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There is growing recognition of the importance of addressing the mental health needs of young people attending university. Anonymous, scalable, and evidence-based online interventions can help to reduce burden on university services and increase access to care for marginalised or disconnected students. This paper reports the participatory design methods used to develop the Uni Virtual Clinic (UVC), a comprehensive online programme that was designed to prevent and treat mental health problems and related issues in university students. Data evaluating the participatory design process is also presented. The potential for the implementation of the UVC within university-based counselling services is strong, and has potential to reduce the prevalence of mental disorders in a high-risk group of young people.

Introduction: This study aimed to investigate the mechanisms of the development of suicidal ideation and its moderating and protective factors. Drawing on the Interpersonal‐psychological theory of suicide, we proposed that disruptions to belongingness, in conjunction with tolerance of health risk, may influence the development of suicidal ideation above and beyond psychosocial changes such as disruptions to finances and work. Methods: The study involved a longitudinal investigation of an Australian representative sample reporting suicidal ideation fortnightly for 12 weeks between March and June 2020. Results: The results indicated that participants who reported higher levels of belongingness, mastery, and intolerance of health risk were less likely to experience suicidal ideation and had lower severity of suicidal ideation. Mastery significantly strengthened the negative link between belongingness and the incidence of suicidal ideation, while agreeableness significantly strengthened the negative link between belongingness and the severity of suicidal ideation over time. Conclusion: The findings suggest that supporting effective social connectedness during times of isolation and promoting self‐efficacy, mastery, and regulation of risk tolerance, may be crucial for suicide prevention and therapeutic intervention. [ABSTRACT FROM AUTHOR]

Internet interventions for common mental disorders are widely available, effective, and economical, yet community uptake remains low. One consistently cited reason for not engaging in mental health interventions is lack of time. This research examined whether lack of time as a rationale for not using online interventions reflects real time scarcity, and whether time availability impacts intention to use interventions. A nationally representative sample (N = 1094, 51% women) reported their time use in activity categories for a typical week. Participants rated their acceptance and likelihood of use of mental health internet interventions, and completed mental health symptom, help-seeking and stigma measures. Amount of leisure time reported by participants was not associated with acceptance or likelihood of use of internet interventions for mental health. However, respondents who worked longer hours ranked time and effort factors as more influential in their intention to use internet-based mental health programs. Younger respondents and those with greater help-seeking attitudes reported higher acceptance of use. These findings suggest lack of time is not a direct barrier to use of internet interventions, and that perceived time scarcity may be masking real barriers to uptake. [ABSTRACT FROM AUTHOR]

BackgroundSelf-guided web-based mental health programs are effective in treating and preventing mental health problems. However, current engagement with these programs in the community is suboptimal, and there is limited evidence indicating how to increase the use of existing evidence-based programs. ObjectiveThis study aims to investigate the views of people with lived experience of depression and anxiety on factors influencing their engagement with self-guided web-based mental health (e–mental health) programs and to use these perspectives to develop an engagement-facilitation intervention (EFI) to increase engagement (defined as both uptake and adherence) with these programs. MethodsA total of 24 community members (female=21; male=3) with lived experience of depression and anxiety or depression or anxiety alone participated in 1 of 4 focus groups discussing the factors influencing their engagement with self-guided e–mental health programs and the appearance, delivery mode, and functionality of content for the proposed EFI. A subsequent evaluation survey of the focus group participants (n=14) was conducted to evaluate the resultant draft EFI. Data were thematically analyzed using both inductive and deductive qualitative methods. ResultsParticipants suggested that the critical component of an EFI was information that would challenge personal barriers to engagement, including receiving personalized symptom feedback, information regarding the program’s content or effectiveness and data security, and normalization of using e–mental health programs (eg, testimonials). Reminders, rewards, feedback about progress, and coaching were all mentioned as facilitating adherence. ConclusionsEFIs have the potential to improve community uptake of e–mental health programs. They should focus on providing information on the content and effectiveness of e–mental health programs and normalizing their use. Given that the sample comprised predominantly young females, this study may not be generalizable to other population groups. There is a strong value in involving people with a lived experience in the design and development of EFIs to maximize their effectiveness.

Effective risk communication is essential for government and health authorities to effectively manage public health during the Coronavirus disease (COVID-19) pandemic. Understanding the factors that influence people's perceptions of crisis-related risk messages is critical to identify gaps and inequalities in population risk communication. Using a longitudinal survey of a representative adult sample, we examined risk communication about COVID-19 during April-June 2020 in Australia across sociodemographic groups especially the at-risk groups, accounting for and exploring the effects of risk attitudes and media engagement. Our findings showed that individuals who were younger, more left-wing, more risk-tolerant, and had a current or a history of mental disorders perceived risk communication of the Australian Government to be lower quality. On the other hand, greater consumption of information from televisions was found to be associated with more positive attitudes toward government risk communication. Our results also revealed the importance of effective and high-quality risk communication in gaining the public endorsement of various public health directions. We discuss the implications of results in terms of the development of effective public communications that lead to health-protective behaviors and effectively scaffold public understanding of risk. [ABSTRACT FROM AUTHOR]

Objective: To examine and describe telehealth use and attitudes among mental health professionals in Australia and New Zealand during the initial stages of the COVID-19 pandemic. Methods: Participants completed a brief online survey between May and July 2020. Participants were recruited via peak and professional organisations and through psychology-focused social media groups and networks. The survey examined frequency of telehealth use, reasons for non-use, telehealth modalities, prior use, attitudes towards use, plans for future use, and training, information or resource needs. Results: A total of 528 professionals (85.2% female) participated in the survey, of which 98.9% reported using telehealth and 32.2% reported using telehealth exclusively. Respondents were less likely to use telehealth if they worked with clients experiencing complex issues (e.g. trauma), had more hours of weekly client contact, had a choice about whether to use telehealth or felt less positive about using technology. Respondents were more likely to hold positive views towards telehealth if they were female, had used online programmes with clients previously, were frequent telehealth users and were comfortable using technology. Participants expressed mixed views on client safety and the impact of telehealth on therapeutic process and effectiveness. Conclusion: Telehealth has a clear and ongoing role within mental healthcare and there is a need for strong guidance for professionals on how to manage client risk, privacy, security and adapt therapy for delivery via telehealth. In particular, there is a need for individual-, organisational-, professional- and policy-level responses to ensure that telehealth remains a viable and effective healthcare medium into the future. [ABSTRACT FROM AUTHOR]

Objective: The present study examined behavioral responses during the coronavirus disease 2019 (COVID-19) pandemic and the role of dispositional risk tolerance in the Australian context. Method: The study involved a six-wave longitudinal investigation with a nationally representative sample of Australians (N = 1,296). Dispositional risk tolerance was measured at Wave 1 and participants' anxiety level and self-report implementation of 10 COVID actions was assessed in each wave. Autoregressive multinomial regression models were estimated to assess the unique contribution of risk tolerance to the longitudinal change of participants' implementation of COVID actions. Results: The results revealed a high implementation rate for protective actions when Australia had a peak in the severity of the COVID-19 pandemic and subsequently declined with the easing threat of the pandemic. Individuals' dispositional risk tolerance significantly predicted transition to, and endorsement of, protective actions. Participants who had low risk tolerance were more likely to remain at the state of implementing COVID-19 measures than being in, or transitioning to, other states. Conclusions: The findings suggest that when encouraging protective actions, governments and public authorities should acknowledge variability in the community in responding to risk and consider measures in addition to risk messaging to encourage protective actions among individuals with a high level of risk tolerance. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has resulted in disruptions across many life domains. The distress associated with the pandemic itself, and with public health efforts to manage the outbreak, could result in increased alcohol use. This study aimed to quantify changes in alcohol use during the early stages of the pandemic and factors associated with different patterns of use. Methods: Data were obtained from a longitudinal survey of a representative Australian adult sample (N = 1296, 50% female, Mage = 46.0) conducted from March to June 2020, during the first wave of the COVID‐19 outbreak in Australia. Change in alcohol consumption was examined using Alcohol Use Disorders Identification Test‐Consumption (AUDIT‐C) scores from waves one, three, five, and seven of the study, each 4 weeks apart. Factors associated with alcohol consumption were examined, including depression (PHQ‐9) and anxiety (GAD‐7) symptoms, health risk tolerance, stress and coping, work and social impairment (WSAS), COVID impacts, and sociodemographic variables. We tested changes in alcohol use across the full sample using a mixed effects repeated measure ANOVA model and a multinomial logistic regression to identify factors assessed at wave 1 that were independently associated with alcohol use. Results: There was no significant change in AUDIT‐C scores across the study. For most participants, alcohol use did not increase during the early phase of the COVID‐19 pandemic in Australia. COVID‐19 exposure, higher perceived coping, depression symptoms, and male gender were associated with greater odds of increasing or elevated levels of alcohol use. Social changes, which included working from home, had mixed effects on alcohol consumption. Conclusions: Although no evidence was found for increased alcohol use overall during the early months of the pandemic, several factors were associated with alcohol consumption at risky levels. Greater understanding of motivations for drinking across public and private contexts, along with targeted support for high‐risk groups, could assist in reducing harm associated with alcohol consumption. [ABSTRACT FROM AUTHOR]

Objectives: To estimate initial levels of symptoms of depression and anxiety, and their changes during the early months of the COVID-19 pandemic in Australia; to identify trajectories of symptoms of depression and anxiety; to identify factors associated with these trajectories.Design, Setting, Participants: Longitudinal cohort study; seven fortnightly online surveys of a representative sample of 1296 Australian adults from the beginning of COVID-19-related restrictions in late March 2020 to mid-June 2020.Main Outcome Measures: Symptoms of depression and anxiety, measured with the Patient Health Questionnaire (PHQ-9) depression and Generalised Anxiety Disorder (GAD-7) scales; trajectories of symptom change.Results: Younger age, being female, greater COVID-19-related work and social impairment, COVID-19-related financial distress, having a neurological or mental illness diagnosis, and recent adversity were each significantly associated with higher baseline depression and anxiety scores. Growth mixture models identified three latent trajectories for depression symptoms (low throughout the study, 81% of participants; moderate throughout the study, 10%; initially severe then declining, 9%) and four for anxiety symptoms (low throughout the study, 77%; initially moderate then increasing, 10%; initially moderate then declining, 5%; initially mild then increasing before again declining, 8%). Factors statistically associated with not having a low symptom trajectory included mental disorder diagnoses, COVID-19-related financial distress and social and work impairment, and bushfire exposure.Conclusion: Our longitudinal data enabled identification of distinct symptom trajectories during the first three months of the COVID-19 pandemic in Australia. Early intervention to ensure that vulnerable people are clinically and socially supported during a pandemic should be a priority. [ABSTRACT FROM AUTHOR]

There is minimal knowledge about the impact of large-scale epidemics on community mental health, particularly during the acute phase. This gap in knowledge means we are critically ill-equipped to support communities as they face the unprecedented COVID-19 pandemic. This study aimed to provide data urgently needed to inform government policy and resource allocation now and in other future crises. The study was the first to survey a representative sample from the Australian population at the early acute phase of the COVID-19 pandemic. Depression, anxiety, and psychological wellbeing were measured with well-validated scales (PHQ-9, GAD-7, WHO-5). Using linear regression, we tested for associations between mental health and exposure to COVID-19, impacts of COVID-19 on work and social functioning, and socio-demographic factors. Depression and anxiety symptoms were substantively elevated relative to usual population data, including for individuals with no existing mental health diagnosis. Exposure to COVID-19 had minimal association with mental health outcomes. Recent exposure to the Australian bushfires was also unrelated to depression and anxiety, although bushfire smoke exposure correlated with reduced psychological wellbeing. In contrast, pandemic-induced impairments in work and social functioning were strongly associated with elevated depression and anxiety symptoms, as well as decreased psychological wellbeing. Financial distress due to the pandemic, rather than job loss per se , was also a key correlate of poorer mental health. These findings suggest that minimizing disruption to work and social functioning, and increasing access to mental health services in the community, are important policy goals to minimize pandemic-related impacts on mental health and wellbeing. Innovative and creative strategies are needed to meet these community needs while continuing to enact vital public health strategies to control the spread of COVID-19. [ABSTRACT FROM AUTHOR]

There is growing recognition of the importance of addressing the mental health needs of young people attending university. Anonymous, scalable, and evidence-based online interventions can help to reduce burden on university services and increase access to care for marginalised or disconnected students. This paper reports the participatory design methods used to develop the Uni Virtual Clinic (UVC), a comprehensive online programme that was designed to prevent and treat mental health problems and related issues in university students. Data evaluating the participatory design process is also presented. The potential for the implementation of the UVC within university-based counselling services is strong, and has potential to reduce the prevalence of mental disorders in a high-risk group of young people. [ABSTRACT FROM AUTHOR]

General practice care plans are designed to improve the management of chronic illness, facilitating multidisciplinary care and enabling GPs and consumers to work collaboratively. Evidence suggests that they work well for chronic physical illnesses, but it is unclear if they operate as intended for people with mental disorders. The aims of this study were to: (1) compare rates of creation and review of GP care plans for mental disorders and type II diabetes; and (2) examine consumer experiences. Secondary analysis of 109 589 recorded encounters from a national cross-sectional study in Australian general practice (2006–16) demonstrated that encounters involving creation of a care plan for depression or anxiety were significantly higher than those for diabetes, bipolar disorder and schizophrenia. Rates of review were commensurate with creation of plans for diabetes, but not for mental disorders. Eighteen people with a GP care plan completed an online survey about their experiences, reporting that care plans facilitated access to allied health professionals, but did not improve the quality of care they received. Findings suggest that care plans are underutilised for people with low prevalence mental disorders, and while they offer financial benefits to consumers, they may not result in ongoing, collaborative care. [ABSTRACT FROM AUTHOR]

General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined modifiable psychosocial risk factors for mental disorders among university students, and of these, none have employed measures that correspond to clinical diagnostic criteria. The aim of this study was to examine psychosocial and demographic risk factors for major depression and generalised anxiety disorder (GAD) in a sample of Australian university students. Methods: An anonymous web-based survey was distributed to undergraduate and postgraduate students at a mid-sized Australian university. A range of psychosocial and demographic risk factors were measured, and logistic regression models were used to examine significant predictors of major depression and GAD. Results: A total of 611 students completed the survey. The prevalence of major depression and GAD in the sample was 7.9 and 17.5%, respectively. In terms of demographic factors, the risk of depression was higher for students in their first year of undergraduate study, and the risk of GAD was higher for female students, those who moved to attend university, and students experiencing financial stress. In terms of psychosocial factors, students with experience of body image issues and lack of confidence were at significantly greater risk of major depression, and feeling too much pressure to succeed, lack of confidence, and difficulty coping with study was significantly associated with risk of GAD. Conclusions: University students experience a range of unique psychosocial stressors that increase their risk of major depression and GAD, in addition to sociodemographic risk factors. It is important to examine psychosocial factors, as these are potentially modifiable and could be the focus of university-specific mental health interventions. [ABSTRACT FROM AUTHOR]

Background: Self-guided web-based programs are effective; however, inadequate implementation of these programs limits their potential to provide effective and low-cost treatment for common mental health problems at scale. There is a lack of research examining optimal methods for the dissemination of web-based programs in the community.Objective: This study aimed to compare the uptake, reach, relative costs, and adherence associated with 3 community-based pathways for delivering a low-intensity web-based transdiagnostic mental health program. The 3 dissemination pathways were social media advertising, advertising in general practice, and advertising in pharmacies.Methods: Participants were recruited on the web, from general practices, or from community pharmacies; completed a screener for psychological distress; and were offered the 4-week FitMindKit program-a 12-module psychotherapeutic intervention. Uptake was defined as the number of participants who enrolled in the web-based program; reach was defined as the rate of uptake per exposure; and costs were calculated based on staff time, equipment, and advertising. Adherence was assessed as the number of modules of FitMindKit completed by the participants.Results: Uptake comprised 1014 participants who were recruited through the 3 dissemination pathways: on the web (991/1014, 97.73%), in general practice (16/1014, 1.58%), and in pharmacy (7/1014, 0.69%). Reach was highest for social media: 1 in every 50 people exposed to web-based advertising took up the intervention compared with 1 in every 441 in general practitioner clinics and 1 in every 1708 in pharmacies. The dissemination cost was US $4.87 per user on social media, US $557 per user for general practitioner clinics, and US $1272 per user for pharmacy dissemination. No significant differences in adherence were observed between the conditions, whereas all pathways showed an underrepresentation of men and linguistic diversity.Conclusions: The web-based dissemination pathway was the most efficient and cost-effective for delivering a self-guided internet-based mental health program to people in the community. More research is needed to identify how best to engage men and those with culturally diverse backgrounds in web-based interventions.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001688279; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376113. [ABSTRACT FROM AUTHOR]

Keywords: coronavirus; COVID-19; bushfire; mental health; anxiety; depression; financial strain EN coronavirus COVID-19 bushfire mental health anxiety depression financial strain N.PAG N.PAG 2 01/25/21 20210121 NES 210121 In the original article, there was an error in Table 3 as published. Table 3 Prevalence of depression and generalized anxiety based on self-reported current mental health diagnosis. Coronavirus, COVID-19, bushfire, mental health, anxiety, depression, financial strain. [Extracted from the article]

Background: Psychosocial, self-guided, internet-based programs are effective in treating depression and anxiety. However, the community uptake of these programs is poor. Recent approaches to increasing engagement (defined as both uptake and adherence) in internet-based programs include brief engagement facilitation interventions (EFIs). However, these programs require evaluation to assess their efficacy.Objective: The aims of this hybrid implementation effectiveness trial are to examine the effects of a brief internet-based EFI presented before an internet-based cognitive behavioral therapy self-help program (myCompass 2) in improving engagement (uptake and adherence) with that program (primary aim), assess the relative efficacy of the myCompass 2 program, and determine whether greater engagement was associated with improved efficacy (greater reduction in depression or anxiety symptoms) relative to the control (secondary aim).Methods: A 3-arm randomized controlled trial (N=849; recruited via social media) assessed the independent efficacy of the EFI and myCompass 2. The myCompass 2 program was delivered with or without the EFI; both conditions were compared with an attention control condition. The EFI comprised brief (5 minutes), tailored audio-visual content on a series of click-through linear webpages.Results: Uptake was high in all groups; 82.8% (703/849) of participants clicked through the intervention following the pretest survey. However, the difference in uptake between the EFI + myCompass 2 condition (234/280, 83.6%) and the myCompass 2 alone condition (222/285, 77.9%) was not significant (n=565; χ21=29.2; P=.09). In addition, there was no significant difference in the proportion of participants who started any number of modules (1-14 modules) versus those who started none between the EFI + myCompass 2 (214/565, 37.9%) and the myCompass 2 alone (210/565, 37.2%) conditions (n=565; χ21<0.1; P=.87). Finally, there was no significant difference between the EFI + myCompass 2 and the myCompass 2 alone conditions in the number of modules started (U=39366.50; z=-0.32; P=.75) or completed (U=39494.0; z=-0.29; P=.77). The myCompass 2 program was not found to be efficacious over time for symptoms of depression (F4,349.97=1.16; P=.33) or anxiety (F4,445.99=0.12; P=.98). However, planned contrasts suggested that myCompass 2 may have been effective for participants with elevated generalized anxiety disorder symptoms (F4,332.80=3.50; P=.01).Conclusions: This brief internet-based EFI did not increase the uptake of or adherence to an existing internet-based program for depression and anxiety. Individuals' motivation to initiate and complete internet-based self-guided interventions is complex and remains a significant challenge for self-guided interventions.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001565235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375839. [ABSTRACT FROM AUTHOR]

Background: Online recruitment is feasible, low-cost, and can provide high-quality epidemiological data. However, little is known about the feasibility of recruiting postpartum women online, or sample representativeness.Objective: The current study investigates the feasibility of recruiting a population of postpartum women online for health research and examines sample representativeness.Methods: Two samples of postpartum women were compared: those recruited online as participants in a brief survey of new mothers (n=1083) and those recruited face-to-face as part of a nationally representative study (n=579). Sociodemographic, general health, and mental health characteristics were compared between the two samples.Results: Obtaining a sample of postpartum women online for health research was highly efficient and low-cost. The online sample over-represented those who were younger (aged 25-29 years), were in a de facto relationship, had higher levels of education, spoke only English at home, and were first-time mothers. Members of the online sample were significantly more likely to have poor self-rated health and poor mental health than the nationally representative sample. Health differences remained after adjusting for sociodemographic differences.Conclusions: Potential exists for feasible and low-cost e-epidemiological research with postpartum populations; however, researchers should consider the potential influence of sample nonrepresentativeness. [ABSTRACT FROM AUTHOR]

Background: There is a growing need to develop online services for university students with the capacity to complement existing services and efficiently address student mental health problems. Previous research examining the development and acceptability of online interventions has revealed that issues such as privacy critically impact user willingness to engage with these services. Objective: To explore university student perspectives on privacy issues related to using an online mental health service within the context of the development of an online, university-based virtual mental health clinic. Methods: There were two stages of data collection. The first stage consisted of four 1.5-hour focus groups conducted with university students (n=19; 10 female, 9 male, mean age = 21.6 years) to determine their ideas about the virtual clinic including privacy issues. The second stage comprised three 1-hour prototype testing sessions conducted with university students (n=6; 3 male, 3 female, mean age = 21.2 years) using participatory design methods to develop and refine a service model for the virtual clinic and determine student views on privacy within this context. Results: The students raised a number of issues related to privacy in relation to the development of the university virtual clinic. Major topics included the types of personal information they would be willing to provide (minimal information and optional mental health data), concern about potential access to their personal data by the university, the perceived stigma associated with registering for the service, and privacy and anonymity concerns related to online forums contained within the virtual clinic. Conclusions: Students would be more comfortable providing personal information and engaging with the virtual clinic if they trust the privacy and security of the service. Implications of this study include building the clinic in a flexible way to accommodate user preferences. [ABSTRACT FROM AUTHOR]

Objective: The direct and indirect mental health impacts of the COVID-19 pandemic are considerable. However, it is unclear how suicidal ideation was affected in communities during the acute lockdown phase of the pandemic, and over the longer-term. This study provides longitudinal data on the prevalence of, and risk factors for, suicidal ideation in the Australian national population, during the pandemic.Method: The Australian National COVID-19 Mental Health and Risk Communication Survey assessed a nationally representative sample of Australian adults (N = 1296) fortnightly for 12 weeks from late-March to June 2020 (7 waves), and again in March 2021 (wave 8). Cox proportional hazards models examined demographic and pandemic-related risk factors for suicidal ideation over time.Results: Prevalence of suicidal ideation was high but steady at ∼18% across the acute lockdown phase of the pandemic, and 16.2% in March 2021. People who had direct experience with COVID-19 (tested, diagnosed, or contact with someone who was diagnosed) had increased risk for suicidal ideation. Higher pandemic-related work and social impairment, recent adversity, loneliness, and being younger were also associated with increased risk of suicidal ideation over time.Conclusion: Both the direct and indirect impacts of COVID-19 were associated with increased risk for suicidal ideation over time, although prevalence did not vary over time. The high prevalence of suicidal ideation in our sample flags a critical need for accessible mental health support, and findings provide insights into the factors placing people at risk during the pandemic. [ABSTRACT FROM AUTHOR]

• The sources of strength program takes a social connectedness approach to suicide prevention. • A cluster randomised controlled trial was conducted with 13 schools in Australia. • The program increased awareness of help seeking but was not effective in increasing intentions or behaviour. • The program may be most suitable in schools with limited mental health programming or highly disconnected young people. Suicide is a significant public health problem and there is a clear need for interventions to improve help seeking for suicide and psychological distress in young people. This trial aimed to assess the effectiveness of the school-based Sources of Strength program in increasing help-seeking intentions and behaviours in adolescents. A cluster, randomised controlled trial was conducted in 13 Australian secondary schools (N = 1633), with each school randomly allocated to the intervention (n = 7) or wait-list control condition (n = 6). Participants in the intervention condition received the Sources of Strength program over two years and all participants completed self-report measures of help-seeking intentions and behaviour at four time-points. Staff and students in the intervention condition also provided qualitative feedback on the perceived impact of the program. Mixed model repeated measures analyses demonstrated no significant effect of the Sources of Strength program on help-seeking intentions or behaviour at post-intervention or 6- or 18-month follow-up. Staff and students reported, through qualitative feedback, that the program increased awareness of and openness to help seeking and promoted a common language and school community. The current study only included self-report measures that may have been influenced by situational factors or biases. Although the Sources of Strength program may have increased awareness of help seeking, there was no evidence that it is effective in increasing help-seeking intentions or behaviours in this cohort. The program may be more suitable for schools in disadvantaged areas where there may be limited existing connections to trusted adults. [ABSTRACT FROM AUTHOR]

Abstract Background There is substantial evidence that psychosocial programs delivered online can be effective in treating and preventing mental health problems. However, use of evidence-based programs in the community is currently suboptimal, and there is a lack of evidence around how to increase engagement with existing evidence-based programs. Novel approaches to increasing the acceptability of online programs such as the use of brief engagement-facilitation interventions (EFI) require evaluation. Aims The aims of this study are to 1) examine the effectiveness of a brief online engagement-facilitation intervention (EFI) presented prior to an online self-help mental health program (myCompass) in improving uptake of and adherence to that program, and 2) assess if greater uptake and/or adherence are associated with improved efficacy (greater reduction in symptoms of depression and anxiety) relative to a control condition). Methods A three-arm randomized controlled trial will be conducted (target sample: N = 693 participants recruited via social media). An active online cognitive behavioral therapy (iCBT) intervention will be delivered either with (arm 1) or without (arm 2) the EFI. An attention control group (arm 3) will enable testing of the relative efficacy of the iCBT intervention. Primary outcomes are uptake of the intervention (initiation) and adherence (module completion). Results Findings will inform the more efficient dissemination of a range of psychosocial programs into the community, with potential for significant efficiency gains in treating common mental health problems. Conclusions Greater engagement with online psychosocial programs may lead to significant reductions in the burden of common mental health problems in the community. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001565235. [ABSTRACT FROM AUTHOR]

Background: Mental health problems are common among university students, yet many students do not seek professional help. Digital mental health interventions can increase students' access to support and have been shown to be effective in preventing and treating mental health problems. However, little is known about the extent to which students implement therapeutic skills from these programs in everyday life (ie, skill enactment) or about the impact of skill enactment on outcomes., Objective: This study aims to assess the effects of a low-intensity video-based intervention, Uni Virtual Clinic Lite (UVC-Lite), in improving skill enactment relative to an attention-control program (primary aim) and examine whether skill enactment influences symptoms of depression and anxiety (secondary aim). The study also qualitatively explored participants' experiences of, and motivations for, engaging with the therapeutic techniques., Methods: We analyzed data from a randomized controlled trial testing the effectiveness of UVC-Lite for symptoms of depression and anxiety among university students with mild to moderate levels of psychological distress. Participants were recruited from universities across Australia and randomly assigned to 6 weeks of self-guided use of UVC-Lite (243/487, 49.9%) or an attention-control program (244/487, 50.1%). Quantitative data on skill enactment, depression, and anxiety were collected through baseline, postintervention, and 3- and 6-month follow-up surveys. Qualitative data were obtained from 29 intervention-group participants through open-ended questions during postintervention surveys (n=17, 59%) and semistructured interviews (n=12, 41%) after the intervention period concluded., Results: Mixed model repeated measures ANOVA demonstrated that the intervention did not significantly improve skill enactment (F 3,215.36 =0.50; P=.68). Skill enactment was also not found to influence change in symptoms of depression (F 3,241.10 =1.69; P=.17) or anxiety (F 3,233.71 =1.11; P=.35). However, higher levels of skill enactment were associated with lower symptom levels among both intervention and control group participants across time points (depression: F 1,541.87 =134.61; P<.001; anxiety: F 1,535.11 =73.08; P<.001). Inductive content analysis confirmed low levels of skill enactment among intervention group participants. Participants were motivated to use techniques and skills that were perceived to be personally relevant, easily integrated into daily life, and that were novel or had worked for them in the past., Conclusions: The intervention did not improve skill enactment or mental health among students with mild to moderate psychological distress. Low adherence impacted our ability to draw robust conclusions regarding the intervention's impact on outcomes. Factors influencing skill enactment differed across individuals, suggesting that it may be necessary to tailor therapeutic skills and engagement strategies to the individual user. Theoretically informed research involving collaboration with end users is needed to understand the processes underlying skill enactment in digital mental health interventions., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://tinyurl.com/7b9ar54r., (©Hayley M Jackson, Philip J Batterham, Alison L Calear, Jeneva L Ohan, Louise M Farrer. Originally published in JMIR Mental Health (https://mental.jmir.org), 21.08.2024.)

Background: Numerous studies have demonstrated the effectiveness of digital interventions for improving the mental health of university students. However, low rates of engagement with these interventions are an ongoing challenge and can compromise effectiveness. Brief, transdiagnostic, web-based video interventions are capable of targeting key mental health and related issues affecting university students and may be more engaging and accessible for this population., Objective: This study used a 2-arm randomized controlled trial to evaluate the effectiveness of Uni Virtual Clinic-Lite (UVC-Lite), a fully automated, transdiagnostic, web-based video intervention, relative to an attention-control condition. The primary outcomes were symptoms of depression and generalized anxiety disorder. The secondary outcomes included psychological distress, social anxiety symptoms, body appreciation, quality of life, well-being, functioning, general self-efficacy, academic self-efficacy, and help seeking. Program use (intervention uptake and engagement) and satisfaction were also assessed., Methods: University students (n=487) with mild to moderate symptoms of distress were recruited from universities across Australia and randomly allocated to receive access to the UVC-Lite intervention or an attention-control condition targeting general health for a period of 6 weeks. UVC-Lite includes 12 modules, each comprising a brief animated video and an accompanying exercise. Of the 12 modules, 7 also included a brief symptom screening quiz. Outcomes were assessed at baseline, postintervention, and 3- and 6-months postintervention., Results: The primary and secondary outcomes were analyzed on an intention-to-treat basis using mixed models repeated measures ANOVA. The intervention was not found to be effective relative to the control condition on any of the primary or secondary outcomes. While 67.9% (114/168) of participants accessed at least 1 module of the intervention, module completion was extremely low. Subgroup analyses among those who engaged with the program (completed at least 1 video) and those with higher baseline distress (Distress Questionnaire-5 score ≥15) did not reveal any differences between the conditions over time. However, uptake (accessing at least 1 video) and engagement (completing at least 1 video) were higher among those with higher baseline symptoms. Satisfaction with the intervention was high., Conclusions: The UVC-Lite intervention was not effective relative to a control program, although it was associated with high satisfaction among students and was not associated with symptom deterioration. Given the challenges faced by universities in meeting demand for mental health services, flexible and accessible interventions such as UVC-Lite have the potential to assist students to manage symptoms of mental health problems. However, low uptake and engagement (particularly among students with lower levels of symptomatology) are significant challenges that require further attention. Future studies should examine the effectiveness of the intervention in a more highly symptomatic sample, as well as implementation pathways to optimize effective engagement with the intervention., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380146., (©Louise M Farrer, Hayley M Jackson, Amelia Gulliver, Alison L Calear, Liana Leach, Penelope Hasking, Natasha Katruss, Philip J Batterham. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 13.08.2024.)

Background: Most people with mental health problems do not seek help, with delays of even decades in seeking professional help. Lack of engagement with professional mental health services can lead to poor outcomes and functional impairment. However, few effective interventions have been identified to improve help-seeking in adults, and those that exist are not widely implemented to deliver public health impact. Co-designing interventions with people with lived experience of mental ill-health and other relevant stakeholders is critical to increase the likelihood of uptake and engagement with these programs., Objective: This study aims to (1) test the effectiveness of a co-designed help-seeking program on increasing professional help-seeking intentions in employees in a workplace setting; (2) determine whether the program reduces mental illness stigma and improves help-seeking intentions and behavior, mental health literacy, mental health symptoms, and work and activity functioning relative to the control condition; (3) explore factors that facilitate broader implementation of the co-designed program; and (4) explore the cost-effectiveness of the co-designed program compared to the control condition over 6 months., Methods: A 2-arm cluster randomized controlled trial will be conducted (target sample: N=900 from 30 to 36 workplaces, with n=25 to 35 participants per workplace). The trial will compare the relative effectiveness of an enhanced interactive program (intervention condition) with a standard psychoeducation-alone program (active control condition) on the primary outcome of professional help-seeking intentions as measured by the General Help-Seeking Questionnaire. Secondary outcomes include the impact on mental illness stigma; mental health literacy; help-seeking attitudes and behavior; work and activity functioning; quality of life; and symptoms of mental ill-health including depression, anxiety, and general psychological distress., Results: Facilitators of and risks to the trial are identified and addressed in this protocol. Recruitment of workplaces is scheduled to commence in the first quarter of 2024., Conclusions: If effective, the program has the potential to be ready for rapid dissemination throughout Australia, with the potential to increase appropriate and efficient service use across the spectrum of evidence-based services., Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000270617p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385376., International Registered Report Identifier (irrid): PRR1-10.2196/55529., (©Philip J Batterham, Amelia Gulliver, Cassandra Heffernan, Alison L Calear, Aliza Werner-Seidler, Alyna Turner, Louise M Farrer, Mary Lou Chatterton, Cathrine Mihalopoulos, Michael Berk. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 24.05.2024.)

A burgeoning array of affective indices are proposed to capture features of affect that contribute to mental health and well-being. However, because indices are often investigated separately, it is unclear what-if any-unique role they have. The present study addresses this question in a high-stress naturalistic context by prospectively testing the relative contributions of eight affective indices to psychological outcomes during the first acute lockdown phase of the COVID-19 pandemic. Across six fortnightly waves of data collection, participants ( N = 613, aged 19 to 87 years) reported how much they experienced five positive and five negative emotions in response to images showing the health and social impacts of the pandemic. We used these ratings to calculate participant-level indices of intensity, variability, and differentiation for positive and negative emotions separately, and positive-negative co-occurrence and ratios. Psychosocial outcome measures were general psychological distress, loneliness, work, and social impairment specifically due to the pandemic, well-being, and coping. On average, psychosocial functioning improved across the lockdown period, and, for most affective indices, bivariate relationships with psychosocial functioning supported existing theory and empirical work. However, multiple regression analyses suggested that the contributions of the individual indices were rarely unique, with most of the change in psychosocial functioning over time being explained by affect intensity and variability. These findings highlight that affective indices should be studied in concert to build a comprehensive and integrated understanding of their role in mental health and well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Digital cognitive behavioral therapy (CBT) interventions can effectively prevent and treat depression and anxiety, but engagement with these programs is often low. Although extensive research has evaluated program use as a proxy for engagement, the extent to which users acquire knowledge and enact skills from these programs has been largely overlooked., Objective: This study aimed to investigate how skill enactment and knowledge acquisition have been measured, evaluate postintervention changes in skill enactment and knowledge acquisition, examine whether mental health outcomes are associated with skill enactment or knowledge acquisition, and evaluate predictors of skill enactment and knowledge acquisition., Methods: PubMed, PsycINFO, and Cochrane CENTRAL were searched for randomized controlled trials (RCTs) published between January 2000 and July 2022. We included RCTs comparing digital CBT with any comparison group in adolescents or adults (aged ≥12 years) for anxiety or depression. Eligible studies reported quantitative measures of skill enactment or knowledge acquisition. The methodological quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs. Narrative synthesis was used to address the review questions., Results: In total, 43 papers were included, of which 29 (67%) reported a skill enactment measure and 15 (35%) reported a knowledge acquisition measure. Skill enactment was typically operationalized as the frequency of enacting skills using the completion of in-program activities (ie, formal skill enactment; 13/29, 45%) and intervention-specific (9/29, 31%) or standardized (8/29, 28%) questionnaires. Knowledge measures included tests of CBT knowledge (6/15, 40%) or mental health literacy (5/15, 33%) and self-report questionnaires (6/15, 40%). In total, 17 studies evaluated postintervention changes in skill enactment or knowledge acquisition, and findings were mostly significant for skill enactment (6/8, 75% of the studies), CBT knowledge (6/6, 100%), and mental health literacy (4/5, 80%). Of the 12 studies that evaluated the association between skill enactment and postintervention mental health outcomes, most reported ≥1 significant positive finding on standardized questionnaires (4/4, 100%), formal skill enactment indicators (5/7, 71%), or intervention-specific questionnaires (1/1, 100%). None of the 4 studies that evaluated the association between knowledge acquisition and primary mental health outcomes reported significant results. A total of 13 studies investigated predictors of skill enactment; only type of guidance and improvements in psychological variables were associated with increased skill enactment in ≥2 analyses. Predictors of knowledge acquisition were evaluated in 2 studies., Conclusions: Digital CBT for depression and anxiety can improve skill enactment and knowledge acquisition. However, only skill enactment appears to be associated with mental health outcomes, which may depend on the type of measure examined. Additional research is needed to understand what types and levels of skill enactment and knowledge acquisition are most relevant for outcomes and identify predictors of these constructs., Trial Registration: PROSPERO CRD42021275270; https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=275270., (©Hayley M Jackson, Alison L Calear, Philip J Batterham, Jeneva L Ohan, Glenda M Farmer, Louise M Farrer. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 31.05.2023.)

Background: Social distancing requirements due to the COVID-19 pandemic saw a rapid increase in the delivery of telehealth consultations as an alternative to face-to-face health care services., Objective: The aims of this study were to assess the use and acceptability of telehealth during the early stages of the pandemic and identify factors associated with telehealth avoidance during this period., Methods: Data were obtained from waves 4 and 7 of a longitudinal survey designed to assess the impact of the COVID-19 pandemic on the health and behavior of a representative sample of Australian adults. Participants reported on their use or avoidance of telehealth during the assessment period, as well as the mode of telehealth used and acceptability., Results: Approximately 30% of participants reported using telehealth during the assessment periods, with the most common telehealth modality being the telephone. Acceptance of telehealth was generally high and was higher among those who used telehealth compared with those who did not. Approximately 18% of participants reported avoiding health care due to telehealth. Across assessment waves, avoidance was associated with younger age, speaking a language other than or in addition to English, having a current medical diagnosis, and lower levels of telehealth acceptability., Conclusions: While most participants in this study were accepting of telehealth services, there remain barriers to use, especially among those from particular sociodemographic groups. At a population level, avoidance of health services in nearly one in five adults may have considerable long-term impacts on morbidity and potentially mortality. Targeted efforts to promote engagement with telehealth services are critical if these adverse outcomes are to be avoided, particularly during periods when access to face-to-face services may be limited., (©Louise M Farrer, Philip J Batterham, Amelia Gulliver, Alyssa Morse, Alison L Calear, Sonia McCallum, Michelle Banfield, Yiyun Shou, Eryn Newman, Amy Dawel. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 08.02.2023.)

Students transitioning from secondary school to university may experience unique issues that impact their mental health. There is limited research, however, on what drives first year students to seek professional help for mental health problems. There is also a current lack of knowledge about the factors that may be associated with engagement with university life in students transitioning to university, and how engagement may be related to help seeking attitudes and behaviours in a first year university population. Data ( N = 165) were drawn from two waves (Wave 1, February 2021, and Wave 4, June 2021) of a longitudinal study of Australian university students commencing study for the first time, which included measures of engagement, belonging, stigma and help seeking intentions and behaviours. The results showed that students with higher levels of depression stigma prior to commencing university at Wave 1 had less positive attitudes towards help seeking at Wave 4. Students had increased odds of seeking help for a mental health problem in Wave 4 if they had moved away for university, reported higher levels of mental health literacy or willingness to disclose, had lower levels of engagement with university life and were experiencing higher levels of general psychological distress. Students experiencing higher thwarted belongingness were also found to have lower levels of engagement with university at Wave 4. Both thwarted belongingness and stigma were found to be associated with engagement with university and help seeking behaviours and should be examined further.

Objective: The present study examined behavioral responses during the coronavirus disease 2019 (COVID-19) pandemic and the role of dispositional risk tolerance in the Australian context., Method: The study involved a six-wave longitudinal investigation with a nationally representative sample of Australians ( N = 1,296). Dispositional risk tolerance was measured at Wave 1 and participants' anxiety level and self-report implementation of 10 COVID actions was assessed in each wave. Autoregressive multinomial regression models were estimated to assess the unique contribution of risk tolerance to the longitudinal change of participants' implementation of COVID actions., Results: The results revealed a high implementation rate for protective actions when Australia had a peak in the severity of the COVID-19 pandemic and subsequently declined with the easing threat of the pandemic. Individuals' dispositional risk tolerance significantly predicted transition to, and endorsement of, protective actions. Participants who had low risk tolerance were more likely to remain at the state of implementing COVID-19 measures than being in, or transitioning to, other states., Conclusions: The findings suggest that when encouraging protective actions, governments and public authorities should acknowledge variability in the community in responding to risk and consider measures in addition to risk messaging to encourage protective actions among individuals with a high level of risk tolerance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Previous work has generally conceptualized emotion regulation as contributing to mental health outcomes, and not vice versa. The present study challenges this assumption by using a prospective design to investigate the directionality of underlying relationships between emotion regulation and mental health in the context of a major population-level stressor. We surveyed a large nationally representative sample of adults (18-91 years, N = 704) at three 1-month intervals across the acute lockdown phase of the COVID-19 pandemic in Australia, using standardized measures of depression and anxiety symptoms. At each time point, we also measured the use of two emotion regulation strategies-cognitive reappraisal and emotional suppression-previously associated with adaptive and maladaptive mental health outcomes, respectively. We found cognitive reappraisal was unrelated to mental health symptoms. In contrast, greater emotional suppression was robustly associated with higher symptom levels for both depression and anxiety. Longitudinal analyses revealed this association reflected bidirectional relationships. Higher symptoms of depression and anxiety each predicted greater subsequent use of emotional suppression, and greater use of emotional suppression predicted higher subsequent symptoms. This bidirectionality suggests emotional suppression is both symptomatic and predictive of psychological distress. The lack of a relationship for cognitive reappraisal is discussed with respect to the pandemic context and evidence that high stress might reduce people's ability to use this strategy effectively. Given the strong emphasis on reappraisal in clinical practice, there is a critical need to understand for whom, what and when this strategy is helpful. (PsycInfo Database Record (c) 2021 APA, all rights reserved).