The Reach, Use, and Impact of a Free mHealth Mindfulness App in the General Population: Mobile Data Analysis

Background As smartphones are now used by most Americans, it is increasingly possible for mental health mobile apps to be disseminated to the general public. However, little is known about how mobile mental health apps are used by the general population outside of a controlled research design. Objective Our objective is to describe how the general population engages with Mindfulness Coach, an iOS- and Android-based app designed to deliver a mindfulness training course. Methods Using anonymous download and analytics data, we characterized the reach, usage, retention, and impact of Mindfulness Coach. We included mobile analytics data from all unique downloads of Mindfulness Coach between August 1, 2018, and April 8, 2019 (N=104,067) as well as starred reviews from all Mindfulness Coach users who provided reviews of the app as of March 1, 2020. Mindfulness characteristics were measured by an in-app assessment using the Five-Facet Mindfulness Questionnaire–Short Form (FFMQ-SF). Results Users engaged, on average, in 4.3 visits to the app (SD 8.8; median 2; 90th percentile 8) and associated with an average total of 49.2 interactions with the app (ie, clicks within the app) (SD 113.8; median 19; 90th percentile 105). Users spent an average of 16.2 minutes (SD 63.1) engaged with the app over the full study time period. There were strong linear effects of app engagement on total FFMQ-SF scores. For example, FFMQ-SF scores were associated with more time spent engaged with the app (R2=.23; P<.001). Mindfulness Coach has been reviewed in the Google Play Store 3415 times, with an average rating of 4.7 out of 5 stars, and over 2000 times in the Apple App Store, with an average rating of 4.8 out of 5 stars. Conclusions These findings suggest that Mindfulness Coach has achieved substantial and sustained reach in the general population; however, it was used less frequently by many downloaders than researchers and designers intended. There was a subpopulation of users who engaged in the app regularly over an extended period of time, and there was a clear relationship between app use and improvements in mindfulness. To strengthen Mindfulness Coach’s public health impact, more research is needed to understand who is using the app and how, and to design strategies to increase user engagement in order for users to receive a larger dose of mindfulness treatment.

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The Reach, Use, and Impact of a Free mHealth Mindfulness App in the General Population: Mobile Data Analysis (Preprint)

10.2196/preprints.23377 ◽

2020 ◽

Author(s):

Elissa Kozlov ◽

Erin Bantum ◽

Ian Pagano ◽

Robyn Walser ◽

Kelly Ramsey ◽

...

Keyword(s):

Mental Health ◽

General Population ◽

Mobile Apps ◽

Short Form ◽

Extended Period ◽

Health Impact ◽

User Engagement ◽

Five Facet Mindfulness Questionnaire ◽

Design Strategies ◽

Average Rating

BACKGROUND As smartphones are now used by most Americans, it is increasingly possible for mental health mobile apps to be disseminated to the general public. However, little is known about how mobile mental health apps are used by the general population outside of a controlled research design. OBJECTIVE Our objective is to describe how the general population engages with Mindfulness Coach, an iOS- and Android-based app designed to deliver a mindfulness training course. METHODS Using anonymous download and analytics data, we characterized the reach, usage, retention, and impact of Mindfulness Coach. We included mobile analytics data from all unique downloads of Mindfulness Coach between August 1, 2018, and April 8, 2019 (N=104,067) as well as starred reviews from all Mindfulness Coach users who provided reviews of the app as of March 1, 2020. Mindfulness characteristics were measured by an in-app assessment using the Five-Facet Mindfulness Questionnaire–Short Form (FFMQ-SF). RESULTS Users engaged, on average, in 4.3 visits to the app (SD 8.8; median 2; 90th percentile 8) and associated with an average total of 49.2 interactions with the app (ie, clicks within the app) (SD 113.8; median 19; 90th percentile 105). Users spent an average of 16.2 minutes (SD 63.1) engaged with the app over the full study time period. There were strong linear effects of app engagement on total FFMQ-SF scores. For example, FFMQ-SF scores were associated with more time spent engaged with the app (R2=.23; P<.001). Mindfulness Coach has been reviewed in the Google Play Store 3415 times, with an average rating of 4.7 out of 5 stars, and over 2000 times in the Apple App Store, with an average rating of 4.8 out of 5 stars. CONCLUSIONS These findings suggest that Mindfulness Coach has achieved substantial and sustained reach in the general population; however, it was used less frequently by many downloaders than researchers and designers intended. There was a subpopulation of users who engaged in the app regularly over an extended period of time, and there was a clear relationship between app use and improvements in mindfulness. To strengthen Mindfulness Coach’s public health impact, more research is needed to understand who is using the app and how, and to design strategies to increase user engagement in order for users to receive a larger dose of mindfulness treatment.

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Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study (Preprint)

10.2196/preprints.27965 ◽

2021 ◽

Author(s):

Silvia Gabrielli ◽

Silvia Rizzi ◽

Giulia Bassi ◽

Sara Carbone ◽

Rosa Maimone ◽

...

Keyword(s):

Mental Health ◽

University Students ◽

Intervention Program ◽

Mental Health Problems ◽

Short Form ◽

User Engagement ◽

Proof Of Concept ◽

Five Facet Mindfulness Questionnaire ◽

Concept Study ◽

Concept Evaluation

BACKGROUND University students are increasingly reporting common mental health problems, such as stress, anxiety, and depression, and they frequently face barriers to seeking psychological support because of stigma, cost, and availability of mental health services. This issue is even more critical in the challenging time of the COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy-coping interventions by lowering cost and supporting prevention. OBJECTIVE The goal of this study was to conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, among a population of university students. METHODS In a proof-of-concept study, 71 university students were recruited during the COVID-19 pandemic; 68% (48/71) were female, they were all in their first year of university, and their mean age was 20.6 years (SD 2.4). Enrolled students were asked to use the Atena psychoeducational chatbot for 4 weeks (eight sessions; two per week), which provided healthy-coping strategies based on cognitive behavioral therapy, positive psychology, and mindfulness techniques. The intervention program consisted of conversations combined with audiovisual clips delivered via the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the Five-Facet Mindfulness Questionnaire (FFMQ) at baseline and postintervention to assess effectiveness. They were also asked to complete the User Engagement Scale–Short Form at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena postintervention. RESULTS Participants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. A total of 61 out of 71 (86%) participants completed the first 2 weeks of the intervention and provided data on engagement (10/71, 14% attrition). A total of 41 participants out of 71 (58%) completed the full intervention and the postintervention questionnaires (30/71, 42% attrition). Results from the completer analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t39=0.94; P=.009) and a decrease in stress symptoms as measured by the PSS-10 (t39=2.00; P=.05) for all participants postintervention. Participants also improved significantly in the describing and nonjudging facets, based on their FFMQ subscale scores, and asked for some improvements in the user experience with the chatbot. CONCLUSIONS This study shows the benefit of deploying a digital healthy-coping intervention via a chatbot to support university students experiencing higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions.

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Mindfulness in Motion for People with Multiple Sclerosis: A Feasibility Study

International Journal of MS Care ◽

10.7224/1537-2073.2015-095 ◽

2017 ◽

Vol 19 (5) ◽

pp. 225-231 ◽

Cited By ~ 9

Author(s):

Rachel M. Gilbertson ◽

Maryanna D. Klatt

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Multiple Sclerosis ◽

Mindfulness Meditation ◽

Short Form ◽

Physical Symptoms ◽

Future Research ◽

Five Facet Mindfulness Questionnaire ◽

Anxiety Depression

Background: Mindfulness in Motion is an 8-week mindfulness-based intervention that uses yoga movement, mindfulness meditation, and relaxing music. This study examined the feasibility of using Mindfulness in Motion in people with multiple sclerosis (MS) and the effect of this program on stress, anxiety, depression, fatigue, and quality of life in people with MS. Methods: Twenty-two people with MS completed the 8-week mindfulness program as well as assessments 1 week before and after the intervention. Results: Pre/post comparison of four self-reported questionnaires—the Mental Health Inventory, 36-item Short Form Health Status Survey, Modified Fatigue Impact Scale, and Five Facet Mindfulness Questionnaire—showed significant improvement in physical functioning, vitality, and mental health. Specifically, improvements were seen in anxiety, depression, and positive affect; cognitive, psychosocial, and overall functioning regarding fatigue; and mindfulness in the areas of observing, acting with awareness, nonjudgment, and nonreactivity. Conclusions: Due to the uncertainty in disease progression associated with MS, and the multiplicity of mental and physical symptoms associated with it, programming that addresses anxiety, depression, and fatigue is a key area of future research in MS disease management. Mindfulness in Motion proved to be a feasible program yielding positive results, supporting the need for research to determine the extent to which the program can improve quality-of-life outcomes for people with MS.

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Health and well being of lesbian, gay, bisexual, transgender and intersex people aged 50 years and over

Australian Health Review ◽

10.1071/ah16200 ◽

2018 ◽

Vol 42 (2) ◽

pp. 146 ◽

Cited By ~ 12

Author(s):

Mark Hughes

Keyword(s):

Mental Health ◽

Psychological Distress ◽

General Population ◽

Short Form ◽

Well Being ◽

Health Issues ◽

Physical And Mental Health ◽

Sexual Diversity ◽

Increased Risk ◽

Health And Well Being

Objectives The aim of the present study was to examine the health and well being of older lesbian, gay, bisexual, transgender and intersex (LGBTI) people, the health issues that concern them, the services they use and challenges accessing services. Methods This study comprised a survey of the health and well being of 312 LGBTI people aged 50 years and over in New South Wales. The survey included the Short-Form 12 (SF-12) measure of health-related quality of life, the Kessler 10 (K10) measure of psychological distress, and the three-item Loneliness Scale. Results Higher levels of psychological distress, lower mental health and greater loneliness were found among this sample than is typically found in the general population. Mental health was lower among carers and those not in a relationship, while psychological distress was greater among those living alone and those experiencing higher rates of loneliness. The most commonly accessed health service was a general practitioner (GP), with most respondents reporting that they were open about their sexuality to their GP and that they had a regular GP. Some reported difficulties accessing health services because of their gender or sexual diversity. Conclusions Although many older LGBTI people are well, both physically and mentally, they do appear to face increased risk of certain health issues compared with the general population. What is known about the topic? Overseas research indicates that older LGBTI people may be at greater risk of certain physical and mental health conditions than the general population. What does this paper add? This paper provides Australian data, using well-validated instruments, on the health and well being of older LGBTI people. It provides evidence of the health issues that older LGBTI people are most concerned about and the barriers they face in accessing services. What are the implications for practitioners? It is important for health practitioners to be aware that older LGBTI people appear to be at increased risk of certain physical and mental health issues, such as loneliness and psychological distress. Providing opportunities for clients to identify their gender or sexual diversity may assist in monitoring risk factors and enable referral to promote healthy aging.

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Mobile Apps that Promote Emotion Regulation, Positive Mental Health and Well-being in the General Population: Systematic Review and Meta-analysis (Preprint)

10.2196/preprints.31170 ◽

2021 ◽

Author(s):

Amelia Eisenstadt ◽

Shaun Liverpool ◽

Elisa Infanti ◽

Roberta Maria Ciuvat ◽

Courtney Carlsson

Keyword(s):

Mental Health ◽

Systematic Review ◽

Emotion Regulation ◽

General Population ◽

Mobile Apps ◽

Meta Analysis ◽

Well Being ◽

Positive Mental Health ◽

Risk Of Bias ◽

Health And Well Being

BACKGROUND Among the general public there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, a number of mental health apps (MHapps) are becoming available for monitoring, managing and promoting positive mental health and well-being. Thus far, the evidence supports positive outcomes when users engage with digital interventions. However, there is high variability in the theoretical base informing MHapps and the features incorporated. Such differences can have implications for the efficacy of the apps and the level of engagement among specific target population groups. Moreover, such heterogeneity may influence the extent to which the data from various MHapps can be pooled to assess the strength of the evidence. OBJECTIVE We aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness. METHODS A comprehensive literature search of key databases; MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL) was conducted until January 2021. Studies were included if they described standalone mental health and well-being apps for adults without a formal mental health diagnosis. All studies were quality assessed against the Mixed Methods Appraisal Tool. In addition, the Cochrane risk-of-bias tool (ROB-2) was used to assess randomized control trials (RCTs). Data were extracted using a modified extraction form the Cochrane Handbook of Systematic Reviews. A narrative synthesis and meta-analysis was then undertaken to address the review aims. RESULTS In total, 3156 abstracts were identified. Of these, 52 publications describing 48 MHapps met the inclusion criteria. Together the studies evaluated interventions across 15 countries. Thirty-nine RCTs were identified that suggested there is some support for the role of individual MHapps in improving and promoting mental health and well-being. Regarding pooled effect, MHapps, when compared to controls, showed a small effect for reducing mental health symptoms (k = 19, g = -0.24, 95% CI [-0.34, -0.14], p < .05) and improving well-being (k = 13, g = 0.17, 95% CI [0.05, 0.29], p < .05), and a medium effect for emotion regulation (k = 6, g = 0.49, 95% CI [0.23,0.74], p<.05). There is also a wide knowledge base of creative and innovative ways to engage users in techniques, such as mood monitoring and guided exercises. Mindfulness and Cognitive Behavioural approaches appear to be the most common among MHapp developers. Studies were generally assessed to contribute unclear or high risk of bias, or be of medium to low methodological quality. CONCLUSIONS The emerging evidence for MHapps that promote positive mental health and well-being continue to show some evidence of promise. Despite a wide range of MHapps, there are not many that specifically promote emotion regulation. However, our findings may position emotion regulation as an important mechanism for inclusion in future positive mental health and well-being MHapps. A fair proportion of the included studies were pilot or feasibility trials (k = 17, 33%), and full scale RCTs reported high attrition rates and non-diverse samples. Given the number and pace at which MHapps are being released, further robust research is warranted to inform the development and testing of evidence-based programs. CLINICALTRIAL Mia Eisenstadt, Elisa Infanti, Shaun Liverpool. Characteristics and effectiveness of mobile apps that promote emotion regulation and well-being in the general population: a systematic review protocol. PROSPERO 2020 CRD42020213051 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020213051

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Mental Health Impact of COVID-19 Pandemic on Health Care Workers in Ebonyi State, Southeast, Nigeria

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol05-i09/955 ◽

2020 ◽

Vol 5 (09) ◽

pp. 400-406

Author(s):

Okechukwu B. Anozie ◽

Johnbosco I. Nwafor ◽

Ephraim I. Nwokporo ◽

Chidi U. Esike ◽

Richard L. Ewah ◽

...

Keyword(s):

Mental Health ◽

Health Outcome ◽

Psychological Distress ◽

Healthcare Workers ◽

Short Form ◽

Health Impact ◽

Mental Health Outcome ◽

Mental Wellbeing ◽

Frontline Healthcare Workers ◽

The Impact

Background: Globally, mental health issues have become one of the predominant public health concerns as a result of the COVID-19 outbreak. The impact of COVID-19 pandemic on the mental health of frontline healthcare workers has not been fully described in Nigeria. Aim: To determine the mental health impact of COVID-19 pandemic and its associated factors among frontline healthcare workers in Ebonyi State, Nigeria. Materials and methods: This was an online cross-sectional study conducted among 315 frontline healthcare workers treating COVID-19 patients at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. The mental health outcome of the participants was assessed using the short form of the Mental Health Continuum (MHC-SF). Results: The prevalence of mental health outcome for different categories was 47% (n = 148) for flourishing, 28.3% (n = 89) for moderate and 24.7% (n = 78) for languishing mental health. The predictors of languishing mental health outcome were being married (OR = 3.12, 95%CI 1.67 - 4.09, p = 0.035), a physician (OR = 4.09, 95%CI 1.98 - 5.61, p = 0.002), a nurse (OR = 2.21, 95%CI 0.05 - 0.24, p < 0.001), limited access to personal protective equipment (OR = 3.25, 95%CI 1.62 - 6.22, p = 0.043) and self-isolation and quarantine due to SARS-CoV-2 infection (OR = 3.03, 95%CI 0.02 - 0.95, p < 0.001). Conclusion: Nigeria’s frontline healthcare workers, especially physicians and nurses, are experiencing COVID-19 related psychological distress. There is need to develop and implement interventions to reduce the impact of prolonged psychological distress on long-term mental wellbeing in healthcare workers treating COVID-19 patients.

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Use of Asynchronous Virtual Mental Health Resources for COVID-19 Pandemic–Related Stress Among the General Population in Canada: Cross-Sectional Survey Study (Preprint)

10.2196/preprints.24868 ◽

2020 ◽

Author(s):

Chris G Richardson ◽

Allie Slemon ◽

Anne Gadermann ◽

Corey McAuliffe ◽

Kimberly Thomson ◽

...

Keyword(s):

Mental Health ◽

General Population ◽

Minority Group ◽

Total Sample ◽

Health Impact ◽

Rapid Expansion ◽

Health Impacts ◽

Survey Study ◽

Cross Sectional ◽

Related Stress

BACKGROUND The COVID-19 pandemic has resulted in profound mental health impacts among the general population worldwide. As many in-person mental health support services have been suspended or transitioned online to facilitate physical distancing, there have been numerous calls for the rapid expansion of asynchronous virtual mental health (AVMH) resources. These AVMH resources have great potential to provide support for people coping with negative mental health impacts associated with the pandemic; however, literature examining use prior to COVID-19 illustrates that the uptake of these resources is consistently low. OBJECTIVE The aim of this paper is to examine the use of AVMH resources in Canada during the COVID-19 pandemic among the general population and among a participant subgroup classified as experiencing an adverse mental health impact related to the pandemic. METHODS Data from this study were drawn from the first wave of a large multiwave cross-sectional monitoring survey, distributed from May 14 to 29, 2020. Participants (N=3000) were adults living in Canada. Descriptive statistics were used to characterize the sample, and bivariate cross-tabulations were used to examine the relationships between the use of AVMH resources and self-reported indicators of mental health that included a range of emotional and coping-related responses to the pandemic. Univariate and fully adjusted multivariate logistic regression models were used to examine associations between sociodemographic and health-related characteristics and use of AVMH resources in the subgroup of participants who reported experiencing one or more adverse mental health impacts identified in the set of self-reported mental health indicators. RESULTS Among the total sample, 2.0% (n=59) of participants reported accessing AVMH resources in the prior 2 weeks to cope with stress related to the COVID-19 pandemic, with the highest rates of use among individuals who reported self-harm (n=5, 10.4%) and those who reported coping “not well” with COVID-19–related stress (n=22, 5.5%). Within the subgroup of 1954 participants (65.1% of the total sample) who reported an adverse mental health impact related to COVID-19, 54 (2.8%) reported use of AVMH resources. Individuals were more likely to have used AVMH resources if they had reported receiving in-person mental health supports, were connecting virtually with a mental health worker or counselor, or belonged to a visible minority group. CONCLUSIONS Despite substantial government investment into AVMH resources, uptake is low among both the general population and individuals who may benefit from the use of these resources as a means of coping with the adverse mental health impacts of the COVID-19 pandemic. Further research is needed to improve our understanding of the barriers to use.

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Mental Health Problems Among Whistleblowers: A Comparative Study

Psychological Reports ◽

10.1177/0033294118757681 ◽

2018 ◽

Vol 122 (2) ◽

pp. 632-644 ◽

Cited By ~ 4

Author(s):

Peter G. van der Velden ◽

Mauro Pecoraro ◽

Mijke S. Houwerzijl ◽

Erik van der Meulen

Keyword(s):

Mental Health ◽

General Population ◽

Comparative Study ◽

Mental Health Problems ◽

Short Form ◽

Health Problems ◽

Interpersonal Sensitivity ◽

General Mental Health ◽

Sleeping Problems ◽

Work Disabilities

Whistleblowers play a very important and indispensable role in society and health care sector, but their act may elicit retaliation and other negative effects, which may impact their mental health. The main aim of the present comparative study is to assess to what extent whistleblowers ( N = 27) more often suffer from severe mental health problems than other population-based groups in the Netherlands, i.e., matched controls ( N = 135), cancer patients ( N = 130), persons with (partial) work disabilities ( N = 194), physically “healthy” persons ( N = 200), and general population ( N = 1026), using the 36-Item Short-Form Health Survey scales (for general mental health) and the Symptom Checklist-90-Revised scales (for specific mental health problems: depression, anxiety, agoraphobia, interpersonal sensitivity and distrust, and sleeping problems). Logistic regression analyses showed that the prevalence of general mental health problems was much higher than among matched controls and people with work disabilities but similar to cancer patient when controlling for demographics. About 85% suffered from severe to very severe anxiety, depression, interpersonal sensitivity and distrust, agoraphobia symptoms, and/or sleeping problems, and 48% reached clinical levels of these specific mental health problems. These specific mental health problems were much more prevalent than among the general population.

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Mental Health Impact of COVID-19 pandemic

ANALES RANM ◽

10.32440/ar.2020.137.03.rev03 ◽

2020 ◽

Vol 137 (137(03)) ◽

pp. 276-280

Author(s):

María Inés López-Ibor Alcocer

Keyword(s):

Mental Health ◽

General Population ◽

Health Professionals ◽

Mental Health Problems ◽

Health Impact ◽

Mental Health Disorders ◽

Health Problems ◽

Principal Characteristics ◽

Health Disorders ◽

Healthy Persons

SRAS COV-19 pandemic will have an impact in mental health, for general population, for health professionals, and for those who had suffered infection and for people with previous mental health disorders. Mental health problems after in pandemic can be considered similar as those that happened in a disasters or catastrophes situations, natural or human being induce; one of the principal characteristics is that they affect healthy persons. Up to now, there are some studies that considered that the incidence of mental health problems will raised up to 30%, and therefore is very important identified risk population, and vulnerability and protection factors to give this people the attention needed.

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