Digital mental health interventions for hard-to-reach populations

Digital interventions for mental health conditions such as depression and anxiety have gained significant attention in recent years. These digital interventions promise to improve access to mental health care and a growing body of research supports their effectiveness in treating common mental health conditions. However, the effectiveness of digital interventions among hard-to-reach populations remains under debate. These populations often delay seeking help, which can exacerbate risky behaviors and lead to poorer health outcomes. This dissertation aims to evaluate the effectiveness of digital interventions for a number of hard-to-reach populations, focusing on young adult drinkers, adult substance users, and individuals with personality disorders. This dissertation consists of six studies that examine the effectiveness of digital mental health interventions for a number of hard-to-reach populations. Each study uses its own methodological approach, which broadens the range of conclusions that can be drawn. The first chapter provides an introduction that outlines the importance of digital interventions as a tool to overcome traditional treatment barriers, potentially making psychotherapeutic interventions more accessible and acceptable to these populations. This chapter also describes the key objectives of the dissertation. Four of the six studies employ meta-analytic methods, which allow for the aggregation and analysis of existing research. These methods are particularly useful for synthesizing data from multiple sources and formulating recommendations that form the basis of evidence-based guidelines for health care interventions. Chapter 6 outlines the protocol for a randomized controlled trial investigating a mobile intervention targeting low-risk drinking habits among young adults, while Chapter 7 presents the results of the intervention's effectiveness. The concluding chapter provides a holistic discussion that synthesizes the findings, identifies the strengths and limitations of the research, and suggests future research directions

On structural reforms and debt relief

The recent trip of the Greek Prime Minister to the US was dominated by repeated calls for debt relief. The Greek pile of debt, currently at 177% of the country’s GDP, is undoubtedly high (see here for a recent analysis on the sustainability of the Greek debt). In July 2015, the IMF (one of Greece’s so-called Troika partners) produced a sustainability report which raised the issue of extending Greek debt maturity. Indeed, a possible way forward for debt relief involves pushing Greece’s average debt maturity, currently at 16.5 years (see also here and here) further into the future. In its July 2015 report, the IMF also raised the issue of “voluntary” haircut in the debt holdings of Greece’s Eurozone partners. The Greek PM Speaking in September 2015 to The Wall Street Journal (here) argued that a possible Greek debt restructuring will almost immediately be followed by access to international financial markets. This, however, is not certain since getting access to financial markets works through the credit scores assigned by credit rating agencies

On Economic Policy Uncertainty and Sovereign Credit Rating Decisions: Panel Quantile Evidence for the Eurozone

We employ a panel quantile framework that quantifies the relative importance of quantitative and qualitative factors across the conditional distribution of sovereign credit ratings in the Eurozone area. We find that regulatory quality and competitiveness have a stronger impact for low rated countries whereas GDP per capita is a major driver of high rated countries. A reduction in the current account deficit leads to a rating or outlook upgrade for low rated countries. Economic policy uncertainty impacts negatively on credit ratings across the conditional distribution; however, the impact is stronger for the lower rated countries. In other words, the creditworthiness of low rated countries takes a much bigger ‘hit’ than that of high rated countries when European policy uncertainty is on the rise

Fair or not? How credit rating agencies calculated their ratings during the Eurozone crisis

Credit rating agencies received a great deal of criticism during the Eurozone crisis, but what actually explains the changes that occur in a country’s credit rating? Drawing on new research, Periklis Boumparis, Costas Milas and Theodore Panagiotidis write that ratings agencies have responded differently to low-rated and high-rated Eurozone countries. Regulatory quality and competitiveness have a stronger impact for low rated countries, while GDP per capita is a major driver for high rated countries. The creditworthiness of low rated countries also takes a much bigger ‘hit’ than that of high rated countries when European policy uncertainty is on the rise

The effect of e-mental health interventions on academic performance in university and college students:A meta-analysis of randomized controlled trials

Background: Mental health symptoms are common among college and university students and these can affect their academic performance. E-mental health interventions have proven effective in addressing mental health complaints but their effect on academic performance has not been synthesized yet. Objectives: To synthesize the evidence from randomized controlled trials for the effectiveness of e-mental health interventions on academic performance in college and university students compared to inactive controls. Data sources and eligibility criteria: We searched six databases (PubMed, Cochrane library, CINAHL, ERIC, PsycINFO, Web of Science) during the period January 2000 until September 2019 for randomized controlled trials that reported on e-mental health interventions (guided or unguided) for college and university students and measured academic performance (e.g. grade point average). Study appraisal and synthesis methods: Study and participant characteristics and the academic performance measures at post-intervention were extracted. The latter were pooled and Hedges' g was calculated as the effect size. Heterogeneity and publication bias were investigated. Results: Six studies containing 2428 participants were included in the meta-analysis. These focussed on either mood and anxiety or alcohol and tobacco use. The pooling of data resulted in a small but non-significant effect of g = 0.26 (95% CI, −0.00, 0.52; p = .05) on academic performance, favouring e-mental health interventions over inactive controls. Interventions had positive effects on depression (g = −0.24) and anxiety (g = −0.2). Heterogeneity was high. Discussion: Despite the small and non-significant effect, our meta-analysis points to a promising direction for the effectiveness of e-mental health interventions on academic performance. Yet, these results must be interpreted with caution, as heterogeneity was high and few studies on the effectiveness of e-mental health interventions for students reported academic performance measures

Predictors of Youth Accessibility for a Mobile Phone-Based Life Skills Training Program for Addiction Prevention

Background: Digital interventions are an emerging and promising avenue for addiction prevention and mental health promotion, but their reach and use are often limited, and little is known about the factors associated with youth accessibility. SmartCoach is a life skills training program for addiction prevention where adolescents are proactively invited for program participation in secondary school classes. The mobile phone-based program provides individualized coaching for a period of 4 months and addresses self-management skills, social skills, and substance use resistance skills. This study examined sociodemographic and other predictors of program participation and program use. Methods: A total of 476 adolescents in 28 secondary and upper secondary school classes in the German-speaking part of Switzerland were proactively invited for participation in the SmartCoach program. Using generalized linear mixed models (GLMMs), we examined predictors of both program participation and program use at the individual and school class levels. Results: In total, 315 (66.2%) of the present 476 adolescents gave their active consent and provided the necessary information to be included in the program. None of the individual sociodemographic characteristics significantly predicted program participation, however, the participation rate was significantly higher in upper secondary school classes (84%) than secondary school classes (59%). The mean number of interactions with the program was 15.9, i.e., participants took part in almost half of the 34 possible interactions with the SmartCoach program. None of the baseline characteristics on the level of the school class significantly predicted program use. On the level of the individual, the univariate models showed that, compared to the reference category of 14-year-old students, program use was significantly lower for students who were 16 or older. Furthermore, participants with a migration background or an origin from a non-German-speaking country showed significantly lower program use. Finally, students with a medium level of perceived stress showed higher program use compared to those with a low level of stress. Within the final multivariate model for program use, only the variable “origin from a non-German-speaking country” remained significant. Conclusions: SmartCoach is an attractive offer for young people, in which two out of three young people who are invited in the classroom to participate do so. Among the program participants, the use of the program is acceptable, with an average of almost half of the content being worked on. There is potential for improvement in terms of recruitment, especially in school classes with a lower level of education. The most important starting point for improving program use lies in taking greater account of needs and wishes of students with non-German-speaking countries of origin

Internet-based interventions for behavioral addictions: A systematic review

Background and aims Behavioral addictions are a public health problem that causes harm to both individuals and society. Internet-based interventions offer potential benefits over face-to-face therapy for the treatment of behavioral addictions, including their accessibility, perceived anonymity, and low costs. We systematically reviewed the characteristics and effectiveness of these interventions. Methods A systematic literature search was conducted in: PubMed, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials. A standardized methodological quality assessment was performed on all identified studies via the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Results Twenty-nine studies were assessed in this systematic review. Between them, considerable heterogeneity was noted in various study characteristics, including screening tools, inclusion criteria, and outcome measures. Attrition rates also ranged widely (9–89%), as did study quality, with three of the 29 studies rated strong, 12 moderate, and 14 weak methodologically. Twenty-two studies focused on gambling disorder, most revealing significant within-group effects for the assessed intervention on gambling-related symptoms and four of these studies identified significant between-group effects. Behavioral addictions studied in the remaining studies included gaming disorder, internet use disorder, hoarding disorder, and pornography use disorder, revealing generally-promising, albeit limited results. Conclusions Internet-based interventions seem promising at reducing gambling problems, but too few studies have been published, to date, for conclusions to be drawn for other behavioral addictions. Internet-based interventions targeting other behavioral addictions – like gaming disorder, internet use disorder, hoarding disorder, and pornography use disorder – remain under-examined, warranting considerable additional research to assess their effectiveness

Efficacy of a Mobile App-Based Coaching Program for Addiction Prevention among Apprentices: A Cluster-Randomized Controlled Trial

Background: Addictive behaviors such as tobacco/e-cigarette smoking, at-risk alcohol consumption, cannabis use or compulsive internet use are common among apprentices. ready4life is a mobile app-based preventive intervention program for apprentices that promotes life skills and reduces risky behavior. The present study tested the efficacy of ready4life for addiction prevention among apprentices in Switzerland within a controlled trial. Methods: Two-arm, cluster-randomized controlled trial including assessments at baseline and follow-up after 6 months. Participants of the intervention group received coaching by a conversational agent for 16 weeks. The main outcome measure was a composite score for addictive behaviors, which included (1) at-risk drinking, (2) tobacco/e-cigarette smoking, (3) cannabis use and (4) problematic internet use. Results: A total of 2275 students from 159 vocational school classes in Switzerland, were invited for study participation. Of these, 1351 (59.4%) students with a mean age of 17.3 years and a male proportion of 56.6% provided informed consent to participate. The follow up assessment at month 6 was completed by 962 (71.2%) study participants. The results concerning the primary outcome showed a stronger decrease of addictive behaviors between baseline and follow up in the intervention group compared to the control group. In particular, significant effects were observed for at-risk drinking and problematic Internet use, while no significant effects were observed for tobacco/e-cigarette smoking and cannabis use. Conclusions: The majority of apprentices invited for program participation within vocational schools participated in the ready4life program for addiction prevention. The mobile app-based coaching was effective in reducing risk behaviors such as at-risk drinking and problematic Internet use in a group of adolescents who have an especially high risk of engaging in addictive activities