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Purpose: Promoting women's health during the interconception period is critical for the health of future pregnancies., Methods: This was a cross-sectional study to better understand interconception mental health and wellbeing using a convenience sample of women recruited on social media who completed an online survey., Results: Women who participated in the survey (N = 146) were 1 to 4 years since last pregnancy, primarily non-Hispanic White (81.2%), with an average age of 30 years (SD = 5.0; range = 19-47 years); 20% were insured by Medicaid. Depression, anxiety, stress, social support, mindfulness, and resilience were assessed. Approximately 22.9% reported depressive symptomatology, 18.8% symptoms of anxiety, 6.5% high stress, and 52.9% moderate stress. These patterns differed across years after giving birth, with percentages peaking for depressive symptoms during the first to second year (χ2 = 9.81, p = 0.007), and anxiety symptoms peaking after the third year (χ2 = 7.28, p = 0.026). Women reported moderate scores on wellbeing measures, with resilience scores decreasing as years since last pregnancy increased (F = 3.24, p = 0.042). Less than 25% reported that a provider discussed depressed mood during the interconception period., Clinical Implications: Our findings revealed high prevalence and temporal patterns of depressive and anxiety symptoms during the interconception period, identifying a need for nurses to continue to follow-up with their patients about mental health concerns well after the traditionally defined 1 year postpartum. Further investigation of women's mental health and wellbeing and their unique needs during the interconception period is warranted., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: In the United States, 68% of children do not get the recommended nine hours of sleep, which can lead to many negative health outcomes (e.g., mental health). Mindfulness meditation mobile apps may be an option for improving children's sleep and mental health outcomes; however, there is limited research on how children across different ages access these types of apps, the content they prefer, and the benefits they experience. Objective: The purpose of this study was to describe parents' reports of how and why their children use the Calm mindfulness meditation app and how using Calm may impact their sleep and mental well-being across age and gender. Method: This study was a cross-sectional survey of Calm subscribers (N = 2437) with children who used Calm. Participants were asked how their child accessed content, why their child used Calm, and the benefits of Calm for their child's sleep and mental well-being. Results: Approximately half of the parents reported that they used Calm with their child. Older children (13-17 years) were more likely to use Calm independently, preferred content outside of Calm Kids, and were more likely to use Calm to manage emotions. Younger children (2-12 years) most commonly used Calm with their parents and on a parent's device and preferred Calm Kids Sleep Stories. Conclusion: To our knowledge, this is the first study to explore parents' perceptions of children's use of a commercial mindfulness meditation app across ages. Children use Calm differently based on their.

Use of mindfulness mobile apps has become popular, however, there is little information about subscribers' perceptions of app content and its impact on sleep and mental health. The purpose of this study was to survey subscribers to Calm, a popular mindfulness meditation app, to explore perceived improvements in sleep and mental health, evaluate what components of the app were associated with improvements in sleep and mental health, and determine whether improvements differed based on sleep quality. Calm subscribers who had used a sleep-related component in the last 90 days completed a Web-based investigator-developed survey and the Pittsburgh Sleep Quality Index. The survey included questions about using Calm for sleep, sleep disturbances, mental health diagnoses (i.e., anxiety, depression, PTSD) and perceived impacts of the app. Participants reported on the extent to which they felt that using Calm had improved their sleep and mental health. Most participants reported sleep disturbance, and almost half reported a mental health diagnosis. The majority of participants reported that using Calm helped them fall asleep, stay asleep, and get restful sleep. All sleep components were associated with perceived improvements in sleep disturbance. Severity of sleep disturbance moderated relationships between using Calm components and reporting improved sleep. Among subscribers with mental health diagnoses, most reported that Calm helped improve symptoms. Perceived improvement in anxiety and depression was associated with using Calm's meditation components but not Sleep Stories or music/soundscapes. Severity of sleep disturbance did not moderate relationships between using Calm components and reporting mental health improvements. Given the accessibility of app-based meditation, research is needed to evaluate the efficacy of meditation apps to improve sleep disturbance. While some sleep content may be helpful for sleep, more research is needed to test what specific content affects mental health.

BackgroundOver 30% of Americans report regular sleep disturbance, and consumers are increasingly seeking strategies to improve sleep. Self-guided mindfulness mobile apps may help individuals improve their sleep. Despite the recent proliferation of sleep content within commercially available mindfulness apps, there is little research on how consumers are using these apps for sleep.ObjectiveWe conducted a cross-sectional survey among subscribers to Calm, a popular, consumer-based, mindfulness-based meditation app, and described and compared how good sleepers, poor sleepers, and those with self-reported insomnia use the app for sleep.MethodsParticipants who were paying subscribers of Calm and had used a sleep component of Calm in the last 90 days were invited to complete an investigator-developed survey that included questions about sleep disturbance and the use of Calm for sleep. Based on self-reports of sleep disturbances and of insomnia diagnosis, participants were categorized as "good sleepers," "poor sleepers," or "those with insomnia diagnosis." Chi-square tests compared reasons for downloading the app and usage patterns across participants with and without sleep disturbance.ResultsThere was a total of 9868 survey respondents. Approximately 10% of participants (1008/9868, 10.21%) were good sleepers, 78% were poor sleepers (7565/9868, 77.66%), and 11% reported a diagnosis of insomnia (1039/9868, 10.53%). The sample was mostly White (8185/9797, 83.55%), non-Hispanic (8929/9423, 94.76%), and female (8166/9578, 85.26%). The most common reasons for sleep disturbances were racing thoughts (7084/8604, 82.33%), followed by stress or anxiety (6307/8604, 73.30%). Poor sleepers and those with insomnia were more likely than good sleepers to have downloaded Calm to improve sleep (χ22=1548.8, P

The digital mental health industry has seen remarkable growth in recent years. However, within this crowded landscape, many companies overlook a critical factor for gaining a competitive edge: the integration of science. In this context, "science" refers to the strategic collection and analysis of information (i.e., data) at digital mental health companies, aimed at guiding business decisions and achieving business objectives. This paper demonstrates that science is integral, yet underutilized in the digital mental health industry, with common misconceptions about its role. When science is integrated within a company, it enables them to (1) innovate, (2) understand customers, (3) make informed decisions, and (4) drive revenue. Digital mental health companies recognizing the multifaceted value of science may be better equipped for sustainable growth and success amid the crowded digital health market. [ABSTRACT FROM AUTHOR]

Background: A growing body of evidence supports the efficacy of measurement-based care (MBC) for children and adolescents experiencing mental health concerns, particularly anxiety and depression. In recent years, MBC has increasingly transitioned to web-based spaces in the form of digital mental health interventions (DMHIs), which render high-quality mental health care more accessible nationwide. Although extant research is promising, the emergence of MBC DMHIs means that much is unknown regarding their effectiveness as a treatment for anxiety and depression, particularly among children and adolescents. Objective: This study uses preliminary data from children and adolescents participating in an MBC DMHI administered by Bend Health Inc, a mental health care provider that uses a collaborative care model to assess changes in anxiety and depressive symptoms during participation in the MBC DMHI. Methods: Caregivers of children and adolescents participating in Bend Health Inc for anxiety or depressive symptoms reported measures of their children's symptoms every 30 days throughout the duration of participation in Bend Health Inc. Data from 114 children (age 6-12 years) and adolescents (age 13-17 years) were used for the analyses (anxiety symptom group: n=98, depressive symptom group: n=61). Results: Among children and adolescents participating in care with Bend Health Inc, 73% (72/98) exhibited improvements in anxiety symptoms and 73% (44/61) exhibited improvement in depressive symptoms, as indicated by either a decrease in symptom severity or screening out of completing the complete assessment. Among those with complete assessment data, group-level anxiety symptom T-scores exhibited a moderate decrease of 4.69 points (P=.002) from the first to the last assessment. However, members' depressive symptom T-scores remained largely stable throughout their involvement. Conclusions: As increasing numbers of young people and families seek DMHIs over traditional mental health treatments due to their accessibility and affordability, this study offers promising early evidence that youth anxiety symptoms decrease during involvement in an MBC DMHI such as Bend Health Inc. However, further analyses with enhanced longitudinal symptom measures are necessary to determine whether depressive symptoms show similar improvements among those involved in Bend Health Inc. [ABSTRACT FROM AUTHOR]

Background: Middle-aged adults (40-65 years) report higher stress levels than most other age groups. There is a need to determine the feasibility of using a meditation app to reduce stress and improve stress-related outcomes in middle-aged adults with a focus on men, as previous meditation app–based studies have reported a low proportion of or even no male participants. Objective: This study aims to (1) determine the feasibility (ie, acceptability and demand with a focus on men) of a consumer-based meditation app (Calm), to reduce stress among middle-aged adults reporting elevated stress levels, and (2) explore the preliminary effects of Calm on perceived stress, psychological outcomes (anxiety, depressive symptoms, mindfulness, and general coping), health behaviors (physical activity and eating habits), and COVID-19 perceptions. Methods: This feasibility randomized controlled trial evaluated an app-based meditation intervention in middle-aged adults (N=83) with elevated stress levels (ie, Perceived Stress Scale score ≥15) and limited or no previous experience with meditation. Participants were randomized to the intervention group (Calm app) or a control (educational podcasts; POD) group. Participants completed self-report assessments at baseline and postintervention (week 4). Feasibility was measured as acceptability and demand using Bowen framework. Feasibility and COVID-19 perceptions data were examined using descriptive statistics, and preliminary effects were evaluated using repeated measures analysis of variance. Results: Participants were satisfied with Calm (27/28, 96%) and found it appropriate or useful (26/28, 93%). Most reported they would likely continue using the Calm app (18/28, 64%). More Calm users reported satisfaction, appropriateness or usefulness, and intent to continue app use than POD users. Calm users (n=33) completed a mean of 20 (SD 31.1) minutes of meditation on the days they meditated and 103 (SD 109.1) minutes of meditation per week. The average adherence rate to the prescribed meditation was 71% among Calm app users, compared to 62% among POD users. Recruitment rate of men was 35% (29/83). Of those randomized to Calm, 55% (15/29) were men, and retention among them was higher (14/15, 93%) than that among women (12/20, 60%). No significant within or between group differences were observed. Conclusions: A 4-week, app-based mindfulness meditation intervention (Calm) may be feasible for middle-aged adults and a useful stress-management tool. Calm users expressed satisfaction with the app and felt it was appropriate and useful. Significant improvements in perceived stress and psychological outcomes or stress-related health behaviors were not observed. Even though men spent less time in meditation than women did and completed fewer weekly sessions, they were more likely to adhere to the prescription. Further research is needed for improving stress and stress-related outcomes among middle-aged adults with emphasis on the effects of mindfulness meditation apps for men. [ABSTRACT FROM AUTHOR]

The objective of this study was to 1) determine the effects of a meditation app on depression and anxiety in adults with sleep disturbance, and 2) explore the potential mediating effects of fatigue, daytime sleepiness, and pre-sleep arousal on the relationship between use of the meditation app and changes in depression and anxiety. Participants were 239 adults with elevated insomnia symptoms (i.e., scores ≥ 10 on the Insomnia Severity Index) and limited or no previous experience with meditation. Depression, anxiety, fatigue, daytime sleepiness, and pre-sleep arousal were assessed at baseline, four weeks, and eight weeks. Repeated-measures ANCOVAs assessed intervention effects on depression and anxiety. Mediation models were estimated using the PROCESS macro. Participants in the meditation group had more improvement in depression and anxiety symptoms during the intervention period than did those in the control group. Changes in somatic and cognitive pre-sleep arousal at mid-intervention fully mediated effects on depression and partially mediated effects on anxiety. There were no significant indirect effects of fatigue and daytime-sleepiness on changes in mental health. A meditation app may improve depression and anxiety in adults with sleep disturbance, with effects being driven by improvements in pre-sleep arousal. Future studies should consider targeting pre-sleep arousal to improve mental health in this population. [ABSTRACT FROM AUTHOR]

Background: Depression, anxiety, and sleep disturbance are common problems that greatly affect quality of life for many myeloproliferative neoplasm (MPN) patients. App-based mindfulness meditation is a feasible nonpharmacologic approach for managing symptoms. However, previous research has not considered how patients' overall mental health may influence their responsiveness to these interventions. Objective: The purpose of this study was to conduct an exploratory, secondary analysis of the effects of a smartphone meditation app, Calm, on depression, anxiety, and sleep disturbance in MPN patients based on patients' baseline levels of Global Mental Health (GMH). Methods: Participants (N = 80) were a subset of MPN patients from a larger feasibility study. Patients were enrolled into an intervention (use Calm for 10 minutes daily for 4 weeks) or educational control group. Results: In multilevel models, there were significant 3-way interactions between time, group, and baseline GMH for depression and anxiety symptoms, with participants in the meditation intervention who reported the poorest baseline GMH experiencing the greatest reduction in symptoms over time. For both intervention and control participants, poorer initial GMH was associated with increases in sleep disturbance symptoms over time. Conclusions: Mindfulness meditation apps, such as Calm, may be effective in reducing depression and anxiety symptoms in MPN patients, particularly for those experiencing mental health difficulties. Given the need for accessible tools to self-manage chronic cancer–related symptoms, especially strong negative emotions, these findings warrant larger efficacy studies to determine the effects of app-based meditation for alleviating depression and anxiety in cancer populations. [ABSTRACT FROM AUTHOR]

Background: In the United States, approximately one in 110 pregnancies end in stillbirth affecting more than 26,000 women annually. Women experiencing stillbirth have a threefold greater risk of developing depressive symptoms compared to women experiencing live birth. Depression contributes negatively to health outcomes for both mothers and babies subsequent to stillbirth. Physical activity may improve depression in these women, however, little is known about acceptable physical activity interventions for women after stillbirth. This is the purpose of this descriptive exploratory study. Methods: Eligible women were between ages 19 and 45, and experienced stillbirth within one year of the study. An online survey was used to ask questions related to 1) pregnancy and family information (i.e., time since stillbirth, weight gain during pregnancy, number of other children) 2) physical activity participation, 3) depressive symptomatology, and 4) demographics. Results: One hundred seventy-five women participated in the study (M age = 31.26 ± 5.52). Women reported participating in regular physical activity (at least 150 minutes of moderate activity weekly) before (60%) and during (47%) their pregnancy, as well as after their stillbirth (61%). Only 37% were currently meeting physical activity recommendations. Approximately 88% reported depression (i.e., score of >10 on depression scale). When asked how women cope with depression, anxiety, or grief, 38% said physical activity. Of those that reported using physical activity to cope after stillbirth, they did so to help with depression (58%), weight loss (55%), and better overall physical health (52%). To cope with stillbirth, women used walking (67%), followed by jogging (35%), and yoga (23%). Women who participated in physical activity after stillbirth reported significantly lower depressive symptoms (M = 15.10, SD = 5.32) compared to women who did not participate in physical activity (M = 18.06, SD = 5.57; t = -3.45, p = .001). Conclusions: Physical activity may serve as a unique opportunity to help women cope with the multiple mental sequelae after stillbirth. This study provides data to inform healthcare providers about the potential role of physical activity in bereavement and recovery for women who have experienced stillbirth. Additional research is necessary in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Behavioral habits are often initiated by contextual cues that occur at approximately the same time each day; so, it may be possible to identify a reflexive habit based on the temporal similarity of repeated daily behavior. Mobile health tools provide the detailed, longitudinal data necessary for constructing such an indicator of reflexive habits, which can improve our understanding of habit formation and help design more effective mobile health interventions for promoting healthier habits.Objective: This study aims to use behavioral data from a commercial mindfulness meditation mobile phone app to construct an indicator of reflexive meditation habits based on temporal similarity and estimate the association between temporal similarity and meditation app users' perceived health benefits.Methods: App-use data from June 2019 to June 2020 were analyzed for 2771 paying subscribers of a meditation mobile phone app, of whom 86.06% (2359/2771) were female, 72.61% (2012/2771) were college educated, 86.29% (2391/2771) were White, and 60.71% (1664/2771) were employed full-time. Participants volunteered to complete a survey assessing their perceived changes in physical and mental health from using the app. Receiver operating characteristic curve analysis was used to evaluate the ability of the temporal similarity measure to predict future behavior, and variable importance statistics from random forest models were used to corroborate these findings. Logistic regression was used to estimate the association between temporal similarity and self-reported physical and mental health benefits.Results: The temporal similarity of users' daily app use before completing the survey, as measured by the dynamic time warping (DTW) distance between app use on consecutive days, significantly predicted app use at 28 days and at 6 months after the survey, even after controlling for users' demographic and socioeconomic characteristics, total app sessions, duration of app use, and number of days with any app use. In addition, the temporal similarity measure significantly increased in the area under the receiver operating characteristic curve (AUC) for models predicting any future app use in 28 days (AUC=0.868 with DTW and 0.850 without DTW; P<.001) and for models predicting any app use in 6 months (AUC=0.821 with DTW and 0.802 without DTW; P<.001). Finally, a 1% increase in the temporal similarity of users' daily meditation practice with the app over 6 weeks before the survey was associated with increased odds of reporting mental health improvements, with an odds ratio of 2.94 (95% CI 1.832-6.369).Conclusions: The temporal similarity of the meditation app use was a significant predictor of future behavior, which suggests that this measure can identify reflexive meditation habits. In addition, temporal similarity was associated with greater perceived mental health benefits, which demonstrates that additional mental health benefits may be derived from forming reflexive meditation habits. [ABSTRACT FROM AUTHOR]

Background: Meditation has become increasingly popular due to its health benefits; however, barriers to delivering meditation programs in traditional group-based formats limit the accessibility of these benefits. Smartphone-based meditation may increase the availability of these programs to larger, more diverse audiences; however, research on subscriber characteristics and usage patterns in meditation mobile apps is lacking. Objective: This study aimed to describe the demographics, clinical characteristics, and usage patterns of a convenience sample of Calm subscribers and explore the relationship between self-reported app usage and changes in health, stress, and sleep. Methods: Participants were 12,151 paying Calm subscribers (response rate=12.08%, 12,151/100,594) who completed an anonymous Web-based survey with 11 quantitative questions related to user engagement, reasons for starting Calm, and changes after using the app. Demographic characteristics, chronic health diagnoses, and sleep difficulties were also assessed. Chi-square tests were used to examine differences in app usage. Logistic regression models were used to examine demographic and health characteristics that may predict changes in health, stress, and sleep. Results: Respondents were 18-96 years old (mean 48.57 [SD 13.79]), primarily female (79.94%, 8778/10,981), white (81.41%, 8959/11,005), and most reported a chronic health diagnosis (56.86%, 6289/11,061). Mental health diagnoses (41.13%, 4549/11,061) were more common than physical health diagnoses (32.19%, 3560/11,061). Most respondents (76.31%, 8684/11,360) reported difficulties falling or staying asleep. On average, respondents had been using Calm for 11.49 months (SD 10.49), and 60.03% (7281/12,129) used it 5 or more times per week. Meditations (used by 80.02%, 9497/11,841) and Sleep Stories (55.66%, 6591/11,841) were the most popular components. The frequency of using Calm was associated with incremental increases in the likelihood of noticing changes in mental health (χ22=136.8; P <.001), physical health (χ22=102.8; P <.001), stress (χ22=128.1; P <.001), and sleep (χ22=141.4; P <.001). Respondents who had used Calm longer were also more likely to notice changes in mental health (OR 1.06 [95% CI 1.05 to 1.06]), physical health (OR 1.01 [95% CI 1.01 to 1.02]), stress (OR 1.04 [95% CI 1.04 to 1.05]), and sleep (OR 1.004 [95% CI 1.00 to 1.01]). Subscribers with sleep difficulties used Calm more frequently (χ82=11.5; P =.003), were more likely to use Sleep Stories (χ12=1590.2; P <.001), and were more likely to notice changes in their physical health (χ12=49.2; P <.001) and sleep (χ12=2391.1; P <.001). Conclusions: Results highlight important demographic characteristics and usage patterns among a self-selected sample of Calm subscribers. Mental health concerns and sleep appear to be top reasons for downloading Calm. Sleep Stories and meditations are the most popular app components. The frequency of using Calm was associated with incremental changes in outcomes. Findings support future randomized controlled trials testing the efficacy of Calm for health, stress, and sleep. Studies should also explore strategies to attract a more diverse sample of subscribers. [ABSTRACT FROM AUTHOR]