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Background: Digital mental health interventions offer unique advantages, and research indicates that these interventions are effective for a range of mental health concerns. Although these interventions are less established for individuals with serious mental illnesses, they demonstrate significant promise. A central consideration in traditional face-to-face therapies is the therapeutic alliance, whereas the nature of a digital therapeutic alliance and its relationship with outcomes requires further attention, particularly for individuals with serious mental illnesses. Objective: This narrative review aims to encourage further consideration and critical evaluation of the therapeutic alliance in digital mental health, specifically for individuals with serious mental illnesses. Methods: A narrative review was conducted by combining 3 main areas of the literature: the first examining the evidence for digital mental health interventions for serious mental illnesses, the second illuminating the nature and role of the therapeutic alliance in digital interventions, and the third surrounding practical considerations to enhance a digital therapeutic alliance. Results: Results indicated that a therapeutic alliance can be cultivated in digital interventions for those with serious mental illnesses, but that it may have unique, yet-to-be-confirmed characteristics in digital contexts. In addition, a therapeutic alliance appears to be less directly associated with outcomes in digital interventions than with those in face-to-face therapies. One possibility is that the digital therapeutic alliance is associated with increased engagement and adherence to digital interventions, through which it appears to influence outcomes. A number of design and implementation considerations may enhance the digital therapeutic alliance, including human support and technological features. Conclusions: More research is required to further understand the nature and specific role of a therapeutic alliance in digital interventions for serious mental illnesses, particularly in informing their design. This review revealed several key research priorities to advance the therapeutic alliance in digital interventions.

The Buddhist construct of nonattachment is a related, yet distinct construct to mindfulness. Whereas mindfulness refers to an individual’s open, present-centred awareness of what is happening in their field of consciousness, nonattachment denotes an absence of attempts to control what is happening in their field of consciousness. The aim of the present research was to determine whether nonattachment is a mechanism of mindfulness that mediates its relationship to psychological and subjective well-being, depression, anxiety and stress. Two sequential studies were conducted. Study 1 (N = 516) established that nonattachment mediated the relationship of mindfulness to psychological and subjective well-being. Study 2 (N = 416) demonstrated that nonattachment also mediated the relationship of mindfulness to depression, anxiety and stress. In combination, these studies are the first to demonstrate that the relationship of mindfulness to a broad range of psychological outcomes is at least partially determined by nonattachment. These findings provide insight into how mindfulness impacts mental health and have implications for the development and assessment of mindfulness-based interventions.

Objective Semi-automated tools used during the preliminary screening of articles in systematic reviews can start with a small set of seed articles and actively learn from human decisions to prioritise more relevant articles for subsequent screening. However, given that these tools are vulnerable to biases and lack clear stopping criteria, their performance in large-scale systematic reviews remains uncertain, especially in reviews covering broad subject areas that require a substantial number of representative seed articles. This article presents a hybrid approach that uses text-mining techniques combined with a semi-automated tool to effectively reduce, screen, and validate a large cohort of articles ( N  = 90,871). Result A preliminary evaluation using simulations indicated that this approach has the potential to craft a comprehensive collection of seed articles that covers broad subject areas for semi-automated tools in a large-scale systematic review. The strengths and limitations of using a semi-automated tool alone in such a context are discussed. Our approach increases the efficiency of automated tools by providing a larger and more focused selection of articles to start with, optimising the learning process for those tools and reducing biases. Additionally, our approach could increase the transparency and reusability of keywords for future review updates.

Seasonal variation of manic and depressive symptoms is a controversial topic in bipolar disorder research. Several studies report seasonal patterns of hospital admissions for depression and mania and variation in symptoms that appear to follow a seasonal pattern, whereas others fail to report such patterns. Differences in research methodologies, data analysis strategies, and temporal resolution of data may partly explain the variation in findings between studies. The current study adds a novel perspective to the literature by investigating specific meteorological factors such as atmospheric pressure, hours of sunshine, relative humidity, and daily maximum and minimum temperatures as more proximal predictors of self-reported daily mood change in people diagnosed with bipolar disorder. The results showed that daily maximum temperature was the only meteorological variable to predict clinically-relevant mood change, with increases in temperature associated with greater odds of a transition into manic mood states. The mediating effects of sleep and activity were also investigated and suggest at least partial influence on the prospective relationship between maximum temperature and mood. Limitations include the small sample size and the fact that the number and valence of social interactions and exposure to natural light were not investigated as potentially important mediators of relationships between meteorological factors and mood. The current data make an important contribution to the literature, serving to clarify the specific meteorological factors that influence mood change in bipolar disorder. From a clinical perspective, greater understanding of seasonal patterns of symptoms in bipolar disorder will help mood episode prophylaxis in vulnerable individuals.

IntroductionDigital technologies present tremendous opportunities for enabling long-term measurement of mental health in the general population. Emerging studies have established preliminary efficacy of collecting self-report data digitally. However, a key challenge when developing a new self-report instrument is navigating the abundance of existing instruments to select relevant constructs for measurements. This review is a precursor to developing a novel future integrated digital instrument for repeated measurements. We interrogate the literature as the first step towards optimal measurement of the multifaceted mental health concept, in the context of digital repeated measurement. This review aims to identify (1) digital self-report instruments administered repeatedly to measure the mental health of the general adult population; (2) their structure and format; (3) their psychometric properties; (4) their usage in empirical studies; and (5) the constructs these instruments were designed to measure (as characterised in the original publication), and the constructs the instruments have been used to measure in the identified empirical studies.Methods and analysisFive major electronic databases will be searched. Studies administering mental health instruments (in English) repeatedly to community dwellers in the general adult population are eligible. A reviewer will preliminarily screen for eligible studies. Then, two reviewers will independently screen the full text of the eligible articles and extract data. Both reviewers will resolve any disagreement through discussion or with a third reviewer. After the data extraction, a reviewer will manually search for the structure, format, psychometric properties and the original constructs these instruments were developed to measure. This review will synthesise the results in a narrative approach. The reporting in this review will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.Ethics and disseminationEthical approval is not required as no data will be collected. Findings of the systematic review will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42022306547

Robust connections have been identified between the pathophysiology of mental disorders and the functioning of the circadian system. The overarching objective of this study was to investigate the potential for circadian rhythms to be leveraged for therapeutics in mental disorders. We considered two approaches to chronotherapy-optimal timing of existing medications (\"clocking the drugs\") and redressing circadian abnormalities with small molecules (\"drugging the clock\"). We assessed whether circadian rhythm-modulating compounds can interact with the prominent drug targets of mental disorders utilizing computational tools like molecular docking and molecular dynamics simulation analysis. Firstly, an analysis of transcript-level rhythmic patterns in recognized drug targets for mental disorders found that 24-hour rhythmic patterns were measurable in 54.4% of targets in mice and 35.2% in humans. We also identified several drug receptors exhibiting 24-hour rhythmicity involved in critical physiological pathways for neural signaling and communication, such as neuroactive ligand-receptor interaction, calcium signaling pathway, cAMP signaling pathway, and dopaminergic and cholinergic synapses. These findings advocate that further research into the timing of drug administration in mental disorders is urgently required. We observed that many pharmacological modulators of mammalian circadian rhythms, including KL001, SR8278, SR9009, Nobiletin, and MLN4924, exhibit stable binding with psychotropic drug targets. These findings suggest that circadian clock-modulating pharmacologically active small molecules could be investigated further for repurposing in the treatment of mood disorders. In summary, the present analyses indicate the potential of chronotherapeutic approaches to mental disorder pharmacotherapy and specify the need for future circadian rhythm-oriented clinical research.

With the ubiquity of smartphones, digital self-report instruments have enormous potential to support the general population in monitoring their mental health. A primary challenge for researchers committed to advancing this work is simply to scope the plethora of widely used candidate instruments. The overarching aim of this study was to address this challenge to support and guide future research in this burgeoning area. This study aimed to conduct a literature review of self-report instruments used in empirical studies to measure mental health (1) in the general population, (2) delivered in a digital format, and (3) in longitudinal designs. Given the wide range of recognized \"mental health\" constructs, the review's search strategies were guided by Keyes' dual continua model of mental health, recognizing both deficits- and strengths-based constructs. This study's primary objective was to develop a first-of-its-kind ranking and synthesis of the most frequently used instruments that are potentially suitable for mental health self-monitoring. It was not an objective of this study to evaluate psychometric properties of the identified instruments-we hope the present ranking and synthesis will provide the foundation for future research into optimal digital, prospective self-report of mental health. Five major electronic databases were searched. Studies that administered digital mental health instruments (in English) repeatedly to community dwellers in the general adult population were eligible. The included studies were grouped by instruments for synthesis using a narrative approach. Preliminary screening of 95,849 records identified 8460 eligible records, among which 1000 records were randomly selected over 4 iterations for full-text screening. A total of 223 records were included. We found that the top 30 most commonly used instruments accounted for 78.4% (308/393) of the total usage across studies. These instruments predominantly measure deficits-based mental health constructs. The Patient Health Questionnaire 9 Items and Generalized Anxiety Disorder 7 Items were by far the most used instruments. The most commonly measured strengths-based constructs were life satisfaction and mental well-being. The findings of this review strongly suggest that scientific investigation of mental health constructs across time on digital platforms still prioritizes deficits-focused instruments originally developed for pen-and-paper administration using classical test theory. These findings are discussed in light of evidence in the literature that deficits-focused instruments demonstrate inferior distributional properties (floor effects) in the general population and theory suggesting that both deficits- and strengths-focused measurements are required to holistically assess mental health. Limitations of the review include the restricted focus on English language instruments and the pragmatic approach to selecting records for full-text screening. It is concluded that, in the smartphone age, it would be timely to develop new digital instruments framed by holistic models of mental health and using contemporary test construction approaches. PROSPERO CRD42022306547; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022306547. RR2-10.1136/bmjopen-2022-065162.

It is well established that gross prefrontal cortex damage can affect an individual's personality. It is also possible that subtle prefrontal cortex changes associated with conditions such as chronic pain, and not detectable until recent advances in human brain imaging, may also result in subtle changes in an individual's personality. In an animal model of chronic neuropathic pain, subtle prefrontal cortex changes including altered basal dendritic length, resulted in altered decision making ability. Using multiple magnetic resonance imaging techniques, we found in humans, although gray matter volume and on-going activity were unaltered, chronic neuropathic pain was associated with reduced free and bound proton movement, indicators of subtle anatomical changes, in the medial prefrontal cortex, anterior cingulate cortex and mediodorsal thalamus. Furthermore, proton spectroscopy revealed an increase in neural integrity in the medial prefrontal cortex in neuropathic pain patients, the degree of which was significantly correlated to the personality temperament of novelty seeking. These data reveal that even subtle changes in prefrontal cortex anatomy may result in a significant change in an individual's personality.

Pain is a complex phenomenon that is highly modifiable by expectation. Whilst the intensity of incoming noxious information plays a key role in the intensity of perceived pain, this intensity can be profoundly shaped by an individual's expectations. Modern brain imaging investigations have begun to detail the brain regions responsible for placebo and nocebo related changes in pain, but less is known about the neural basis of stimulus-expectancy changes in pain processing. In this functional magnetic resonance imaging study, we administered two separate protocols of the same noxious thermal stimuli to 24 healthy subjects. However, different expectations were elicited by different explanations to subjects prior to each protocol. During one protocol, pain intensities were matched to expectation and in the other protocol they were not. Pain intensity was measured continuously via a manually operated computerized visual analogue scale. When individuals expected the stimulus intensity to remain constant, but in reality it was surreptitiously increased or decreased, pain intensity ratings were significantly lower than when expectation and pain intensities were matched. When the stimulus intensities did not match expectations, various areas in the brain such as the amygdala, anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (dlPFC), and the midbrain periaqueductal gray matter (PAG) displayed significantly different patterns of activity compared to instances when stimulus intensity and pain expectations were matched. These results show that stimulus-expectancy manipulation of pain intensity alters activity in both higher brain and brainstem centers which are known to modulate pain under various conditions.

Background Knowledge construction is a form of communication in which people can work individually or collaboratively. Peer support services have been adopted by the public psychiatric and social welfare service as a regular form of intervention since 2015 in Hong Kong. Peer-based services can help people with bipolar disorder (BD) deal with the implications of the diagnosis, the way in which individuals with BD receive treatment, and the lifestyle changes that take place as a result of the diagnosis. Through a qualitative paradigm, this study aims to examine how individuals with BD use technical and expert-by-experience knowledge. Methods A total of 32 clients of mental health services were recruited from hospitals, Integrated Community Centers for Mental Wellness, and non-governmental organizations. They participated in semi-structured individual interviews. All interviews were recorded, transcribed verbatim, and analyzed using thematic analysis with the aid of NVivo. The findings were verified by peer researchers. Results Three main themes are presented in this article, including how clients made sense of the knowledge provided by mental health professionals and peer support workers (PSWs), critical perspectives about peer support services, and the way in which the services are more than knowledge transfer alone. Participants generally indicated that knowledge sharing revolved around three experiences: mood changes, medications, and sense of hope. Nevertheless, an empathic understanding of the clients’ experience was more important than the sharing of knowledge. Some clients perceived medication as the chief means to recovery, so PSWs were not useful for them. However, PSW role models had an effect beyond mere knowledge transmission, as they could promote clients’ pursuit of functional recovery goals. Conclusions The present study has improved our understanding of knowledge sharing between clients with BD and health professionals or PSWs, which should take place in an empathic and hope-instilling manner. It has also emphasized the value of the presence of a role model who can speak convincingly with clients to facilitate recovery. The present findings can be used to improve the care of people with BD by generating important guidance with regard to enhancing the knowledge exchange between clients and health practitioners.