Mobile interventions targeting common mental disorders among pregnant and postpartum women: An equity-focused systematic review

Introduction Pregnant and postpartum women face major psychological stressors that put them at higher risk of developing common mental disorders, such as depression and anxiety. Yet, their limited access to and uptake of traditional mental health care is inequitable, especially during the COVID-19 pandemic. Mobile interventions emerged as a potential solution to this discontinued healthcare access, but more knowledge is needed about their effectiveness and impact on health equity. This equity-focused systematic review examined the effectiveness and equity impact of mobile interventions targeting common mental disorders among pregnant and postpartum women. Methods and results We systematically searched MEDLINE, EMBASE, PsychINFO and 3 other databases, from date of database inception and until January 2021, for experimental studies on mobile interventions targeting pregnant and postpartum women. We used pooled and narrative synthesis methods to analyze effectiveness and equity data, critically appraised the methodological rigour of included studies using Cochrane tools, and assessed the certainty of evidence using the GRADE approach. Our search identified 6148 records, of which 18 randomized and non-randomized controlled trials were included. Mobile interventions had a clinically important impact on reducing the occurrence of depression (OR = 0.51 [95% CI 0.41 to 0.64]; absolute risk reduction RD: 7.14% [95% CI 4.92 to 9.36]; p<0.001) and preventing its severity perinatally (MD = -3.07; 95% CI -4.68 to -1.46; p<0.001). Mobile cognitive behavioural therapy (CBT) was effective in managing postpartum depression (MD = -6.87; 95% CI -7.92 to -5.82; p<0.001), whereas other support-based interventions had no added benefit. Results on anxiety outcomes and utilization of care were limited. Our equity-focused analyses showed that ethnicity, age, education, and being primiparous were characteristics of influence to the effectiveness of mobile interventions. Conclusion As the COVID-19 pandemic has increased the need for virtual mental health care, mobile interventions show promise in preventing and managing common mental disorders among pregnant and postpartum women. Such interventions carry the potential to address health inequity but more rigorous research that examines patients’ intersecting social identities is needed.

Smoking Cessation Mobile Interventions in Latin America: A Systematic Review

Objective: To systematically review published articles reporting the use of smoking cessation mobile health (mHealth) interventions in Latin America. Methods: Five different databases were searched from database inception to 2020. Criteria: (1) the research was a smoking cessation randomized controlled trial (RCT), quasi-experimental research, or single-arm study; (2) the intervention used at least one type of mHealth intervention; (3) the research was conducted in Latin American; and (4) the research reported the cessation rate. Results: Of the seven selected studies, four were conducted in Brazil, two in Mexico, and one in Peru. Only one study was an adequately powered RCT. Interventions relied on text messages ( n = 3), web-based tools ( n = 2), and telephone calls ( n = 3). Some studies ( n = 4) provided pharmacotherapy support. Smoking cessation outcomes included self-reported ( n = 5) and biochemically verified ( n = 2) abstinence. Follow-ups were conducted at Month 6 ( n = 2), Week 12 ( n = 4), and Day 30 ( n = 1). Cessation rates varied from 9.4% at Week 12 to 55.5% at Day 30. Conclusion: Despite the promising cessation rates of mHealth interventions in Brazil, Mexico, and Peru, there is a need to rigorously evaluate these interventions in different Latin American countries with RCTs that are long-term, adequately powered, and use biochemical verification of cessation.

Improving Social Functioning in People With Schizophrenia-Spectrum Disorders via Mobile Experimental Interventions: Results from the CLIMB Pilot Trial. (Preprint)

BACKGROUND Patients with Schizophrenia Spectrum Disorder (SSD) demonstrate poor social functioning and lack the ability to engage in meaningful social interactions. While several integrated, behavioral approaches have shown long-term improvements, access to group-based treatment is limited. Digital platforms, however, are a promising mechanism to overcome barriers to treatment delivery. Though little research has been conducted to assess the feasibility of group-based, mobile-delivered interventions, evidence suggests that technology-based solutions may be leveraged to personalize and improve treatment quality and delivery, increase adherence, and promote transfer of skills in real-world settings. OBJECTIVE The goal of this study was to test the effects of two experimental mobile approaches in people with SSD, in hopes to reduce negative symptoms and enhance social functioning. in a parallel arm, double-blind, randomized, controlled clinical trial, we compared a clinician-assisted, adjunct to treatment, mobile intervention that included computerized social cognition training (SCT), ecological momentary assessments, group tele-therapy, and moderated peer-to-peer messaging (CLIMB), with another mobile treatment serving as an active control that included general cognitive training (GCT) program, unstructured support groups, and unmoderated peer-to-peer messaging. METHODS Participants were recruited through the Internet and engaged in remote study and intervention activities. Participants used iOS devices to attend remote weekly CLIMB or unstructured group sessions, connect with peers and access up to 18 hours of their respective cognitive training. Primary outcomes were negative symptoms, social functioning, and quality of life. Participant engagement was analyzed to assess mediation effects. Given the small sample size of our study population, a Propensity Score Model was used to ensure balanced baseline covariates. Mixed-effects models examined change over time. RESULTS Twenty-four participants completed the study and were equally randomized into the CLIMB and control conditions. As a group, participants showed significant improvements in social functioning (p = 0.046), with no between-group differences. Intent-to-treat analyses indicated greater improvements in quality of life (p = 0.025) for the active control participants. There were no significant between-group differences in engagement—participants in CLIMB attended a median of 8 sessions (IQR=2), completed a median of 2.83 hours of SCT(IQR=7.5), and 2710 EMAs, while those in the control attended a median of 9 sessions (IQR=3), and completed a median of 2.2hours of GCT (IQR=7.9). CONCLUSIONS Our results demonstrate that digital platforms are a feasible mechanism for delivering group-based mobile interventions to individuals with SSD. Notably, EMAs prove to be an innovative feature that maintain inter-session engagement, build participant self-awareness and inform clinician led group-therapy sessions. Across groups, participants were highly engaged in remote intervention activities, and even participants in the control appear to benefit from social interactions through unstructured group sessions. However, it is unclear whether SCT or GCT are more effective in this treatment model. Further research is required to evaluate group-based mobile interventions and implications for improving quality of life in individuals with SSD. CLINICALTRIAL ClinicalTrials.gov NCT03317769; http://clinicaltrials.gov/ct2/show/NCT03317769

Benefits of Digital Health Resources for Substance Use Concerns in Women: A Scoping Review (Preprint)

BACKGROUND Digital health resources are being increasingly used to support women with substance use concerns. Although empirical research demonstrates that these resources have promise, the available evidence for their benefit in women requires further investigation. OBJECTIVE The objective of the current investigation was to evaluate the evidence supporting the efficacy or effectiveness for online or mobile interventions for risky or harmful substance use in adults who identify as female or women, or who report a history of trauma. METHODS This scoping review is based on an academic search in MEDLINE, APA PsycINFO, EMBASE, Cochrane Central, and CINAHL, as well as a grey literature search in U.S. and Canadian government and funding agency websites. Of the 4977 records identified, 355 remained following title and abstract screening. Of these, 121 met all eligibility criteria and were reviewed and synthesized. RESULTS The 121 records reflected 96 distinct studies, and 85 distinct interventions. Investigations and the interventions evaluated predominantly focused on alcohol use or general substance use. Digital health resources evaluated included multi-session and brief session interventions, with a wide range of therapeutic elements. More intensive online and mobile interventions exhibited moderate to strong effects in the vast majority of studies, whereas brief interventions demonstrated smaller effect sizes at short-term follow-up periods. Most investigations did not assess gender identity, or conduct sex- or gender-based analyses. Only 10 investigations that included trauma were located. CONCLUSIONS Despite the overall promise of digital health interventions for substance use concerns, direct or quantitative evidence for efficacy or effectiveness of interventions in females or women specifically is weak.

Digital Tools to Ameliorate Psychological Symptoms Associated With COVID-19: Scoping Review

Background In the four months after the discovery of the index case of coronavirus disease (COVID-19), several studies highlighted the psychological impact of COVID-19 on frontline health care workers and on members of the general public. It is evident from these studies that individuals experienced elevated levels of anxiety and depression in the acute phase, when they first became aware of the pandemic, and that the psychological distress persisted into subsequent weeks. It is becoming apparent that technological tools such as SMS text messages, web-based interventions, mobile interventions, and conversational agents can help ameliorate psychological distress in the workplace and in society. To our knowledge, there are few publications describing how digital tools have been used to ameliorate psychological symptoms among individuals. Objective The aim of this review was to identify existing SMS text message, web-based, mobile, and conversational agents that the general public can access to ameliorate the psychological symptoms they are experiencing during the COVID-19 pandemic. Methods To identify digital tools that were published specifically for COVID-19, a search was performed in the PubMed and MEDLINE databases from the inception of the databases through June 17, 2020. The following search strings were used: “NCOV OR 2019-nCoV OR SARS-CoV-2 OR Coronavirus OR COVID19 OR COVID” and “mHealth OR eHealth OR text”. Another search was conducted in PubMed and MEDLINE to identify existing digital tools for depression and anxiety disorders. A web-based search engine (Google) was used to identify if the cited web-based interventions could be accessed. A mobile app search engine, App Annie, was used to determine if the identified mobile apps were commercially available. Results: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. Results A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. Conclusions The COVID-19 pandemic has caused significant psychological distress. Digital tools that are commercially available may be useful for at-risk individuals or individuals with pre-existing psychiatric symptoms.

Needs and Requirements in the Designing of Mobile Interventions for Patients With Peripheral Arterial Disease: Questionnaire Study

Background The development of mobile interventions for noncommunicable diseases has increased in recent years. However, there is a dearth of apps for patients with peripheral arterial disease (PAD), who frequently have an impaired ability to walk. Objective Using a patient-centered approach for the development of mobile interventions, we aim to describe the needs and requirements of patients with PAD regarding the overall care situation and the use of mobile interventions to perform supervised exercise therapy (SET). Methods A questionnaire survey was conducted in addition to a clinical examination at the vascular outpatient clinic of the West-German Heart and Vascular Center of the University Clinic Essen in Germany. Patients with diagnosed PAD were asked to answer questions on sociodemographic characteristics, PAD-related need for support, satisfaction with their health care situation, smartphone and app use, and requirements for the design of mobile interventions to support SET. Results Overall, a need for better support of patients with diagnosed PAD was identified. In total, 59.2% (n=180) expressed their desire for more support for their disease. Patients (n=304) had a mean age of 67 years and half of them (n=157, 51.6%) were smartphone users. We noted an interest in smartphone-supported SET, even for people who did not currently use a smartphone. “Information,” “feedback,” “choosing goals,” and “interaction with physicians and therapists” were rated the most relevant components of a potential app. Conclusions A need for the support of patients with PAD was determined. This was particularly evident with regard to disease literacy and the performance of SET. Based on a detailed description of patient characteristics, proposals for the design of mobile interventions adapted to the needs and requirements of patients can be derived.

Community-Based Early Intervention with Trauma Survivors

The number of individuals affected by frequently occurring traumatic events such as accidents and assaults, as well as large-scale traumas such as war and disaster, calls for systematic, comprehensive community-based responses to manage mental health consequences of such exposure. This chapter reviews several key components of such a comprehensive response; these components can be initiated immediately after a trauma occurs. Communities should develop capacity to identify and engage those at risk for continuing problems; provide phased support to include immediate assistance, brief counseling after the immediate period, and treatment for trauma-related problems; and provide opportunities for participation in trauma-related community activities. Two domains of posttrauma care, hospital-based acute care of injury and assault survivors and disaster mental health, are reviewed to illustrate ways of developing some of these components. Key challenges include engagement of survivors with early interventions, training of providers and effective implementation of interventions, program monitoring and evaluation, and integration of Internet and mobile interventions into community-based service delivery. In the future, there remains significant opportunity for service innovation and improvement of interventions, a need to develop and implement population-based intervention approaches, and an imperative to increase research into early posttrauma interventions in community settings.

Digital Tools to Ameliorate Psychological Symptoms Associated With COVID-19: Scoping Review (Preprint)

BACKGROUND In the four months after the discovery of the index case of coronavirus disease (COVID-19), several studies highlighted the psychological impact of COVID-19 on frontline health care workers and on members of the general public. It is evident from these studies that individuals experienced elevated levels of anxiety and depression in the acute phase, when they first became aware of the pandemic, and that the psychological distress persisted into subsequent weeks. It is becoming apparent that technological tools such as SMS text messages, web-based interventions, mobile interventions, and conversational agents can help ameliorate psychological distress in the workplace and in society. To our knowledge, there are few publications describing how digital tools have been used to ameliorate psychological symptoms among individuals. OBJECTIVE The aim of this review was to identify existing SMS text message, web-based, mobile, and conversational agents that the general public can access to ameliorate the psychological symptoms they are experiencing during the COVID-19 pandemic. METHODS To identify digital tools that were published specifically for COVID-19, a search was performed in the PubMed and MEDLINE databases from the inception of the databases through June 17, 2020. The following search strings were used: “NCOV OR 2019-nCoV OR SARS-CoV-2 OR Coronavirus OR COVID19 OR COVID” and “mHealth OR eHealth OR text”. Another search was conducted in PubMed and MEDLINE to identify existing digital tools for depression and anxiety disorders. A web-based search engine (Google) was used to identify if the cited web-based interventions could be accessed. A mobile app search engine, App Annie, was used to determine if the identified mobile apps were commercially available. Results: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. RESULTS A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. CONCLUSIONS The COVID-19 pandemic has caused significant psychological distress. Digital tools that are commercially available may be useful for at-risk individuals or individuals with pre-existing psychiatric symptoms.