTrials.gov NCT05436717; https://clinicaltrials.gov/study/NCT05436717 International Registered Report Identifier (IRRID): RR2-10.1186/s12912-022-01089-5

Background: Rates of opioid use disorder (OUD) have increased among women over the past 2 decades. Medication treatment for opioid use disorder (MOUD) is effective but underused. Gender-specific treatments for women have been associated with improved substance use outcomes. However, these treatments have not specifically targeted women’s engagement in MOUD, and the impact of existing gender-specific treatments is restricted by in-person delivery. Objective: The aim of this study was to develop a digital intervention to feasibly deliver gender-specific care that addresses the individualized needs of women with OUD to increase engagement in MOUD. Methods: A mixed methods, user-centered design approach was used to inform the development of a digital intervention. In phase 1, qualitative interviews were conducted with women with lived experience of OUD (n=20) and providers who treat women with OUD (n=8). Interviews were recorded, transcribed, and coded for themes. In addition, a larger sample of treatment providers (n=55) completed an online survey to further inform the content of the digital intervention. Phase 2 consisted of designing, beta-testing (n=5), and refining the intervention. Results: The age of women with lived experience ranged from 21 to 59 (mean 38.5, SD 9.4) years; 63% (5/8) of providers interviewed were female participants. The qualitative interview data from women with lived experience and providers were grouped into 6 thematic categories: 3 treatment-related (1) barriers to treatment, (2) facilitators to successful recovery, and (3) important issues to address in treatment, and 3 technology-related (4) positives of using technology as part of treatment, (5) suggested technology features, and (6) barriers to using technology. Across the treatment-related categories, several themes touched on women-specific factors including family responsibilities, abusive partners, stigma, and motivation for treatment (eg, pregnancy). The technology-related categories provided information for designing the features of the intervention, as well as revealing barriers to technology use, which could be helpful in developing implementation strategies. Provider survey participants were primarily female participants (40/55, 73%), with a mean age of 42.5 (SD 12.5) years. Survey data provided additional information on barriers to treatment and suggested technology features. Based on these data and preliminary work, the intervention was created. Minor edits to content and visual design were made in the beta-testing phase. The final version includes a web-based component with 6 topic modules and a mobile component. Topics in the web-based component are presented through infographics, text, videos, and interactive questions. The mobile component includes daily motivational messages, skills practice activities (2/wk), weekly check-ins, and resources (always available). Conclusions: Important themes and suggested features from women with lived experience and providers were incorporated into a digital intervention for women with OUD. Data on #feasibility, satisfaction, and engagement with the intervention are currently being collected in phase 3, a pilot randomized controlled trial.

Background: Self-harm (SH) affects around 20% of all young people in the United Kingdom. Treatment options for SH remain limited and those available are long and costly and may not suit all young people. There is an urgent need to develop new scalable interventions to address this gap. IMAGINATOR is a novel imagery-based intervention targeting SH initially developed for individuals aged 16 to 25 years. It is a blended digital intervention delivering functional imagery training via therapy sessions and a smartphone app. Objective: This study aimed to pilot a new version of the app, IMAGINATOR 2.0, extended to adolescents from the age of 12 years and coproduced with a diverse group of young people with lived experience. Our aim was also to test the #feasibility and acceptability of delivering IMAGINATOR 2.0 in secondary mental health services. Methods: A total of 4 co-design workshops were conducted online with UK-based lived-experience co-designers aged 14-25 years to develop the IMAGINATOR 2.0 app. The intervention was then piloted with participants recruited from West London NHS Trust Tier 2 Child and Adolescent Mental Health Services and adult Mental Health Integrated Network Teams. Participants received 3 face-to-face functional imagery training sessions in which the app was introduced and 5 brief phone support sessions. Outcome assessments were conducted after completing therapy, approximately 3 months post baseline. Two focus groups gathered the therapists’ perspectives on IMAGINATOR 2.0’s acceptability and means of improvement. For quantitative data, descriptives are reported. Qualitative data were analyzed using a coproduced thematic analysis method with young people with lived experiences. Results: Overall, 83 participants were referred, and 29 (gender: n=28 women, n=1 transgender; mean age 18.9, SD 3.74 years) were eligible and completed screening. Of the 27 participants who started, 59% (n=16) completed therapy per protocol, while only 15 (55.6%) completed the quantitative outcome assessment. There was an overall reduction in the number of SH episodes over 3 months from pre- to postintervention (baseline: median 7, IQR 3.5-21.5 months; postintervention: median 0, IQR 0-7 months; median difference=–6.5; r=0.69). Six themes were identified through thematic analysis of therapists’ feedback, including mental imagery’s potential and boundaries, therapy expectations, experience and effectiveness, accessibility of digital support, and adaptation of the IMAGINATOR 2.0 app to complement care pathways. The app was valued by therapists who highlighted the need for an intervention like IMAGINATOR 2.0 in their services. Conclusions: IMAGINATOR 2.0 shows initial promise as an acceptable brief intervention targeting SH in young people under adolescent and adult mental health services. Challenges with attrition need to be addressed for a definitive randomized controlled trial to test the intervention efficacy. Clinical Trial: ClinicalTrials.gov NCT06311084; https://clinicaltrials.gov/study/NCT06311084

Background: Online harm affects many people and has been associated with self-harm and suicidal ideation. Although there is an emerging body of evidence that addressing adverse online experiences should be part of the support offered to people who are at risk of self-harm and suicide, there has been little guidance to date on how this support might be provided and how safe conversations can be had on the subject. A UK charity dedicated to offering emotional support to anyone experiencing mental discomfort, having difficulty coping, or being at risk of suicide developed a digital intervention, the Online Safety Hub (the Hub), to address this shortfall. Objective: The study aimed to evaluate the impact of the Hub on practitioners (people who provide support) and people with lived experiences of suicide and self-harm. Methods: A mixed-method evaluation comprised a rapid literature review, data collected from people with lived experience and practitioners through surveys, interviews, focus groups and analysis of the Hub’s activity data. The study design was informed by a panel of people with lived experience of online harm resulting in either self-harm and/or suicidal ideation. Results: Initially, the evaluation found limited uptake of the Hub. Engagement with the Hub was impeded by a lack of clarity on the part of practitioners as to whether they were the intended audience. The evaluation process prompted the charity to design and deliver webinars to facilitate uptake of the Hub. Practitioners who engaged with the Hub via webinars found the content useful and were able to consider incorporating their learning into practice. The webinars offered a more social learning experience than individual engagement with the Hub, providing a community of practice for people with common interests across diverse organisational settings. Opportunities for shared learning and the supportive nature of the community of practice were valued when learning about the sensitive and difficult topic of online harm in relation to self-harm and suicide. The Hub contributed to awareness raising and shared learning. Conclusions: Online resources alone may not be sufficient for an intervention to effectively raise awareness and change practice. Social learning facilitated through communities of practice can enhance engagement, uptake, and learning.

Background: Globally, we face a significant treatment gap in mental health care, with extensive wait times, exorbitant prices, and concerns about appropriateness for non-Western clients. Digital single-session interventions (SSIs) may offer a promising alternative. SSIs target particular mechanisms that underlie broad-ranging psychopathology, including deficits in problem-solving skills. Objective: Developed in the United States, Project SOLVE is a digital SSI that teaches problem-solving skills to adolescents. This study evaluated the acceptability, appropriateness, and utility of an adapted version, Project SOLVE-NZ, among rangatahi (young people) in Aotearoa New Zealand. Additionally, we evaluated a comparable online activity, Project Success-NZ, as a potential active control condition in a future randomized controlled trial of Project SOLVE-NZ. Methods: A sample of school students and teachers completed Project SOLVE-NZ and Project Success-NZ. Feedback on the interventions was collected through focus groups and semistructured interviews. Interviews were recorded, transcribed, and analyzed using reflexive thematic analysis. Results: In total, 12 students (aged between 13 and 14 years; female students: n=6, 50%) participated in a focus group, and 8 teachers (teaching experience: mean 8.75, SD 7.96 years; female teachers: n=5, 62.5%) participated in individual interviews. Participants endorsed the sociocultural relevance of Project SOLVE-NZ and Project Success-NZ to rangatahi in Aotearoa New Zealand and viewed all existing adaptations favorably. Participants felt that the interventions would be valuable to a wide range of rangatahi, helping to fill gaps in students’ learning and providing benefits to mental health. Participants also believed that the interventions may be particularly relevant for youths experiencing economic hardship. Interestingly, most participants had no preference for either Project SOLVE-NZ or Project Success-NZ, and they believed that both interventions could provide ongoing support to rangatahi throughout the school year. Teachers provided some suggestions on increasing student engagement with the interventions, namely, through increased cultural and gender representation, visual and literacy aids, whakawhanaungatanga (relationship building), and teacher guidance. Overall, interviews revealed that both interventions were perceived as acceptable, appropriate, and useful for rangatahi in New Zealand and highlighted further adaptations that could be made prior to a randomized controlled trial of Project SOLVE-NZ across schools nationwide. Conclusions: Digital SSIs show promise in addressing the mental health treatment gap for adolescents. Both Project SOLVE-NZ and Project Success-NZ were well-received by students and teachers in Aotearoa New Zealand and may provide benefits to youth mental health. We make the following recommendations for others interested in designing digital SSIs or similar tools for young people: involve rangatahi and relevant stakeholders in the design process, consider how the intervention will be implemented, ensure that the intervention accommodates a range of cognitive abilities, and ensure that the intervention reflects the diversity of rangatahi today.

Background: The growing global burden of #MentalHealth disorders has intensified the search for scalable, accessible, and cost-effective interventions. Conversational agents in the form of #Digital humans have emerged as promising tools to deliver #MentalHealth support across diverse populations and settings. Objective: The scoping review seeks to provide a comprehensive analysis of #Digital humans' roles in #depression management, identifying their specific #Applications in both diagnostic processes and therapeutic interventions. Additionally, this study aims to evaluate the design choices implemented in #Digital human systems, including their #Appearance, interaction modalities, back-end intelligence systems, and the various roles they assume. Methods: Following the PRISMA-ScR guidelines, we systematically searched peer-reviewed literature across major databases including ACM #Digital Library, IEEE Xplore, Web of Science, and PubMed to capture both psychological and technological perspectives. The search query used was to include a wide variety of synonyms for #Digital humans and #depression: ("avatar" OR "virtual agent" OR "embodied conversational agent" OR "relational agent" OR "#Digital human" OR "virtual human" OR "virtual character") AND ("Major #depressive Disorder" OR "#depression"). Studies were included if they described the development, implementation, or evaluation of #Digital humans designed to support #MentalHealth outcomes. Data were charted on agent design, therapeutic #Approach, target population, delivery context, and reported effectiveness. Results: Twenty studies (2010-2024) were included. #depression assessment studies comprised 35% (n=7), interventions 55% (n=11), and combined #Approaches 10% (n=2). Assessment protocols included questionnaires (PHQ-9, CES-D-VAS-VS), semi-structured interviews based on DSM-5 criteria, and interactive tasks designed to elicit emotional responses. Intervention #Approaches employed Cognitive Behavioral Therapy, psychoeducation, Compassion-Focused Therapy, and Avatar Therapy. #Digital humans assumed five distinct roles: interviewer (n=6), facilitator (n=3), counselor (n=3), educator (n=3), and actor (n=5). Interviewers primarily #Appeared in assessment studies, presenting structured questions. Counselors engaged in therapeutic dialogues, while educators delivered psychoeducational content. Facilitators assisted participants in achieving system goals. Actors portrayed specific emotions or dysfunctional beliefs to facilitate therapeutic processes. Studies highlighted #Digital humans' utility in enhancing diagnostic processes and therapeutic interventions, noting potential for transformation through physiological data integration. Conclusions: This scoping review demonstrates that #Digital humans represent a transformative advancement in #depression management, offering innovative #Applications across both assessment and intervention phases. The evidence reveals #Digital humans' effectiveness in replicating traditional therapeutic roles while providing unique advantages including 24/7 accessibility, reduced stigma, consistent care delivery, and personalized support. #Digital humans successfully function across multiple roles with demonstrated capability to establish therapeutic alliances and elicit meaningful engagement comparable to human providers. Findings underscore the need for continued research to fully realize #Digital humans' potential in addressing #depression-specific needs, advocating for expansion into diverse therapeutic scenarios and exploration of unexplored #Digital human #Applications.

Background: There is a shortage of services available to address the growing demand for mental health support in Australia and worldwide. Digital interventions, including conversational agents, can overcome barriers to accessing mental health support. The recent advances in large language models have led to an improvement in the perceived human-like naturalness of chatbot conversations, but there is little research on the experience of chatbots to support mental health. Manage your life online (MYLO) is a rule-based chatbot that was co-designed with young people and uses questions to help users explore their problems. In a case series conducted before the release of ChatGPT (OpenAI), users rated a new smartphone interface for MYLO as acceptable, and there was a large effect size for reduction in problem-related distress. Objective: This study aimed to evaluate an improved version of MYLO and compare the user experience of MYLO in this case series to the previous version that was completed in November 2022. Methods: We replicated and extended the previous 2-week case-series, conducted from September to November 2022, by testing 4-week usage of MYLO with a larger sample between October and December 2023. We recruited 24 young people living in Western Australia who self-described as having a lived experience of anxiety or depression. Participants had access to and used MYLO over a 4-week period while completing online weekly surveys that included a range of health and psychological questionnaires. After the 4-week testing phase, participants were invited to provide feedback on their experience of using MYLO through an interview or focus group discussion. Results: In total, 13 of the 24 participants were retained throughout the study and took part in interviews. On average, participants had around 4 conversations with MYLO. They experienced both benefits and limitations of these conversations. They spoke about their recent experiences with ChatGPT (released in November 2022 after the previous case-series concluded) and other generative artificial intelligence (#AI) (AI) tools, stating that they had expected MYLO to possess similar functionality, which it did not. Nonetheless, we found moderate to large effect sizes for improvements in problem-related distress (Cohen d=–1.07), anxiety (Cohen d=–0.41), and psychiatric impairment (Cohen d=–0.60) and some evidence of reliable improvement in clinical outcomes. Conclusions: These findings have implications for mental health chatbots in the age of ChatGPT and highlight a need for researchers to engage with new technologies to improve user experience, while maintaining the necessary safety and ethical standards that can be a significant challenge for generative AI.

Background: University communities, especially in low-resource settings like Peru’s Andean region, experience high rates of depression, anxiety, and stress that harm academic performance and well-being. Traditional mental health services often remain inaccessible, creating a need for scalable, self-guided solutions. While digital mental health interventions have shown promise broadly, evidence is scarce for fully self-administered platforms in low resource university environments. Objective: We aimed to evaluate the efficacy of a self-administered digital mental health service in members of a public university to reduce symptoms of depression, anxiety, and perceived stress. Methods: We conducted a double-blind, parallel-group randomized controlled trial with 1:1 allocation to the DMHSS or a 30-day waiting-list control. Recruitment in May–June 2024 yielded 427 eligible participants (students, teachers, administrative staff) reporting mild to moderate symptoms of depression, anxiety and stress. Participants were randomized via simple randomization and blinded through automated platform assignment. The intervention comprised six sequential five-day modules grounded in Acceptance and Commitment Therapy, mindfulness, and behavioral activation, delivered via videos, daily text prompts, workbooks, and a responsive chatbot. SMS/WhatsApp reminders promoted adherence. Depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), and perceived stress (PSS-10) were assessed at baseline and immediately post-intervention (day 30). Secondary outcomes in the intervention arm included #usability (CSUQ), satisfaction (CSQ-8), and subjective commitment (TWEETS). Analysis of covariance (ANCOVA) adjusted for baseline scores, and multivariate ANCOVA accounted for correlations among outcomes. Effect sizes were quantified using Cohen’s d and partial epsilon-squared (ε²ₚ). Results: Of 427 randomized, 85 (19.9%) completed all assessments (intervention n=30; control n=55). Baseline demographic and clinical characteristics were comparable between groups. Post-intervention, the DMHSS group exhibited significantly greater reductions in mean PHQ-9 scores (mean difference 2.78; Cohen’s d 0.64; p=0.006), GAD-7 scores (2.13; d 0.56; p=0.015), and PSS-10 scores (4.08; d 0.69; p=0.003) compared to controls. ANCOVA confirmed robust group effects for depression (F₁,₈₂ = 9.78; p=0.002; ε²ₚ = 0.31) and anxiety (F₁,₈₂ = 8.28; p=0.005; ε²ₚ = 0.32), with a trend toward stress reduction (F₁,₈₂ = 3.73; p=0.057; ε²ₚ = 0.46). MANCOVA demonstrated a significant multivariate effect (F₄,₁₂ = 7.23; p=0.015). Among intervention completers, 100% scored below the CSQ-8 satisfaction threshold (