Preference of Virtual Reality Game in Psychological Pressure and Depression Prevention: A Discrete Choice Experiment (Preprint)

BACKGROUND Virtual reality (VR) can be used to build many different scenes aimed at reducing study-related stress. However, few academic experiments about university students for preference testing have been done. Our study aimed to assess the preference of VR games for stress and depression prevention by using a discrete choice experiment (DCE). OBJECTIVE The candidate could wear the headset and alleviate the stress and depression in the game. The purpose of this experiment was to investigate the preference of VR technology in college students’ psychological pressure relief and depression prevention. METHODS Five different attributes were selected based on the depression therapy parameter and attributes about VR: (1) treatment modality, (2) therapy duration, (3) perceived remission rate, (4) probability of adverse events, and the (5) monthly cost of adding treatment to a discrete choice experiment. By comparing different attributes and levels, we could draw some conclusions about the depression therapy testing preference for university students. One university student was responsible for VR scene development and one for candidate recruitment. RESULTS The utility report of different attributes for “zero” probability of adverse events was higher than others (99.22), and the VR treatment as the most popular treatment method when compared with counseling and medicine treatment was 80.95. Three parameter aspects (different treatments for depression) were statistically significant (P＜0.001), including “0%” and “50%” of “Probability of adverse events” and “RMB$500” of “The monthly cost of treatment”. Most individuals preferred 12 months as the therapy duration, and the odds ratio of “12 months” was 1.095 (95% confidence interval [CI] 0.945–1.270) when compared with the reference of level of “6 months”. Meanwhile, the cheapest price (RMB $500) of depression therapy was the optimum choice for most students. CONCLUSIONS People placed great preference on VR technology psychological intervention methods, which indicates that VR may have a potential market in prevention and treatment of psychological problems. However, adverse events and treatment costs need to be considered. This study can be used to guide policies that are relevant to the development of application of VR technology in the field of psychological pressure and depression prevention. INTERNATIONAL REGISTERED REPORT RR2-doi:10.2196/29375

Adaptation of an Evidence-Based Online Depression Prevention Intervention for College Students: Intervention Development and Pilot Study Results

College and university students across the United States are experiencing increases in depressive symptoms and risk for clinical depression. As college counseling centers strive to address the problem through wellness outreach and psychoeducation, limited resources make it difficult to reach students who would most benefit. Technology-based prevention programs have the potential to increase reach and address barriers to access encountered by students in need of mental health support. Part 1 of this manuscript describes the development of the Willow intervention, an adaptation of the technology-based CATCH-IT depression prevention intervention using a community participatory approach, for use by students at a women’s liberal arts college. Part 2 presents data from a pilot study of Willow with N = 34 (mean age = 19.82, SD = 1.19) students. Twenty-nine participants (85%) logged onto Willow at least once, and eight (24%) completed the full intervention. Participants positively rated the acceptability, appropriateness, and feasibility of Willow. After eight weeks of use, results suggested decreases in depressive symptoms (95% CI (0.46–3.59)), anxiety symptoms (95% CI (0.41–3.04)), and rumination (95% CI (0.45–8.18)). This internet-based prevention intervention was found to be acceptable, feasible to implement, and may be associated with decreased internalizing symptoms.

Randomized Clinical Trial of Primary Care Based Online Depression Prevention Intervention: Impact on Adolescent Modifiable Factors and Behaviors

The developmental period of adolescence can pose a risk for the onset of depressive disorders, but is also a time when potentially modifiable factors and behaviors related to depressive episode onset can develop. An online health intervention can provide an opportunity to reach at-risk adolescents in between primary care visits and could impact these modifiable factors and behaviors to support healthy development. We explore the Competent Adulthood Transition with Cognitive-Behavioral, Humanistic, and Interpersonal Therapy (CATCH-IT), a self-directed online cognitive behavioral therapy prevention intervention, and its impact on modifiable factors and behaviors related to: (1) program completion, (2) normative adolescent development, (3) coping, (4) family relations, (5) general health behaviors, and (6) externalizing behaviors, in a primary care sample of adolescents at intermediate to high risk of developing depression. Adolescents were enrolled into either CATCH-IT or Health Education (HE) control group and followed for 24 months. CATCH-IT improved some factors related to program completion (e.g., motivation, recommendation to peers for depression prevention, and physician positive relationship), coping (e.g., perceived behavior change), and family relations (e.g., parental psychological control, sibling relative status) as compared to HE. HE improved normative adolescent development (e.g., health and loss life events) as compared to CATCH-IT. CATCH-IT utilized in primary care may benefit some at-risk adolescents in selective factors and behaviors.

The Effects of a Community-Based, Multicomponent, Depression Prevention Intervention in Mothers At-Risk

The purpose of this study was to develop a 12-week multicomponent, depression prevention pilot intervention and evaluate its feasibility and preliminary effects on improving levels and correlates of depressive symptoms, including anger, self-esteem perceived stress, social support, and racism. A quasi-experimental, mixed-methods design and a community-based participatory research (CBPR) approach was employed. University faculty, students and community residents collaborated at a low-income housing complex in a low-resourced, urban community. Fifteen low-income, ethnic minority mothers ages 23–46 years completed the intervention and evaluation surveys. Eight mothers participated in a focus group. The intervention included social group-dance, health education, and socialization. t-Tests, sign-tests, and thematic analysis was employed. Mothers identified barriers and facilitators of program engagement. Depressive symptoms were significantly reduced ( t(14) = 2.41, p = .030). Self-esteem ( t(14) = 2.28, p = .039) and social support levels ( M = 4.5, p = .035) were significantly increased. This multicomponent intervention is feasible. Preliminary efficacy evidence was mixed.

The Role of Human Support on Engagement in an Online Depression Prevention Program for Youth

Background: Depression is a significant public health problem for adolescents. The goal of this study was to evaluate the moderating role of human support in an online depression prevention program on both depression outcomes and overall engagement with the intervention. CATCH-IT is an Internet-based depression prevention program that has been shown to reduce symptoms for adolescents who report elevated depression symptom scores, compared to a health education (HE) control group. Participants in the CATCH-IT arm received human support (e.g., motivational interviewing, completed contacts). This study analyzes the moderating role of human support on depressive outcomes and engagement, and examines if engagement predicts depression outcomes. Methods: This secondary analysis consists of a randomized controlled trial for adolescents assigned to the CATCH-IT group. Mixed effects modeling, general linear models, and an exploratory multiple linear regression were used to explore the moderating relationship of human support between intervention and overall engagement. Study variables included depression outcomes (e.g., Center for Epidemiological Studies Depression Scale (CESD)), engagement components (e.g., modules completed, time on the site, and characters typed) and human support (e.g., motivational interviews and completed contacts.) Results: Results showed no significant relationship between contacts, motivational interviews, and depression scores. However, motivational interviews increased engagement with the intervention, such that those who received more motivational interviews completed significantly more modules, spent more time on the site, and typed more characters (p < 0.05). The number of contacts increased engagement with the intervention, and those who received more contacts spent more time on the site and typed more characters (p < 0.05). Exploratory multiple linear regression modeling demonstrated that male, African American/Black, and Hispanic/Latinx users were less engaged compared to other users. Lastly, engagement was not a significant predictor of depression outcomes (p > 0.05). Conclusions: The efficacy of CATCH-IT is not better explained by the degree to which participants received doses of human support from providers during the use of this online intervention. This may reveal the high potential of effective online interventions without the blended integration of human support for adolescents. To increase engagement of adolescents with an online depression prevention program, human support may be more efficient when utilizing MI rather than technical support.

Barriers to the Use of Web-Based Mental Health Programs for Preventing Depression: Qualitative Study

Background Depression has a profound impact on population health. Although using web-based mental health programs to prevent depression has been found to be effective in decreasing depression incidence, there are obstacles preventing their use, as reflected by the low rates of use and adherence. Objective The aims of the study are to understand the barriers to using web-based mental health programs for the prevention of depression and the possible dangers or concerns regarding the use of such programs. Methods BroMatters and HardHat were two randomized controlled trials (RCTs) that evaluated the effectiveness of e–mental health programs for preventing workplace depression. In the BroMatters RCT, only working men who were at high risk of having a major depressive episode were included. The participants were assigned to either the control group or 1 of 2 intervention groups. The control participants had access to the general depression information on the BroMatters website. Intervention group 1 had access to BroMatters and BroHealth—the depression prevention program. Intervention group 2 had access to BroMatters and BroHealth along with weekly access to a qualified coach through telephone calls. The HardHat trial targeted both men and women at high risk of having a major depressive episode. The participants in the intervention group were given access to the HardHat depression prevention program (which included a web-based coach), whereas HardHat access was only granted to the control group once the study was completed. This qualitative study recruited male participants from the intervention groups of the two RCTs. A total of 2 groups of participants were recruited from the BroMatters study (after a baseline interview: n=41; 1 month after the RCT: n=20; 61/744, 8.2%), and 1 group was recruited from the HardHat RCT 1 month after the initial quantitative interview (9/103, 8.7%). Semistructured interviews were performed with the participants (70/847, 8.3%) and analyzed using content analysis. Results There were both personal and program-level barriers to program use. The three personal barriers included time, stress level, and the perception of depression prevention. Content, functionality, and dangers were the program-level barriers to the use of web-based mental health programs. Large amounts of text and functionality issues within the programs decreased participants’ engagement. The dangers associated with web-based mental health programs included privacy breaches and inadequate help for severe symptoms. Conclusions There are personal and program-level barriers to the use of web-based mental health programs. The stigmatization of help seeking for depression symptoms affects the time spent on the program, as does the public perception of depression. Certain barriers may be mitigated by program updates, whereas others may require a complete shift in the perception of depression prevention.