Digital Health Digest: Curated Weekly by Dr. Jennifer Joe - Mental Health

I'm delighted to be serving as the Chief Ambassador for JMIR, and hope that these weekly postings highlight interesting evidence-based medicine for my digital health readers.

I used to open this saying that JMIR Publications is the leading peer-reviewed journal for digital medicine and health and health care in the internet age because of our Impact Factor of 5.03. I'm now delighted to announce that our Impact Factor has increased in 5.43. Additionally relevant to this week's blog, JMIR Mental Health (IF 4.39) saw the largest increase in Impact Factor - an impressive 24% increase on its inaugural score.?

This week, my MedTech Insights and co-host Harvard Professor Ami Bhatt, MD, and I had a very thoughtful interview with Sonia Tita Puopolo, Co-Founder and CEO at Wellness World USA, about the importance of wellness, selfcare, and healing as we all come out of the recent pandemic together. The conclusion was that COVID-19 pushed the healthcare and greater community to explore new and different forms of communications, and that digital tools can provide the mental health support to a larger audience in perhaps a more intimate and easy to access form.

Because of the important topic and the nice growth in data, this week's blog highlights the latest peer-reviewed, evidence-based research supporting the use of digital tools for mental health.

1. Gaming Your Mental Health: A Narrative Review on Mitigating Symptoms of Depression and Anxiety Using Commercial Video Games from lead author, Mark Campbell, BA, GDip, PhD, [email protected] (University of Limerick in Limerick, Ireland) - The authors highlight that depression and anxiety are the two most prevalent mental health disorders globally, and the COVID-19 pandemic has exacerbated the need for accessible and cost-effective methods for coping with mental illness. The authors review and consolidate the current scientific evidence for "playing commercial video games to address symptoms of depression and anxiety," and conclude that "commercial video games show great promise as inexpensive, readily accessible, internationally available, effective, and stigma-free resources for the mitigation of some mental health issues in the absence of, or in addition to, traditional therapeutic treatments." Table 1 below highlights the commercial video game reviewed, the mental health aspect addressed, and the scientific data supporting it. JMIR Serious Games 2021;9(2):e26575

2. Acceptability and Effectiveness of Artificial Intelligence Therapy for Anxiety and Depression (Youper): Longitudinal Observational Study from lead author Ashish Mehta, BA, [email protected] (Stanford University in Stanford, California, USA) - Looking at Youper, a widely used, commercially available mobile app that uses artificial intelligence therapy for the treatment of anxiety and depression, the authors examined data from 4,517 paying Youper users and found that both anxiety and depression symptoms decreased in the first 2 weeks of app use (anxiety: d=0.57; depression: d=0.46). The authors conclude that Youper "is a low-cost, completely self-guided treatment that is accessible to users who may not otherwise access mental health care." They propose that the next step in gathering further data is a randomized clinical trial. J Med Internet Res 2021;23(6):e26771

3. Time to Change for Mental Health and Well-being via Virtual Professional Coaching: Longitudinal Observational Study from lead author Alexis M Jeannotte, BS, PhD, [email protected] (BetterUp Inc, San Francisco, California, USA) - The authors looked at the use of BetterUp, a "coaching platform that offers personalized, professional coaching to employees to improve mental health and well-being," in 391 participants who had completed at least 8 virtual coaching sessions or more, and evaluated them across 9 components of mental health and psychological well-being. The authors found "initial rapid improvements in the first half of the intervention, followed by slower growth in the second half of the intervention" in the areas of "prospection ability, self-awareness, self-efficacy, social connection, emotional regulation, and a reduction in stress (range of unstandardized β values for each assessment: .10-.19)."?The authors concluded that the results "demonstrate the effectiveness of BetterUp virtual one-on-one coaching to improve psychological well-being, while mitigating threats to mental health such as excessive and prolonged stress, low resilience, and poor satisfaction with life." J Med Internet Res 2021;23(7):e27774

4. Effects of Mobile App–Based Intervention for Depression in Middle-Aged and Older Adults: Mixed Methods Feasibility Study from lead author Christine E Gould, PhD, [email protected] (VA Palo Alto Health Care System in Palo Alta, California, USA - In this pilot study, the authors examine the efficacy of the Meru Health Program, an 8-week mobile app-delivered intervention, in 20 community-dwelling middle-aged and older adults (mean age 61 years). "The app was rated as helpful by 89% (17/19) participants. Significant decreases in depressive (P=.03) and anxiety symptom measures (P=.01) were found; 45% (9/20) of participants showed clinically significant improvement in either depressive symptoms or anxiety symptoms." The authors conclude that the commercially available Meru Health Program may be "beneficial to middle-aged and older adults." JMIR Form Res 2021;5(6):e25808

5. Effectiveness and Acceptance of Technology-Based Psychological Interventions for the Acute Treatment of Unipolar Depression: Systematic Review and Meta-analysis from lead author, Moritz K?hnen, MSc, [email protected] (University Medical Center Hamburg–Eppendorf in Hamburg, Germany) - The authors reviewed 15,546 records across numerous clinical trial and scientific literature databases where they investigated 78 studies that met their criteria of reviewing the evidence of "technology-based psychological interventions (TBIs) for the acute treatment of depression." "TBIs delivered as stand-alone interventions showed positive effects on posttreatment depression severity when compared to treatment as usual (SMD –0.44, 95% CI –0.73 to –0.15, k=10; I2=86%), attention placebo (SMD –0.51, 95% CI –0.73 to –0.30; k=12; I2=66%), and waitlist controls (SMD –1.01, 95% CI –1.23 to –0.79; k=19; I2=73%). Superior long-term effects on depression severity were shown when TBIs were compared to treatment as usual (SMD –0.24, 95% CI –0.41 to –0.07; k=6; I2=48%) attention placebo (SMD –0.23, 95% CI –0.40 to –0.07; k=7; I2=21%) and waitlist controls (SMD –0.74, 95% CI –1.31 to –0.18; k=3; I2=79%). TBIs delivered as blended treatments (providing a TBI as an add-on to face-to-face treatment) yielded beneficial effects on posttreatment depression severity (SMD –0.27, 95% CI –0.48 to –0.05; k=8; I2=53%) compared to face-to-face treatments only. Additionally, TBIs delivered within collaborative care trials were more effective in reducing posttreatment (SMD –0.20, 95% CI –0.36 to –0.04; k=2; I2=0%) and long-term (SMD –0.23, 95% CI –0.39 to –0.07; k=2; I2=0%) depression severity than usual care." The authors conclude that "TBIs are effective not only when delivered as stand-alone interventions but also when they are delivered as blended treatments or in collaborative care trials for people with diagnosed depression."?J Med Internet Res 2021;23(6):e24584

I hope this latest summary will excite you over the ability of digital tools and commercial products and games to close the gap in healthcare disparities and allow a larger group of people to access the care they net.

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