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Background: Blended care therapy models are intended to increase the efficiency and effectiveness of evidence-based psychotherapy by combining synchronous and asynchronous components of care., Objective: This retrospective cohort study evaluated the clinical effects of synchronous video therapy sessions and asynchronous guided practice session elements on anxiety and depression in a blended care therapy program, with a novel focus on asynchronous provider feedback messages., Methods: Participants were adults (N=33,492) with clinical symptoms of anxiety (Generalized Anxiety Disorder 7-item scale [GAD-7] score of ≥8) and depression (Patient Health Questionnaire 9-item scale [PHQ-9] score of ≥10) at intake. Symptom trajectories were evaluated via individual growth curve models. Time-varying covariates evaluated effects of synchronous video session attendance and the presence or absence of each asynchronous guided practice session element occurring within 7 days and 8-14 days prior to each clinical outcome assessment. Guided practice session elements included client digital lesson completion, client digital exercise completion, and feedback messages sent by providers., Results: Approximately 86.6% (29,012/33,492) of clients met criteria for clinical improvement by end of care (median 6, IQR 4-8 synchronous sessions). Synchronous video session attendance and client digital lesson completion in the past 7 days and in the past 8-14 days were each uniquely and significantly associated with lower GAD-7 scores (video session effects: b session7 =-0.82, b session8-14 =-0.58, P values<.001; digital lesson effects: b lesson7 =-0.18, b lesson8-14 =-0.26, P values <.001) and PHQ-9 scores (video session effects: b session7 =-0.89, b session8-14 =-0.67, P values <.001; digital lesson effects: b lesson7 =-0.12, b lesson8-14 =-0.30, P values <.001). Client digital exercise completion in the past 8-14 days was significantly associated with lower GAD-7 scores (b exercise8-14 =-0.10; P<.001) but exercise completion in the 7 days prior to clinical outcome assessment was not (b exercise7 =0.00; P=.89). Exercise completion in the past 7 days was significantly associated with lower PHQ-9 scores (b exercise7 =-0.16; P<.001) but exercise completion in the past 8-14 days was not (b exercise8-14 =-0.05; P=.09). Provider feedback messaging in the past 7 days and in the past 8-14 days was significantly associated with lower GAD-7 and PHQ-9 scores, respectively (GAD-7: b feedback7 =-0.12, P<.001; b feedback8-14 =-0.07, P=.004; PHQ-9: b feedback7 =-0.15, P<.001; b feedback8-14 =-0.08, P=.01)., Conclusions: Provider feedback between synchronous therapy sessions provided significant benefit for symptom reduction, beyond the effects of client digital engagement and synchronous video sessions. When guided practice sessions are well integrated into care, blended care therapy provides meaningful improvements upon the traditional, synchronous session-only therapy model. Provider guidance and feedback for clients between synchronous sessions support more efficient and effective mental health care overall., (©Hallie M Espel-Huynh, Lu Wang, Emily G Lattie, Robert E Wickham, Alethea Varra, Connie E Chen, Anita Lungu, Jennifer L Lee. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 18.10.2024.)

Background: eHealth interventions have proven to be valuable resources for users with diverse mental and behavioral health concerns. As these technologies continue to proliferate, both academic researchers and commercial app creators are leveraging the use of features that foster a sense of social connection on these digital platforms. Yet, the literature often insufficiently represents the functionality of these key social features, resulting in a lack of understanding of how they are being implemented., Objective: This study aimed to conduct a methodical review of commercially available eHealth apps to establish the SoCAP (social communication, affiliation, and presence) taxonomy of social features in eHealth apps. Our goal was to examine what types of social features are being used in eHealth apps and how they are implemented., Methods: A scoping review of commercially available eHealth apps was conducted to develop a taxonomy of social features. First, a shortlist of the 20 highest-rated eHealth apps was derived from One Mind PsyberGuide, a nonprofit organization with trained researchers who rate apps based on their (1) credibility, (2) user experience, and (3) transparency. Next, both mobile- and web-based versions of each app were double-coded by 2 trained raters to derive a list of social features. Subsequently, the social features were organized by category and tested on other apps to ensure their completeness., Results: Four main categories of social features emerged: (1) communication features (videoconferencing, discussion boards, etc), (2) social presence features (chatbots, reminders, etc), (3) affiliation and identity features (avatars, profiles, etc), and (4) other social integrations (social network and other app integrations). Our review shows that eHealth apps frequently use resource-intensive interactions (eg, videoconferencing with a clinician and phone calls from a facilitator), which may be helpful for participants with high support needs. Furthermore, among commercially available eHealth apps, there is a strong reliance on automated features (eg, avatars, personalized multimedia, and tailored content) that enhance a sense of social presence without requiring a high level of input from a clinician or staff member., Conclusions: The SoCAP taxonomy includes a comprehensive list of social features and brief descriptions of how these features work. This classification system will provide academic and commercial eHealth app creators with an understanding of the various social features that are commonly implemented, which will allow them to apply these features to enhance their own apps. Future research may include comparing the synergistic effects of various combinations of these social features., (©Ian Kwok, Melanie Freedman, Lisa Kamsickas, Emily G Lattie, Dershung Yang, Judith Tedlie Moskowitz. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.09.2024.)

Background: As research on the use of mobile technology to deliver mental health support grows, the research from China is still very limited. How to design an acceptable and usable mobile mental health service model suitable for China's social and cultural environment remains to be studied., Objective: To understand the acceptability and usability of a WeChat-based intervention among Chinese patients with depression, and to provide insights to promote future development of user-centered mobile mental health services design., Methods: The research team developed a multi-theoretical intervention that includes seven modules: recovery lessons, recovery journal, coaching sessions, mindfulness, personalized support, regular assessments and feedback collection. Forty-two patients diagnosed with depressive disorder were recruited, with a mixed sample of patients who were using an antidepressant medication ( n  = 29) and patients who were not using an antidepressant medication ( n  = 13). A single-arm mixed-methods study was conducted to understand engagement, satisfaction, usability and potential clinical effectiveness of the intervention., Results: There was a retention rate of 83.33% - 22 participants who used an antidepressant medication and 13 participants who did not use an antidepressant medication completed the final assessments. The median (upper quartile-lower quartile) of the completed 60 recovery journals and 7 coaching sessions was 56 (59-46) and 6 (7-4) times, respectively. Participants' satisfaction regarding their recovery progress, and on perceived helpfulness on different modules were high. The overall score of the user version of the Mobile Application Rating Scale was 4.23 (SD 0.44, range 1-5), indicating high acceptability and usability. Qualitative feedback identified three key themes: an efficient access to professional help, a personalized source of social support, and a facilitator of cognitive and behavioral change., Conclusions: This study demonstrated that a WeChat-based intervention for depression was acceptable, and has the potential to promote personal recovery. More studies are needed to understand the efficacy and implementation of this model in real world., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Emily G. Lattie is currently employed by Lyra Health. All other authors have declared no conflicts of interest., (© The Author(s) 2024.)

Background: Alzheimer disease is a degenerative neurological condition that requires long-term care. The cost of these responsibilities is often borne by informal caregivers, who experience an elevated risk of negative physical and psychological outcomes. Previously, we designed a positive emotion regulation intervention that was shown to improve well-being among dementia caregivers when delivered through one-on-one videoconferencing lessons with a trained facilitator. However, the format required significant resources in terms of logistics and facilitator time. To broaden the reach of the intervention, we aimed to develop the Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF) program, an iteration of the intervention in a self-guided, web-based format with enhanced opportunities for social connection., Objective: The aim of this study was to gather feedback to inform the design of social features for the SAGE LEAF intervention. In the absence of a facilitator, our goal with the self-guided SAGE LEAF intervention was to integrate various social features (eg, discussion board, automated support, and profiles) to maximize engagement among participants., Methods: Qualitative data were collected from 26 individuals through (1) interviews with participants who completed a previous version of the intervention via videoconferencing with a facilitator, (2) focus groups with dementia caregivers who had not previously experienced the intervention, and (3) focus groups with Alzheimer disease clinical care providers. We conducted a qualitative thematic analysis to identify which social features would be the most helpful and how they could be implemented in a way that would be best received by caregivers., Results: Interview and focus group feedback indicated that participants generally liked the potential features suggested, including the discussion boards, multimedia content, and informational support. They had valuable suggestions for optimal implementation. For example, participants liked the idea of a buddy system where they would be matched up with another caregiver for the duration of the study. However, they expressed concern about differing expectations among caregivers and the possibility of matched caregivers not getting along. Participants also expressed interest in giving caregivers access to a podcast on the skills, which would allow them to review additional content when they wished., Conclusions: Taken together, the discussions with caregivers and providers offered unique insights into the types of social features that may be integrated into the SAGE LEAF intervention, as well as implementation suggestions to improve the acceptability of the features among caregivers. These insights will allow us to design social features for the intervention that are optimally engaging and helpful for caregivers., (©Ian Kwok, Emily Gardiner Lattie, Dershung Yang, Amanda Summers, Paul Cotten, Caroline Alina Leong, Judith Tedlie Moskowitz. Originally published in JMIR Formative Research (https://formative.jmir.org), 25.04.2024.)

Objective: The COVID-19 pandemic has drastically increased use of remote-delivered mental health services. This study identifies advantages and limitations of remote-delivered services on college campuses to inform mental health delivery post-pandemic. Methods: Clinicians ( n  = 30) were asked to evaluate COVID-19's impact on their work, environment, and wellness in an online survey. Qualitative data was coded using a thematic analysis approach, while quantitative data was analyzed using descriptive statistics. Results: Many clinicians reported benefits of remote services, including increased accessibility, greater convenience, no change in therapeutic alliance, and decreased stress for clinicians. Clinicians also experienced challenges such as social isolation, technological difficulties, and personal/family concerns. Clinicians envisioned a hybrid service combining online and in-person activities post-pandemic. Conclusions: Overall, remote-delivered mental health services on college campuses have potential in increasing treatment quality while highlighting a necessity for further research in hybrid mental health delivery., Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2022.2038178 .