Engaging children and young people in digital mental health interventions:Systematic review of modes of delivery, facilitators, and barriers

Background There is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible. Objective This review aimed to (1) identify modes of delivery used in CYP digital MH interventions, (2) explore influencing factors to usage and implementation, and (3) investigate ways in which the interventions have been evaluated and whether CYP engage in DHIs. Methods A literature search was performed in the Cochrane Library, Excerpta Medica dataBASE (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and PsycINFO databases using 3 key concepts “child and adolescent mental health,” “digital intervention,” and “engagement.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using rigorous inclusion criteria and screening by at least two reviewers. The selected articles were assessed for quality using the mixed methods appraisal tool, and data were extracted to address the review aims. Data aggregation and synthesis were conducted and presented as descriptive numerical summaries and a narrative synthesis, respectively. Results This study identified 6 modes of delivery from 83 articles and 71 interventions for engaging CYP: (1) websites, (2) games and computer-assisted programs, (3) apps, (4) robots and digital devices, (5) virtual reality, and (6) mobile text messaging. Overall, 2 themes emerged highlighting intervention-specific and person-specific barriers and facilitators to CYP’s engagement. These themes encompassed factors such as suitability, usability, and acceptability of the DHIs and motivation, capability, and opportunity for the CYP using DHIs. The literature highlighted that CYP prefer DHIs with features such as videos, limited text, ability to personalize, ability to connect with others, and options to receive text message reminders. The findings of this review suggest a high average retention rate of 79% in studies involving various DHIs. Conclusions The development of DHIs is increasing and may be of interest to CYP, particularly in the area of MH treatment. With continuous technological advancements, it is important to know which modalities may increase engagement and help CYP who are facing MH problems. This review identified the existing modalities and highlighted the influencing factors from the perspective of CYP. This knowledge provides information that can be used to design and evaluate new interventions and offers important theoretical insights into how and why CYP engage in DHIs

Burnout among psychotherapists: a cross-cultural value survey among 12 European countries during the coronavirus disease pandemic.

The aim of this study was to examine cross-cultural differences, as operationalized by Schwartz's refined theory of basic values, in burnout levels among psychotherapists from 12 European countries during the coronavirus disease (COVID-19) pandemic. We focused on the multilevel approach to investigate if individual- and country-aggregated level values could explain differences in burnout intensity after controlling for sociodemographic, work-related characteristics and COVID-19-related distress among participants. 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Maslach Burnout Inventory-Human Service Survey, the revised version of the Portrait Values Questionnaire, and a survey questionnaire on sociodemographic, work-related factors and the COVID-19 related distress. In general, the lowest mean level of burnout was noted for Romania, whereas the highest mean burnout intensity was reported for Cyprus. Multilevel analysis revealed that burnout at the individual level was negatively related to self-transcendence and openness-to-change but positively related to self-enhancement and conservation values. However, no significant effects on any values were observed at the country level. Male sex, younger age, being single, and reporting higher COVID-19-related distress were significant burnout correlates. Burnout among psychotherapists may be a transcultural phenomenon, where individual differences among psychotherapists are likely to be more important than differences between the countries of their practice. This finding enriches the discussion on training in psychotherapy in an international context and draws attention to the neglected issue of mental health among psychotherapists in the context of their professional functioning

Burnout among psychotherapists : a cross-cultural value survey among 12 European countries during the coronavirus disease pandemic

The aim of this study was to examine cross-cultural differences, as operationalized by Schwartz's refined theory of basic values, in burnout levels among psychotherapists from 12 European countries during the coronavirus disease (COVID-19) pandemic. We focused on the multilevel approach to investigate if individual- and country-aggregated level values could explain differences in burnout intensity after controlling for sociodemographic, work-related characteristics and COVID-19-related distress among participants. 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Maslach Burnout Inventory-Human Service Survey, the revised version of the Portrait Values Questionnaire, and a survey questionnaire on sociodemographic, work-related factors and the COVID-19 related distress. In general, the lowest mean level of burnout was noted for Romania, whereas the highest mean burnout intensity was reported for Cyprus. Multilevel analysis revealed that burnout at the individual level was negatively related to self-transcendence and openness-to-change but positively related to self-enhancement and conservation values. However, no significant effects on any values were observed at the country level. Male sex, younger age, being single, and reporting higher COVID-19-related distress were significant burnout correlates. Burnout among psychotherapists may be a transcultural phenomenon, where individual differences among psychotherapists are likely to be more important than differences between the countries of their practice. This finding enriches the discussion on training in psychotherapy in an international context and draws attention to the neglected issue of mental health among psychotherapists in the context of their professional functioning.Peer reviewe

Subjective well-being among psychotherapists during the coronavirus disease pandemic : A cross-cultural survey from 12 european countries

Objective: The aim of this study is to examine the amount of the total variance of the subjective well-being (SWB) of psychotherapists from 12 European countries explained by between-country vs. between-person differences regarding its cognitive (life satisfaction) and affective components (positive affect [PA] and negative affect [NA]). Second, we explored a link between the SWB and their personal (self-efficacy) and social resources (social support) after controlling for sociodemographics, work characteristics, and COVID-19-related distress.Methods: In total, 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Satisfaction with Life Scale (SWLS), the International Positive and Negative Affect Schedule Short Form (I-PANAS-SF), the General Self-Efficacy Scale, and the Multidimensional Scale of Perceived Social Support.Results: Cognitive well-being (CWB; satisfaction with life) was a more country-dependent component of SWB than affective well-being (AWB). Consequently, at the individual level, significant correlates were found only for AWB but not for CWB. Higher AWB was linked to being female, older age, higher weekly workload, and lower COVID-19-related distress. Self-efficacy and social support explained AWB only, including their main effects and the moderating effect of self-efficacy.Conclusions: The results highlight more individual characteristics of AWB compared to CWB, with a more critical role of low self-efficacy for the link between social support and PA rather than NA. This finding suggests the need for greater self-care among psychotherapists regarding their AWB and the more complex conditions underlying their CWB.Peer reviewe

Patient and Public Involvement in Youth Mental Health Research: Protocol for a Systematic Review of Practices and Impact

Various health settings have advocated for involving patients and members of the public (PPI) in research as a means to increase quality and relevance of the produced knowledge. However, youth PPI has been an understudied area. This protocol paper describes a new project that aims to summarize what is known about PPI with young people in mental health research. In line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Statement guidelines we will identify and appraise suitable articles and extract and synthesize relevant information including at least two reviewers at each stage of the process. Results will be presented in two systematic reviews that will describe (a) how youth PPI has been conducted (Review1) and (b) what impact youth PPI had on the subsequent research and on stakeholders (Review2). To our knowledge, this is the first set of reviews that uses a critical appraisal tool, which is co-developed with children and young people. Findings from this project will provide valuable insights and set out the key steps to adopting adequate PPI methods when involving children and young people in mental health research

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study

Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study

Warmth and competence perceptions of key protagonists are associated with containment measures during the COVID-19 pandemic: Evidence from 35 countries

It is crucial to understand why people comply with measures to contain viruses and their effects during pandemics. We provide evidence from 35 countries (Ntotal = 12,553) from 6 continents during the COVID-19 pandemic (between 2021 and 2022) obtained via cross-sectional surveys that the social perception of key protagonists on two basic dimensions—warmth and competence—plays a crucial role in shaping pandemic-related behaviors. Firstly, when asked in an open question format, heads of state, physicians, and protest movements were universally identified as key protagonists across countries. Secondly, multiple-group confirmatory factor analyses revealed that warmth and competence perceptions of these and other protagonists differed significantly within and between countries. Thirdly, internal meta-analyses showed that warmth and competence perceptions of heads of state, physicians, and protest movements were associated with support and opposition intentions, containment and prevention behaviors, as well as vaccination uptake. Our results have important implications for designing effective interventions to motivate desirable health outcomes and coping with future health crises and other global challenges.publishedVersio

Academic model of trauma healing in post-war societies

Objective. The aim of this paper is to examine the implications for healing in a contemporary Balkan post-war context, and to provide a bridge-building model of trauma transformation, reconciliation and recovery through academic reconstruction and cross-border dialogue. Post-war societies are marked by the effects of massive, large group traumatization, and if not properly dealt with, long-term rehabilitation and social recovery cannot be expected. Unprocessed cumulative trauma that has become deeply embedded in the collective memory of the Balkan peoples over centuries, „chosen trauma“, its trans-generational transmission and periodical reactivations across the Balkan have often been addressed in recent literature, in ethno-psychology, psychoanalysis, psychiatry, sociology and anthropology. In order to deepen our understanding of the roots of collective (social) trauma and the specific traumatic experiences of different groups, and to offer different perspectives and information on how trauma can be dealt with, the “Trauma Trust Memory” multinational interdisciplinary research network is being established, and a groundbreaking workshop was held in May 2013 in Tuzla, Bosnia-Herzegovina. Conclusion. The Tuzla Workshop showed that the active participation of affected groups in adequate coping with the past is required for post-conflict reconstruction, trauma healing and peacebuilding in the long run

Changes to women’s childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study

A considerable number of women giving birth during COVID-19 pandemic reported being concerned about changes to their childbirth plans and experiences due to imposed restrictions. Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans. Therefore, this study aimed to examine if the mismatch between women’s planned birth and actual birth experiences during COVID-19 was associated with women’s postpartum PTSS. Women in the postpartum period (up to 6 months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors, and PTSS (PTSD checklist DSM-5 version) using self-report questionnaires (ClinicalTrials.gov: NCT04595123). More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans. All changes were significantly associated with PTSS scores. Participants with one and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes (Exp(β) = 1.12; 95% CI [1.06–1.19]; p < 0.001 and Exp(β) = 1.38; 95% CI [1.29–1.48]; p < 0.001). In addition, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida (Exp(β) = 0.86; 95% CI [0.77–0.97]; p = 0.014). Changes to women’s childbirth plans during the COVID-19 pandemic were common and associated with women’s postpartum PTSS score. Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health.Open access funding provided by FCT|FCCN (b-on). This publication is based upon work from COST Action Research Innovation and Sustainable Pan-European Network in Peripartum Depression Disorder (Riseup-PPD), CA18138 and DEVoTION: Perinatal Mental Health and Birth-Related Trauma: Maximising best practice and optimal outcomes, CA18211 both supported by COST (European Cooperation in Science and Technology). EPIUnit – UIDB/04750/2020, ITR – LA/P/0064/2020, and HEILab – UIDB/05380/2020 are supported by Portuguese fundings through FCT – Fundação para a Ciência e a Tecnologia, IP. RC has a postdoctoral grant supported by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016; RC postdoctoral fellowship). The work developed by ProChild CoLAB was supported by (i) NORTE-06-3559-FSE-000044, integrated in the invitation NORTE59-2018-41, aiming to hire Highly Qualified Human Resources, cofinanced by the Regional Operational Programme of the North 2020, thematic area of Competitiveness and Employment, through the European Social Fund (ESF) and (ii) Mission Interface Program from the Resilience and Recuperation Plan, notice nº 01/C05-i02 /2022, aiming to guarantee public core funding to strengthen the network of interface institutions, as defined in the legal regime in force, approved by DecreeLaw no. 63/2019, of May 16th, as well as in its 1st review on “Technology and Innovation Centres – CTI” and “Collaborative Laboratories – CoLABs,” approved by Decree-Law no. 126-B/2021, of December 31st. The Psychology Research Centre - CIPsi (PSI/01662), School of Psychology, University of Minho, was supported by the Foundation for Science and Technology (FCT) through the Portuguese State Budget (Ref.: UIDB/PSI/01662/2020). Bulgarian national data collection supported by national co-funding of COST Actions, № KP-06-KOST/14 from 16.12.2020, FNI. CAW is funded by the UK’s National Institute for Health and Care Research (NIHR) as an Academic Clinical Lecturer