scholarly journals A Feasibility Study of the WHO Digital Mental Health Intervention Step-by-Step to Address Depression Among Chinese Young Adults

2022 ◽  
Vol 12 ◽  
Author(s):  
Hao Fong Sit ◽  
Ieng Wai Hong ◽  
Sebastian Burchert ◽  
Elvo Kuai Long Sou ◽  
Mek Wong ◽  
...  
Keyword(s):  
Mental Health ◽  
Young Adults ◽  
Symptom Severity ◽  
Large Scale ◽  
Anxiety Symptom ◽  
Dropout Rate ◽  
Mental Health Intervention ◽  
Potential Effectiveness ◽  
Chinese University ◽  
Chinese Young Adults

Background: Chinese young adults experience barriers to mental health treatment, including the lack of treatment providers and stigma around treatment seeking. Evidence-based digital mental health interventions are promising and scalable alternatives to face-to-face treatment for this population, but lack rigorous evidence to support scale-up in China.Aim: The study was a feasibility study for a large-scale RCT of Step-by-Step, a behavioral activation-based, mental health intervention to address depression and anxiety symptoms in Chinese young adults. It sought to assess feasibility of recruitment and of delivery of Step-by-Step in a University setting, to assess acceptability of the intervention, and to examine potential effectiveness.Method: An uncontrolled, feasibility trial was conducted to assess the feasibility and acceptability of Chinese Step-by-Step for Chinese University students with elevated depressive symptoms (PHQ-9 scores at or above 10) in Macao, China. Data was collected at two different time points (i.e., baseline and 8-weeks after baseline), administered via questionnaires embedded in an interventional mobile application. Participation rate and dropout rate were measured. Depressive and anxiety symptom severity, well-being, and self-defined stress were assessed. Satisfaction with the program was assessed using qualitative interviews.Results: A total of 173 students were screened, 22.0% (n = 38) were eligible, and 63.2% of them (n = 24) started the intervention. The dropout rate by post-test was 45.8%. Results from completers showed that Step-by-Step was potentially effective in reducing depressive and anxiety symptom severity, and self-defined stress. Students were generally satisfied with the program, but also offered suggestions for continued improvement. Qualitative feedback was reported within the RE-AIM framework, covering recruitment, effectiveness, adoption, implementation, and maintenance. Amendments to the program were made according to the feedback (e.g., adding notification for new session, modify the time zone).Conclusion: A minimally guided Step-by-Step protocol and the study procedure were successfully pilot tested for use for Chinese University students. The intervention was acceptable and no adverse events were reported. The results support the potential effectiveness and feasibility of a large-scale evaluation of the program.

cThe Cultural Adaptation of Step-by-Step: An intervention to address depression among Chinese young adults (Preprint)

2020 ◽  
Author(s):  
Hao Fong Sit ◽  
Rui Ling ◽  
Agnes Iok Fong Lam ◽  
Wen Chen ◽  
Brian Hall
Keyword(s):  
Mental Health ◽  
Young Adults ◽  
Cultural Adaptation ◽  
Ecological Validity ◽  
Health Intervention ◽  
Health Interventions ◽  
Content Adaptation ◽  
Mental Health Intervention ◽  
Mental Health Interventions ◽  
Chinese Young Adults

BACKGROUND Digital mental health interventions leverage digital communication technology to address the mental health needs of populations. Culturally adapting interventions can lead to a successful scalable mental health intervention implementation, and cultural adaptation of digital mental health interventions is a critical component to implementing interventions at scale within contexts where mental health services are not well supported. OBJECTIVE The study aims to describe the cultural adaptation of a digital mental health intervention Step-by-Step in order to address depression among Chinese young adults. METHODS Cultural adaptation was carried out in four phases following Ecological Validity Model: 1) Stage setting and expert consultation; 2) Preliminary content adaptation; 3) Iterative content adaptation with community members; 4) Finalized adaptation with community feedback meetings. Cognitive interviewing was applied to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Six mental health experts and 34 Chinese young adults were recruited for key informant interviews and focus group discussions. RESULTS We adapted the text and illustrations to fits the culture among Chinese young adults. Eight elements of the intervention were chosen as the targets of cultural adaptation (e.g., language, metaphors, content). Samples of major adaptations included: adding scenarios related to university life (relevance), changing leading characters from a physician to a peer and a cartoon (acceptability), incorporating two language versions (traditional Chinese and simplified Chinese) in the intervention (comprehensibility), and maintaining fundamental therapeutic components (completeness). CONCLUSIONS This study showed the utility of using Ecological Validity Model and a four-point procedure framework for cultural adaptation and achieved a culturally appropriate version of the Step-by-Step program for Chinese young adults.

Randomized controlled trial of digital cognitive behavior therapy for prenatal insomnia symptoms: Effects on postpartum insomnia and mental health

SLEEP ◽  
2021 ◽  
Author(s):  
Jennifer N Felder ◽  
Elissa S Epel ◽  
John Neuhaus ◽  
Andrew D Krystal ◽  
Aric A Prather
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Symptom Severity ◽  
Standard Care ◽  
Anxiety Symptom ◽  
Controlled Trial ◽  
Cognitive Behavior ◽  
Insomnia Symptom

Abstract Study objectives To evaluate the effects of digital cognitive behavior therapy for insomnia (dCBT-I) delivered during pregnancy on subjective sleep outcomes, depressive symptoms, and anxiety symptoms through six months postpartum. Methods People up to 28 weeks gestation (N=208) with insomnia were randomized to six weekly sessions of dCBT-I or standard care. We report follow-up data at three and six months postpartum. The primary outcome was insomnia symptom severity. Secondary sleep outcomes included global sleep quality and insomnia caseness. Mental health outcomes included depressive and anxiety symptom severity. We evaluated between-condition differences in change from baseline for each postpartum timepoint and categorical outcomes. Results dCBT-I participants did not experience significantly greater improvements in insomnia symptom severity relative to standard care participants, but they did experience higher rates of insomnia remission and lower rates of insomnia caseness at six months postpartum. dCBT-I participants experienced greater improvements in depressive symptom severity from baseline to both postpartum timepoints, and in anxiety symptom severity from baseline to three months postpartum. The proportion of participants with probable major depression at three months postpartum was significantly higher among standard care (18%) than dCBT-I (4%, p=.006) participants; this between-condition difference was pronounced among the subset (n=143) with minimal depressive symptoms at baseline (18% vs 0%). Conclusion dCBT-I use during pregnancy leads to enduring benefits for postpartum insomnia remission. Findings provide strong preliminary evidence that dCBT-I use during pregnancy may prevent postpartum depression and anxiety, which is notable when considering the high frequency and importance of these problems.

scholarly journals The Impacts of Air Pollution on Mental Health: Evidence from the Chinese University Students

2020 ◽  
Vol 17 (18) ◽  
pp. 6734
Author(s):  
Daqing Zu ◽  
Keyu Zhai ◽  
Yue Qiu ◽  
Pei Pei ◽  
Xiaoxian Zhu ◽  
...  
Keyword(s):  
Mental Health ◽  
Air Pollution ◽  
Air Quality ◽  
University Students ◽  
Large Scale ◽  
Mental Health Problems ◽  
Depression Scale ◽  
Health Problems ◽  
Chinese University ◽  
The Impact

A growing number of developing countries have experienced worsening air pollution, which has been shown to cause significant health problems. However, few studies have explored the impact of air pollution on the mental health of university students, particularly in the Chinese context. In order to address this gap, through a large-scale cross-sectional survey, this study aims to examine the effects of air pollution on final-year Chinese university undergraduates’ (due to graduate in 2020) mental health by employing multivariable logistic regression. Our findings show that, first, although normal air quality is not strongly associated with lower levels of negative mental health, there is a strong link between poor air quality and higher levels of negative mental health. More specifically, life satisfaction hedonic unhappiness and depression measured by the Centre for Epidemiological Studies’ Depression scale (CES-D) are statistically associated with air pollution. In addition, we also found that gender is a significant factor, as males had more than 1.6 times greater odds of increased mental health problems compared to their female counterparts. Place of birth also plays a significant role in participants’ mental health. Moreover, undergraduates with urban household registration experienced significant levels of hedonic unhappiness and depression on the CES-D scale. Finally, we found that there is an association between respondents’ economic situation and their mental health too. Overall, this study contributes to the research on air pollution management and mental health intervention, particularly in relation to student groups. The undergraduate curriculum should provide more guidance and suggestions on promoting mental health and establishing positive attitudes to life and academic study of the final year students, under the context of air pollution in China.

scholarly journals Childhood Adversity, Resilience, and Mental Health: A Sequential Mixed-Methods Study of Chinese Young Adults

2019 ◽  
pp. 088626051987603
Author(s):  
G. W. K. Ho ◽  
A. C. Y. Chan ◽  
M. Shevlin ◽  
T. Karatzias ◽  
P. S. Chan ◽  
...  
Keyword(s):  
Mental Health ◽  
Young Adults ◽  
Mixed Methods ◽  
Posttraumatic Stress ◽  
Protective Factor ◽  
Mental Health Problems ◽  
Health Problems ◽  
Stress Disorders ◽  
Mixed Methods Design ◽  
Chinese Young Adults

Resilience is a key health protective factor for those with adverse childhood experiences (ACEs), but little research has explored how it manifests in early adulthood or across cultures. The purpose of this study was to generate a fuller understanding of resilience and its contribution to the relationships between mental health problems and ACEs among Chinese young adults in Hong Kong. Using a sequential explanatory mixed-methods design, 433 Chinese young adults aged 18 to 24 years were surveyed online to examine the relationships between ACEs, resilience, and mental health problems (depression, anxiety, maladjustment, and posttraumatic stress symptoms). Among them, 34 participants with ACEs were purposively selected and interviewed to explore cultural factors that influenced their resilience. Quantitative data were analyzed using multiple hierarchical regression analyses; qualitative data were analyzed using a qualitative descriptive approach. Higher cumulative ACE exposure was associated with higher severity of adjustment disorder and odds for screening positive for posttraumatic stress disorders, but not for symptoms of depression or anxiety. Resilience significantly contributed to explaining variances across all mental health outcomes over and beyond ACEs and in a protective fashion. Four themes emerged from qualitative interviews: (a) Privacy, emotional restraint, and “saving face”; (b) Conforming to preserve harmony; (c) A will to excel; and (d) Viewing adversity as a matter of luck. These findings suggest Chinese young adults’ resilience was influenced by cultural norms of restraint, conformity, competition, and superstition. The present study provides a model for future studies using a mixed-methods design to deeply examine resilience among younger people exposed to early adversities within sociocultural, historical, or geographical contexts.

The influence of social support, conflict, and stressful life events on PTSD, depression, and anxiety symptom severity in U.S. army female veterans

2011 ◽  
Vol 26 (S2) ◽  
pp. 1678-1678
Author(s):  
A.M. Nayback-Beebe
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Life Events ◽  
Symptom Severity ◽  
Anxiety Symptom ◽  
Stressful Life Events ◽  
Stressful Life ◽  
Female Veterans ◽  
Depression And Anxiety ◽  
The Social

IntroductionThere have been prevailing gender differences in negative mental health outcomes for female U.S. veterans returning from combat deployments. Research has validated the importance of post-deployment social support in mitigating the effects of these experiences on mental health; however, the influence of conflict within the social network has not been thoroughly explored.Aims(1)Examine the relationships between social support, conflict, and stressful life events to PTSD, depression, and anxiety symptom severity in female veterans 6–12 months after deployment.(2)Determine whether the absence of social support or the presence of social conflict is more influential in the severity of these symptoms.MethodsDescriptive, correlationalResultsThere were significant positive bivariate correlations (p < .01) between conflict and stressful life events and significant negative bivariate correlations (p < .01) between social support and each of the three outcome variables: PTSD, depression, and anxiety symptoms. Hierarchical linear regression showed that co-morbid depression, greater post-deployment stressful life events, and greater conflict within the social network best explained the presence of greater PTSD symptom severity. Stressful life events did not contribute to greater anxiety symptom severity; however, symptom severity was affected by the absence of social support. In contrast, greater depression symptom severity was best explained by the presence of co-morbid PTSD symptoms and the absence of social support.ConclusionsTreatment programs for PTSD and anxiety in female veterans’ post-deployment must assess and address sources of intrapersonal conflict within their social networks. Family therapy may be integral to treatment success.

scholarly journals Digital phenotyping of complex psychological responses to the COVID-19 pandemic

2020 ◽  
Author(s):  
Thomas Hull ◽  
Jacob Levine ◽  
Niels Bantilan ◽  
Angel Desai ◽  
Maimuna S. Majumder
Keyword(s):  
Mental Health ◽  
Large Scale ◽  
Anxiety Symptom ◽  
The United States ◽  
Anxiety Symptoms ◽  
Response To Treatment ◽  
Depression Symptom ◽  
Depression And Anxiety ◽  
Psychological Reactions ◽  
Symptom Scores

Background: The novel coronavirus disease 2019 (COVID-19) has negatively impacted mortality, economic conditions, and mental health. A large scale study on psychological reactions to the pandemic to inform ongoing population-level symptom tracking and response to treatment is currently lacking.Methods: Average intake scores for standard depression and anxiety symptom scales were tracked from January 1, 2017 to June 9, 2020 for patients seeking treatment from a digital mental health service to gauge the relationship between COVID-19 and self-reported symptoms. We applied natural language processing (NLP) to unstructured therapy transcript data from patients seeking treatment during the height of the pandemic in the United States between March 1, 2020 and June 9, 2020 to identify words associated with COVID-19 mentions. This analysis was used to identify symptoms that were present beyond those assessed by standard depression and anxiety measures.Results: Depression and anxiety symptoms reported by 169,889 patients between January 1, 2017 and June 9, 2020 were identified. There was no detectable change in intake depression symptom scores. Intake anxiety symptom scores increased 1.42 scale points [95% CI: 1.18, 1.65] between March 15, 2020 and April 1, 2020, when scores peaked. In the transcript data of these 169,889 patients, plus an expanded sample of 49,267 patients without symptom reports, term frequency-inverse document frequency (tf-idf) identified 2,377 positively correlated and 661negatively correlated terms that were significantly (FDR&lt;.01) associated with mentions of the virus. These terms were classifiable into 24 symptoms beyond those included in the diagnostic criteria for anxiety or depression.Conclusions: The COVID-19 pandemic may have increased intake anxiety symptoms for individuals seeking digital mental health treatment. NLP analyses suggest that standard symptom scales for depression and anxiety alone are inadequate to fully assess and track psychological reactions to the pandemic. Symptoms of grief, trauma, obsession-compulsion, agoraphobia, hypochondriasis, panic, and non- suicidal self-injury should be monitored as part of a new COVID-19 Syndrome category.

scholarly journals The Geographic Distribution of Mental health among Chinese Young Adults: A Nationwide Survey during COVID-19 Pandemic (Preprint)

2020 ◽  
Author(s):  
Fangbiao Tao ◽  
Xiaoyan Wu ◽  
Shuman Tao ◽  
Yi Zhang ◽  
Shiyue Li ◽  
...  
Keyword(s):  
Mental Health ◽  
College Students ◽  
Young Adults ◽  
Perceived Risk ◽  
Mental Health Problems ◽  
Geographic Location ◽  
Health Problems ◽  
Depression Symptoms ◽  
Risk Of Infection ◽  
Chinese Young Adults

BACKGROUND Since the outbreak of novel coronavirus disease 2019 (COVID-19), mental health problems among young adults are concerned OBJECTIVE We assess the prevalence of mental health problems and examine their associations with geographic location METHODS A nationwide cross-sectional survey was conducted in 16 provinces and autonomous regions among Chinese college students from Feb 4 to Feb 12, 2019. An online survey was adopted to collect information including demographics, perceived risk of infection, attitudes toward epidemic and control, and mental health status. Depression symptoms and anxiety were assessed by scales. A total of 11 787 participants were involved in the current study. A Chi-square test was used to compare the percentage of the perceived risk of infection and attitude toward COVID-19 between different geographic locations. The binary logistic models were used to identify associations between associations of geographic location and mental health problems after controlling for covariates RESULTS The prevalence of anxiety, depression symptoms were 17.8% and 25.9% for college students. After controlling for covariates, current living or college geographic location in Wuhan was positively associated with anxiety symptoms (OR=1.38, 95%CI: 1.12-1.69; OR=1.17, 95%CI: 1.03-1.32) and depression symptoms (OR=1.32, 95%CI: 1.10-1.59; OR=1.16, 95%CI: 1.04-1.30) compared with other areas. Living or travel history in Wuhan in the latest month was also positively associated with anxiety symptoms (OR=1.65, 95%CI: 1.49-1.83) and depression symptoms (OR=1.51, 95%CI: 1.34-1.6). CONCLUSIONS Mental health problems are prevalent in Chinese young adults vary geographically during the COVID-19 pandemic. Our results provide further insight into developing targeted intervention strategies

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