Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The onset of mental health problems peaks between adolescence and young adulthood, however young people face barriers to treatment and are often reluctant to seek professional help. Many are instead seeking support and information regarding their mental health online, especially via social networking sites (SNSs), so there is a promising opportunity to use SNSs to deliver or integrate with youth-focused online mental health interventions. Previous reviews have evaluated the effectiveness of SNSs for specific disorders in young people, however none to have covered the breadth of SNS-based youth mental health interventions available across all mental health issues. Objective: The aim of this review was to systematically identify available evidence regarding the use of SNS-based interventions to support the mental health of young people up to 25 years, in order to evaluate their effectiveness, suitability and safety, and identify gaps and opportunities for future research. Methods: The PubMed and PsycInfo databases were searched using Medical Subject Headings (MeSH) terms and exploded keywords and phrases. Retrieved abstracts (n=974) were double screened, yielding 235 articles for screening at the full-text level. Of these, nine articles met the review inclusion criteria. Given the small number of studies, their exploratory nature and the variety of outcome measures used, a quantitative meta-analysis was not possible. Results: The nine articles (quantitative studies, qualitative studies and descriptions of the iterative design process) covered five separate interventions. Two interventions used purpose-built platforms based on the Moderated Online Social Therapy (MOST) model, two used Facebook, and one evaluated a purpose-built mobile app. The two MOST interventions targeted specific mental health issues (depression and psychosis), while the others focused on improving mental health literacy, social support and general wellbeing. Only three quantitative studies were identified, and all used a pre-post design (without a control group) to establish ‘proof of concept’. Of the outcome variables assessed, there were significant improvements in mental health knowledge and number of depressive symptoms, but no improvement in anxiety or psychosis symptoms. Acceptability of and engagement with the SNS platforms was generally high, as were perceptions of usefulness and safety, with no adverse incidents reported. Moderation by clinical experts was identified as a key component of the more successful interventions. When offered a choice, users showed a preference for mobile apps over web-based interfaces. Conclusions: The evidence reviewed suggests young people find SNS-based interventions highly usable, engaging and supportive. However, future studies need to address the current lack of high-quality evidence for their efficacy in reducing mental health symptoms. Given that young people are already turning to SNSs to engage in knowledge-seeking and peer-to-peer support, SNS-based youth mental health interventions provide an opportunity to address some of the barriers young people face in accessing qualified mental health support and information.

Background: Over the past 2 decades, online forums for mental health support have emerged as an important tool for improving mental health and well-being. There has been important research that analyzes the content of forum posts, studies on how and why individuals engage with forums, and how extensively forums are used. However, we still lack insights into key questions on how they are experienced from the perspective of their users, especially those in rural and remote settings.Objective: The aim of our study was to investigate the dynamics, benefits, and challenges of a generalized peer-to-peer mental health online forum from a user perspective; in particular, to better explore and understand user perspectives on connection, engagement, and support offered in such forums; information and advice they gained; and what issues they encountered. We studied experiences of the forums from the perspective of both people with lived experience of mental illness and people who care for people with mental illness.Methods: To understand the experience of forum users, we devised a qualitative study utilizing semistructured interviews with 17 participants (12 women and 5 men). Data were transcribed, and a thematic analysis was undertaken.Results: The study identified 3 key themes: participants experienced considerable social and geographical isolation, which the forums helped to address; participants sought out the forums to find a social connection that was lacking in their everyday lives; and participants used the forums to both find and provide information and practical advice.Conclusions: The study suggests that online peer support provides a critical, ongoing role in providing social connection for people with a lived experience of mental ill-health and their carers, especially for those living in rural and remote areas. Forums may offer a way for individuals to develop their own understanding of recovery through reflecting on the recovery experiences and peer support shown by others and individuals enacting peer support themselves. Key to the success of this online forum was the availability of appropriate moderation, professional support, and advice.

Digital mental health services are becoming increasingly valuable for addressing the global public health burden of mental ill-health. There is significant demand for scalable and effective web-based mental health services. Artificial intelligence (AI) has the potential to improve mental health through the deployment of chatbots. These chatbots can provide round-the-clock support and triage individuals who are reluctant to access traditional health care due to stigma. The aim of this viewpoint paper is to consider the feasibility of AI-powered platforms to support mental well-being. The Leora model is considered a model with the potential to provide mental health support. Leora is a conversational agent that uses AI to engage in conversations with users about their mental health and provide support for minimal-to-mild symptoms of anxiety and depression. The tool is designed to be accessible, personalized, and discreet, offering strategies for promoting well-being and acting as a web-based self-care coach. Across all AI-powered mental health services, there are several challenges in the ethical development and deployment of AI in mental health treatment, including trust and transparency, bias and health inequity, and the potential for negative consequences. To ensure the effective and ethical use of AI in mental health care, researchers must carefully consider these challenges and engage with key stakeholders to provide high-quality mental health support. Validation of the Leora platform through rigorous user testing will be the next step in ensuring the model is effective.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, mindfulness-based psychological treatment for anxiety. However, there are treatment barriers (e.g. financial, geographical, and attitudinal) which prevent people from accessing it. To overcome these barriers, internet-delivered Acceptance and Commitment Therapy (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill training exercises online, either as pure self-help or with therapist guidance. Objective: The present systematic review aimed to examine the therapeutic impact of iACT on all anxiety conditions. Empirical studies of all designs, population types, and comparator groups were included if they appraised the impact of iACT treatment on any standardised measure of anxiety. Data on participant characteristics, intervention delivery, anxiety outcomes, user attrition rates, and treatment satisfaction were extracted to help identify efficacious and acceptable interventions, elucidate research gaps, and guide the design, development and administration of new iACT programs. Methods: The Embase, Medline, ProQuest Central, PsycINFO, Scopus, and Web of Science databases were searched up to September 2018. The titles and abstracts of remaining records after deduplication were screened by two authors with a total of 36 full-text articles being retained for closer inspection next to eligibility criteria. Included studies were appraised on methodological quality and had their data extracted into a standardised coding sheet. Findings were then tabulated and a narrative synthesis was performed due to the heterogeneity found between studies. Results: Twenty studies met inclusion criteria. There were 11 randomised controlled trials and 9 uncontrolled pilot studies. Participants across all studies were adults. Treated anxiety conditions included: generalised anxiety disorder, social anxiety disorder, illness anxiety disorder, and general anxiety symptoms with or without comorbid physical and/or mental health problems. Eighteen studies reported significant anxiety reduction after iACT treatment with effect sizes ranging from small to large. This was observed in studies that delivered iACT with (n = 13) or without (n = 5) therapist guidance. The average attrition rate across all included studies during the active iACT treatment phase was 24.21%. In the 13 studies that assessed treatment satisfaction, participants on average rated their iACT experience with above average to high treatment satisfaction. Conclusions: These findings indicate that iACT can be an efficacious and acceptable treatment for adults with generalised anxiety disorder and general anxiety symptoms. More randomised controlled trial studies are needed to corroborate these early iACT findings using empirical treatments in active control groups (e.g. internet-delivered cognitive behavioural therapy). This would potentially validate the promising results found for social anxiety disorder and illness anxiety disorder as well as address the full spectrum of anxiety disorders.