Artificial Intelligence-Assisted Online Social Therapy for Youth Mental Health

Introduction: Benefits from mental health early interventions may not be sustained over time, and longer-term intervention programs may be required to maintain early clinical gains. However, due to the high intensity of face-to-face early intervention treatments, this may not be feasible. Adjunctive internet-based interventions specifically designed for youth may provide a cost-effective and engaging alternative to prevent loss of intervention benefits. However, until now online interventions have relied on human moderators to deliver therapeutic content. More sophisticated models responsive to user data are critical to inform tailored online therapy. Thus, integration of user experience with a sophisticated and cutting-edge technology to deliver content is necessary to redefine online interventions in youth mental health. This paper discusses the development of the moderated online social therapy (MOST) web application, which provides an interactive social media-based platform for recovery in mental health. We provide an overview of the system's main features and discus our current work regarding the incorporation of advanced computational and artificial intelligence methods to enhance user engagement and improve the discovery and delivery of therapy content.Methods: Our case study is the ongoing Horyzons site (5-year randomized controlled trial for youth recovering from early psychosis), which is powered by MOST. We outline the motivation underlying the project and the web application's foundational features and interface. We discuss system innovations, including the incorporation of pertinent usage patterns as well as identifying certain limitations of the system. This leads to our current motivations and focus on using computational and artificial intelligence methods to enhance user engagement, and to further improve the system with novel mechanisms for the delivery of therapy content to users. In particular, we cover our usage of natural language analysis and chatbot technologies as strategies to tailor interventions and scale up the system.Conclusions: To date, the innovative MOST system has demonstrated viability in a series of clinical research trials. Given the data-driven opportunities afforded by the software system, observed usage patterns, and the aim to deploy it on a greater scale, an important next step in its evolution is the incorporation of advanced and automated content delivery mechanisms

Determinants of anxiety in elite athletes:a systematic review and meta-analysis

OBJECTIVE: To identify and quantify determinants of anxiety symptoms and disorders experienced by elite athletes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Five online databases (PubMed, SportDiscus, PsycINFO, Scopus and Cochrane) were searched up to November 2018 to identify eligible citations. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Articles were included if they were published in English, were quantitative studies and measured a symptom-level anxiety outcome in competing or retired athletes at the professional (including professional youth), Olympic or collegiate/university levels. RESULTS AND SUMMARY: We screened 1163 articles; 61 studies were included in the systematic review and 27 of them were suitable for meta-analysis. Overall risk of bias for included studies was low. Athletes and non-athletes had no differences in anxiety profiles (d=-0.11, p=0.28). Pooled effect sizes, demonstrating moderate effects, were identified for (1) career dissatisfaction (d=0.45; higher anxiety in dissatisfied athletes), (2) gender (d=0.38; higher anxiety in female athletes), (3) age (d=-0.34; higher anxiety for younger athletes) and (4) musculoskeletal injury (d=0.31; higher anxiety for injured athletes). A small pooled effect was found for recent adverse life events (d=0.26)-higher anxiety in athletes who had experienced one or more recent adverse life events. CONCLUSION: Determinants of anxiety in elite populations broadly reflect those experienced by the general population. Clinicians should be aware of these general and athlete-specific determinants of anxiety among elite athletes

Implementation of the Enhanced Moderated Online Social Therapy (MOST+) Model Within a National Youth E-Mental Health Service (eheadspace): Protocol for a Single Group Pilot Study for Help-Seeking Young People

Background: There is a substantial need for youth electronic mental health (e-mental health) services. In addressing this need, our team has developed a novel moderated online social therapy intervention called enhanced moderated online social therapy (MOST+). MOST+ integrates real-time, clinician-delivered Web chat counseling, interactive user-directed online therapy, expert and peer moderation, and private and secure peer-to-peer social networking. MOST+ has been designed to give young people immediate, 24-hour access to anonymous, evidence-based, and short-term mental health care. Objective: The primary aims of this pilot study were to determine the feasibility, acceptability, and safety of the intervention. Secondary aims were to assess prepost changes in key psychosocial outcomes and collect qualitative data for future intervention refinement. Methods: MOST+ will be embedded within eheadspace, an Australian youth e-mental health service, and will be evaluated via an uncontrolled single-group study. Approximately 250 help-seeking young people (16-25 years) will be progressively recruited to the intervention from the eheadspace home page over the first 4 weeks of an 8-week intervention period. All participants will have access to evidence-based therapeutic content and integrated Web chat counseling. Additional access to moderated peer-to-peer social networking will be granted to individuals for whom it is deemed safe and appropriate, through a three-tiered screening process. Participants will be enrolled in the MOST+ intervention for 1 week, with the option to renew their enrollment across the duration of the pilot. Participants will complete a survey at enrollment to assess psychological well-being and other mental health outcomes. Additional assessment will occur following account deactivation (ie, after participant has opted not to renew their enrollment, or at trial conclusion) and will include an online survey and telephone interview assessing psychological well-being and experience of using MOST+. Results: Recruitment for the study commenced in October 2017. We expect to have initial results in March 2018, with more detailed qualitative and quantitative analyses to follow. Conclusions: This is the first Australia-wide research trial to pilot an online social media platform merging real-time clinical support, expert and peer moderation, interactive online therapy, and peer-to-peer social networking. The importance of the project stems from the need to develop innovative new models for the efficient delivery of responsive evidence-based online support to help-seeking young people. If successful, this research stands to complement and enhance e-mental health services in Australia

Family factors and psychiatric disorders among puerto rican children and youth in two different socio-cultural contexts

Objectius: (1) Analitzar si la calidesa dels pares (CP) s'associa amb trastorns psiquiàtrics específics (ansietat, trastorn depressiu major (TDM), TDAH i trastorn de comportament disruptiu (TCD) (Estudi 1)) i consum d'alcohol, us de substàncies (US) sense alcohol, i qualsevol US (Estudi 2) en els nens de Puerto Rico. (2) Analitzar la influència de l'estructura familiar i les transicions en els trastorns psiquiàtrics infantils en aquesta població (Estudi 3). Mètodes: Els nens de Puerto Rico 5-13 anys d'edat en F1 que vivien al South Bronx (SB) i Puerto Rico (PR) (n=2.491), van ser seguits durant tres anys consecutius. Participants: L'estudi 1 utilitza tota la mostra (n=2.491); l'estudi 2 inclou únicament la població de 10 anys d'edat o més a F1 (n=1.085); l'estudi 3 inclou només els participants amb dades de les tres fases (n=2.142). Mesures: Els trastorns psiquiàtrics juvenils (TCD, ADHD, ansietat, TDM, trastorns interioritzats i exterioritzats i US) varen ser mesurats amb L'Entrevista Diagnòstica per a Nens-IV (DISC-IV). Anàlisi: Estudi 1 i 2: models lineals generalitzats mixtes van provar l'associació entre CP i trastorns psiquiàtrics, US i consum d'alcohol en els següents dos anys. Estudi 3: Anàlisi de regressió logística es van dur a terme en oder per examinar els factors que poden explicar com l'estructura familiar i les transicions poden estar relacionats amb trastorns psiquiàtrics infantils. Resultats: CP estava relacionat amb probabilitats més baixes de l'ansietat infantil, TDM, TDAH i TCD, US no alcohòliques i qualsevol US. No hi va haver diferències significatives entre els fills de pares (biològics o pas) que cohabiten o de pares solters en comparació amb els nens els pares biològics casats respecte a presencia de trastorns interioritzats i exterioritzats. En PR únicament, la transició d'una família de dos pares a una família amb un sol pare estava relacionat amb trastorns de interioritzats dels nens.Objetivos: (1) Analizar si la calidez parental (CP) está asociado con trastornos psiquiátricos (Ansiedad, trastorno depresivo mayor (TDM), TDAH y trastorno del comportamiento disruptivo (TCD), (Estudio 1)), uso de alcohol, uso de sustancias (US) no alcohólicas y cualquier US (Estudio 2) en niños Puertorriqueños. (2) Examinar la influencia de la estructura familiar y las transiciones en los trastornos psiquiátricos infantiles en esta población (Estudio 3). Métodos: Se siguieron durante tres años consecutivos niños puertorriqueños de 5-13 años en la F1 residentes en el South Bronx (SB) y Puerto Rico (PR) (n=2.491). Participantes: El estudio 1 utilizó la muestra completa (n=2.491); En el estudio 2 sólo se incluyeron los jóvenes de 10 años o mayores (F1) (n=1.085); Y el estudio 3 sólo participantes con datos en las tres fases (n=2,142). Medidas: Se utilizó la Entrevista Diagnóstica para Niños-IV (DISC-IV) para evaluar los trastornos psiquiátricos infantiles (TCD, ADHD, ansiedad, TDM, trastornos de internalización, trastornos de externalización y US). Análisis: Estudio 1 y 2: Modelos lineales generalizados analizaron la asociación entre CP (F1) y trastornos psiquiátricos, US y consumo de alcohol en los próximos dos años ajustando por características demográficas y procesos familiares. Estudio 3: Análisis de regresión logística para examinar los factores que pueden explicar cómo la estructura familiar y las transiciones pueden estar relacionadas con trastornos psiquiátricos infantiles. Resultados: CP está asociado con menor probabilidad de sufrir ansiedad, TDM, ADHD y TCD (Estudio 1), US no alcohólicas y cualquier US (Estudio 2) a lo largo del tiempo. (Estudio 3). Tanto los trastornos interiorizados como los de exteriorizados no presentaron diferencias significativas entre los hijos de padres (biológicos o no biológicos) en cohabitación o de padres solteros en comparación con los hijos de padres biológicos casados. Sólo en PR, una transición (de familia de dos padres a familia monoparental) estaba asociado con los trastornos de internalización del niño.Objectives: (1) To address whether parental warmth (PW) is associated with specific psychiatric disorders (anxiety, major depressive disorder (MDD), ADHD, and disruptive behavior disorder (DBD) (Study 1)) and youth alcohol use, non-alcohol substance use (SU), and any SU (Study 2) in Puerto Rican children and its changes over time. (2) To examine the influence of family structure and transitions on child psychiatric disorders in this population (Study 3). Methods: Puerto Rican children 5-13 years of age at W1 living in the South Bronx (SB) and Puerto Rico (PR) (n=2,491), were followed for three consecutive years. Participants: Study 1 used the entire sample (n=2,491); study 2 only included youth who were 10 years old or older at W1 (n=1,085); and study 3 only participants with data in the three waves (n=2,142). Measures: The Diagnostic Interview Schedule for Children-IV (DISC-IV) measured youth psychiatric disorders (DBD, ADHD, anxiety, MDD, internalizing disorders, externalizing disorders and SU). Analyses: Study 1 and 2: Generalized Linear Mixed models tested the association between PW (W1) and psychiatric disorders, SU and alcohol use in the next two years adjusting for demographic characteristics and family processes. Study 3: Logistic regression analyses to examine factors that may explain how family structure and transitions may be related to child psychiatric disorders. Results: Higher levels of PW were related to lower odds of child anxiety, MDD, ADHD and DBD (Study 1), using non-alcoholic substances and any SU (Study 2) over time. (Study 3) Both internalizing and externalizing disorders there were no significant differences between children of cohabiting (biological or step) parents or of single parents compared to children of married biological parents. In PR only, transitioning once from a two-parent family to a single-parent family was related to child internalizing disorders

Social media interventions for adolescents and young people with depression and psychosis

Internet use is pervasive among adolescents. In particular, the use of social networking sites (SNS) has become ubiquitous for adolescents, becoming the new context for social support and communication. While SNS likely have a range of benefits for adolescents, excessive use of, or dependence on, social media may increase the likelihood of negative outcomes such as distress, isolation, and low mood. This concern underscores the need to thoroughly understand social media use patterns of vulnerable adolescents experiencing mental health problems. Findings regarding the benefits and detrimental outcomes from social media use among at-risk adolescents are mixed. More recently, social media-based interventions that have targeted particular disorders by combining traditional online therapy with SNS have started to arise. These interventions aim to integrate social media use and deliver therapy to adolescents in a safe online context (e.g., free of cyberbullying). More generally, online interventions appear promising in reducing symptoms of depressive relapse among adolescents and young adults experiencing major depressive disorder, and also adolescents and young adults experiencing first-episode psychosis, although there is a lack of well-designed (i.e., randomized controlled) intervention studies using social networking in these populations. In this chapter, we briefly review key literature regarding social media use by adolescents diagnosed with depression and psychosis, we describe available social media-based interventions for these populations, and we highlight the next generation of clinical and research innovations within this rapidly evolving field

Web-Based Mindfulness Interventions for Mental Health Treatment: Systematic Review and Meta-Analysis

Background: Web-based mindfulness interventions are increasingly delivered through the internet to treat mental health conditions. Objective: The objective of this study was to determine the effectiveness of web-based mindfulness interventions in clinical mental health populations. Secondary aims were to explore the impact of study variables on the effectiveness of web-based mindfulness interventions. Methods: We performed a systematic review and meta-analysis of studies investigating the effects of web-based mindfulness interventions on clinical populations. Results: The search strategy yielded 12 eligible studies. Web-based mindfulness interventions were effective in reducing depression in the total clinical sample (n=656 g=−0.609, P=.004) and in the anxiety disorder subgroup (n=313, g=−0.651, P<.001), but not in the depression disorder subgroup (n=251, P=.18). Similarly, web-based mindfulness interventions significantly reduced anxiety in the total clinical sample (n=756, g=−0.433, P=.004) and the anxiety disorder subgroup (n=413, g=−0.719, P<.001), but not in the depression disorder group (n=251, g=−0.213, P=.28). Finally, web-based mindfulness interventions improved quality of life and functioning in the total sample (n=591, g=0.362, P=.02) in the anxiety disorder subgroup (n=370, g=0.550, P=.02) and mindfulness skills in the total clinical sample (n=251, g=0.724, P<.001). Conclusions: Results support the effectiveness of web-based mindfulness interventions in reducing depression and anxiety and in enhancing quality of life and mindfulness skills, particularly in those with clinical anxiety. Results should be interpreted with caution given the high heterogeneity of web-based mindfulness interventions and the low number of studies included

Support for carers of young people with mental illness : Design and trial of a technology-mediated therapy

In this article, we show how a technology-mediated mental health therapy involving psycho-education, therapist moderators, and social networking can provide support for carers of young people with mental illness. This multi-faceted tool provides opportunities for users to adapt the system to their needs, leading us to refocus the goal of treatment adherence toward a relatively new phenomenon in HCI, concordance, which has not previously been examined in the HCI literature in relation to online mental-health tools. Concordance shares important links with the development of therapeutic alliance, which is centrally important to mental health therapy, and to Self-Determination Theory (SDT), which informed our approach to design. We present a three-month user study, which provides initial encouraging support for both the suitability of concordance as a lens for viewing user engagement and the idea that users can develop a therapeutic alliance with an online support system. This latter result is surprising as the phenomenon of therapeutic alliance generally describes a relationship between client and (human) clinician. Therapeutic alliance has previously been explored for face-to-face groups, and between individuals and online systems, but not for online groups. We show how even automated system behavior can encourage engagement from users and contribute to alliance formation, if the non-human parts of an online system are interactive. We argue that a design approach involving peer/moderator support as well as automated feedback, and which takes account of SDT, can provide support for therapeutic alliance

Mindfulness-based Online Interventions for Mental Health Treatment: A Systematic Review and Meta-analysis

Mindfulness-based online interventions (MOI) are increasingly being delivered through the Internet to treat mental health conditions. OBJECTIVE To determine the effectiveness of MOI in clinical mental health populations. Secondary aims are to explore the impact of study variables on the effectiveness of MOI. METHODS Systematic review and meta-analysis of studies investigating the effects of MOI in clinical populations. RESULTS The search strategy yielded N=12 eligible studies. MOIs were effective in reducing depression in the total clinical sample (n=656 g=-0.609, P=0.004) and in the anxiety disorder subgroup (n=313, g=-0.651, P=0.000) but not in the depression disorder subgroup (n=251, P=0.178). Similarly, MOIs significantly reduced anxiety in the total clinical sample (n=756, g=-0.433, P=0.004) and the anxiety disorder subgroup (n=413, g=-0.719, P=0.000) but not in the depression disorder group (n=251, g=-0.213, P=0.275). Finally, MOIs improved quality of life and functioning in the total sample (n= 591, g=0.362, P=0.023) and the anxiety disorder subgroup (n=370, g=0.550, P=0.021) and mindfulness skills in the total clinical sample (n=251, g=0.724, P=0.000). CONCLUSIONS Results support the effectiveness of MOIs for reducing depression and anxiety, and enhancing quality of life and mindfulness skills, particularly in those with clinical anxiety. Results should be interpreted with caution given the high heterogeneity of MOIs and the low number of studies included

Predictors of functional recovery in first-episode psychosis: A systematic review and meta-analysis of longitudinal studies

Background: Three out of four first-episode psychosis (FEP) patients achieve clinical remission following treatment. Unfortunately, functional recovery lags behind symptomatic remission, and many individuals with FEP remain socially isolated with poor functional outcomes. Aims: To systematically compile and analyse predictors of functional recovery in FEP. Method: Systematic review and meta-analysis of peer-reviewed, longitudinal studies reporting predictors of functioning, with a minimum 12-month follow-up and at least 80% of participants diagnosed with FEP. Results: Out of 2205 citations, 274 articles were retrieved for detailed evaluation resulting in 50 eligible studies (N = 6669). Sociodemographic, clinical, physical and neuroimaging variables had little impact on long-term functioning. Conversely duration of untreated psychosis (DUP), most cognitive variables, and concurrent remission of positive and negative symptoms were independently related to functional recovery. Conclusions: These findings strongly support the rationale for early intervention in FEP. Novel treatments targeting cognitive deficits may improve functional outcomes in FEP

Face-to-face versus online: A comparative study of mindfulness-based stress reduction program in a general Spanish population

Objectives Explore the reduction in general psychological distress after a face-to-face versus an online mindfulness-based stress reduction (MBSR) program in a Spanish population. In addition, we study if program adherence and satisfaction differ between modalities. Methods We performed an 8-week quasi-experimental study in which 373 participants took part in an MBSR program in which face-to-face (n=109) and online (n=264) modalities were compared. Results Participants in both modalities showed a significant reduction in distress (P<0.001). However, there was no significant difference in this reduction between modalities (P=0.314). Adherence (P<0.001) and satisfaction (P=0.024) were significantly better in face-to-face sessions (P<0.001) compared to online ones. Conclusions The MBSR program reduces general psychological distress in both modalities (face-to-face and online). However, the face-to-face modality has higher levels of adherence and program satisfaction.Objetivos Explorar las diferencias entre el efecto de un programa presencial u online de reducción del estrés basado en mindfulness (REBM) sobre el malestar psicológico general en población española. Además, se estudia si la adhesión y satisfacción con el programa difiere entre ambas modalidades. Metodología Estudio cuasiexperimental en el que 373 participantes realizaron un programa REBM de 8 semanas. Se compararon 2 modalidades: presencial (n = 109) y online (n = 264). Resultados Los participantes de ambas modalidades presentaron reducciones significativas de malestar (p < 0,001). No hubo una diferencia significativa en la reducción de malestar entre ambas modalidades (p = 0,314). La adhesión (p < 0,001) y satisfacción (p = 0,024) fueron significativamente superiores en los participantes de la modalidad presencial (p < 0,001) que en los de la modalidad online. Conclusiones Ambas modalidades de REBM (presencial y online) reducen el malestar psicológico general. Sin embargo, la modalidad presencial tiene mayores niveles de adhesión y satisfacción