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Background Previous studies have shown that growing up with rheumatic conditions can fuel dissatisfaction and psychological distress, which in turn affects disease self-management and treatment adherence. Primary objective of this study was to estimate the prevalence of anxiety and depression symptoms in adolescents and young adults (AYA) with juvenile idiopathic arthritis (JIA) and to identify correlates of conspicuous screening results. Methods Initiated as part of the COACH multicenter observational study, outpatients aged 12 to 21 years participating in the National Pediatric Rheumatological Database (NPRD) were prospectively screened for mental health using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder Scale-7 (GAD-7). Results Data from 1,150 adolescents with JIA (mean age 15.6 ± 2.2 years; mean disease duration 7.2 ± 4.9 years, 69% female, 43% oligoarthritis, 26% polyarthritis) were analysed. Overall, 32.7% ( n  = 316) of AYA showed conspicuous screening results, of whom 30.4% reported clinically relevant suicidal or self-harm thoughts. About 19% of screened patients showed moderate to severe depressive or anxious symptoms. AYA with conspicuous screening results were older (15.8 vs. 15.2 years; p  < 0.0001), more often female (81% vs. 64%; p  < 0.0001) and more often overweight (25% vs. 17%; p  = 0.006). They had higher disease activity (physician global assessment on NRS 0–10; 1.7 vs. 1.2; p  < 0.0001), more functional limitations (CHAQ; 0.44 vs. 0.14; <0.0001) and rated their health status worse (NRS 0–10; 3.5 vs. 1.8; p  < 0.0001) than AYA with inconspicuous screening results. Females (OR 2.33 [CI 1.53–3.56]; p  < 0.0001), older age (OR 1.09 [CI 1.01–1.18]; p  = 0.026), patients with more functional limitations (OR 3.36 [CI 1.98–5.72]; p  < 0.0001), and patients with worse subjective health status (OR 1.17 [CI 1.07–1.27]; p  < 0.0001) were more likely to have a conspicuous screening result. Regular sports participation was associated with a lower likelihood of conspicuous screening result (OR 0.69 [CI 0.49–0.98]; p  = 0.039). Conclusions A large-scale outpatient screening of AYA with JIA in Germany shows a high prevalence of anxiety and depression symptoms. The need for routine screening for early detection of mental health problems became apparent.

ObjectiveThis systematic review and meta-analysis evaluates the available evidence on efficacy of social support strategies, as defined by the persuasive system design framework, in internet-based and mobile-based interventions (IMI) targeting mental health.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials.Eligibility criteria for selecting studiesRandomised controlled trials comparing IMI implementing a social support strategy for mental health symptoms to various control conditions. Publications up to June 2023 (date of search 6 June 2023) were considered.Data extraction and synthesisTwo independent reviewers screened and extracted data in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed with the Risk of Bias Tool V.2.0. Data were pooled based on a random-effects model.ResultsAfter screening 6484 records, a total of 45 studies met our inclusion criteria. At 96%, social support was predominantly implemented through the strategy of social facilitation, by which users recognising others using the intervention (eg, discussion forum). IMI implementing social support strategies showed moderate effect sizes of Hedges’ g=−0.34 (95% CI −0.47 to −0.21, p<0.001) in comparison to different control conditions. Heterogeneity was considerable (I2=73.6%; 95% CI 64.8 to 80.3). Subgroup analyses revealed a significant influence of targeted psychological condition (p<0.001), type of social support (p<0.001) and control condition (p<0.001). In k=11 component studies (ie, comparison to a disentangled version of the same intervention), IMI with social support strategies were not significantly more effective in comparison to the same IMI without social support (Hedges’ g=−0.08 (95% CI −0.22 to 0.05, p=0.19, I2=0%). 64% (k=7) of component studies reported higher adherence rates in IMI with social support.ConclusionsBased on a small number of component studies, implementing social support strategies in IMI that target mental health symptoms has no significant incremental benefit on effectiveness. To draw more robust conclusions, the potential of other social support strategies besides social facilitation should be exploited in future component studies.PROSPERO registration numberCRD42020222810.

Background Adolescents and young adults (AYA) with a chronic somatic disease (CD) have a 3-fold higher risk of post-traumatic stress disorder (PTSD) than healthy controls. In addition, elevated post-traumatic stress symptoms (PTSS) have a negative impact on CD severity, treatment adherence, health problems and functional impairment. However, a more detailed understanding of this comorbidity is lacking. Methods AYA with type 1 diabetes mellitus, juvenile idiopathic arthritis or cystic fibrosis (12–21 years of age) and elevated anxiety and/or depression symptoms, as well as their reference persons (≥ 18 years of age), completed online questionnaires in self- or observer report. The most stressful event related to the CD was reported descriptively. Questionnaires were used to assess PTSS, anxious and depressive symptoms, actual overall health, coping, personal growth and social support. Qualitative content analysis, linear regression models and correlations were used for mixed methods analysis. Results According to the reports of n  = 235 AYA (mean age 15.61; 73% girls) and n  = 70 reference persons, four categories were identified as the most stressful events due to CD: (1) psychological burden (40% of AYA / 50% of reference persons); (2) CD self-management (32% / 43%); (3) social burden (30% / 27%); and (4) physical impairment (23% / 16%). 37% of AYA reported clinically relevant PTSS due to CD. The best predictors of PTSS severity were anxious-depressive symptoms, emotional coping, personal growth and current overall health ( F (4, 224) = 59.404, R² = 0.515, p  < .001). Of all categories, psychological ( β  = 0.216, p  = .002) and social burden ( β  = 0.143, p  = .031) showed significant association with the severity of PTSS ( F (4, 230) = 4.489, R² = 0.072, p  = .002). The more categories the most stressful event addressed, the higher was the PTSS symptom severity ( r  = .168, p  = .010). Conclusions Many AYA showed clinically relevant PTSS and reported experiencing stressful events in several areas of life through their CD. The association between the stressful event categories and other variables could help identify AYA with CD who need psychological interventions the most. Trial registration : German Clinical Trials Register (DRKS): DRKS00016714, registered on 25/03/2019 and DRKS00017161, registered on 17/09/201.

The challenge of sustaining user engagement in eHealth interventions is a pressing issue with significant implications for the effectiveness of these digital health tools. This study investigates user engagement in a cognitive-behavioral therapy-based eHealth intervention for procrastination, using a dataset from a randomized controlled trial of 233 university students. Various machine learning models, including Decision Tree, Gradient Boosting, Logistic Regression, Random Forest, and Support Vector Machines, were employed to predict patterns of user engagement. The study adopted a two-phase analytical approach. In the first phase, all features of the dataset were included, revealing ‘total_minutes’—the total time participants spent on the intervention and the eHealth platform—as the most significant predictor of engagement. This finding emphasizes the intuitive notion that early time spent on the platform and the intervention is a strong indicator of later user engagement. However, to gain a deeper understanding of engagement beyond this predominant metric, the second phase of the analysis excluded ‘total_minutes’. This approach allowed for the exploration of the roles and interdependencies of other engagement indicators, such as ‘number_intervention_answersheets’—the number of completed lessons, ‘logins_first_4_weeks’—login frequency, and ‘number_diary_answersheets’—the number of completed diaries. The results from this phase highlighted the multifaceted nature of engagement, showing that while ‘total_minutes’ is strongly correlated with engagement, indicating that more engaged participants tend to spend more time on the intervention, the comprehensive engagement profile also depends on additional aspects like lesson completions and frequency of platform interactions.

Public attitudes vary across mental health (MH) problems. However, research on young people and certain MH conditions is limited. This online-experiment examined stigma and potential help-seeking among 554 adolescents and emerging adults aged 14–29 years towards generalized anxiety disorder, depression (DEP), bulimia nervosa (BN), non-suicidal self-injury (NSSI), and problematic alcohol use (ALC). Participants were randomized to a video vignette depicting one of the five MH problems. Attitudes were measured with the Universal Stigma Scale (subscales: “blame/ personal responsibility” and “impairment/ distrust”) and the General Help Seeking Questionnaire assessing the likelihoods of seeking professional, informal, and no help for the respective MH problem. Data were analysed using Kruskal-Wallis and Bonferroni-corrected Dunn’s tests. Compared to all of the other conditions, ALC was the most stigmatized. Furthermore, ALC was more likely to prompt any help-seeking as compared to DEP, BN, and NSSI, and professional help-seeking in comparison to DEP. BN elicited more blame than DEP, whereas the reverse pattern emerged for distrust. However, this sample generally held positive MH attitudes. The results highlight the importance of addressing disorder-specific stigma and may inform the development of targeted anti-stigma and help-seeking campaigns. Trial registration : This study has been registered at the German Clinical Trials Register (www.drks.de) on September 23rd, 2020 https//drks.de/search/de/trial/DRKS00023110 #DRKS00023110.

This review investigates persuasive design frameworks within eHealth, concentrating on methodologies, their prevalence in mental and behavioral health applications, and identifying current research gaps. An extensive search was conducted across 8 databases, focusing on English publications with full text available. The search prioritized primary research articles, post-2011 applications, and eHealth platforms emphasizing treatment or support. The inclusion process was iterative, involving multiple authors, and relied on detailed criteria to ensure the relevance and contemporaneity of selected works. The final review set comprised 161 articles, providing an overview of persuasive design frameworks in eHealth. The review highlights the state of the art in the domain, emphasizing the utilization and effectiveness of these frameworks in eHealth platforms. This review details the restricted adoption of persuasive design frameworks within the field of eHealth, particularly in the mental and behavioral sectors. Predominant gaps include the scarcity of comparative evaluations, the underrepresentation of tailored interventions, and the unclear influence of persuasive components on user experience. There is a notable requirement for further scrutiny and refinement of persuasive design frameworks. Addressing these concerns promises a more substantial foundation for persuasive design in eHealth, potentially enhancing user commitment and platform efficiency.

Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers. This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people. This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability. No significant group effects on potential professional help seeking were found in the total sample (F =0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F =3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems. Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults. German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110.

Background Academic procrastination is widespread among college students. Procrastination is strongly negatively correlated with psychological well-being, thus early interventions are needed. Internet- and mobile-based cognitive behavioral therapy (iCBT) could provide a low-threshold treatment option. Human guidance seems to be a decisive mechanism of change in iCBT. Persuasive design optimization of iCBT and guidance by a digital coach might represent a resource-saving alternative. The study evaluated the non-inferiority of a digital coach in comparison to human guidance with regard to the primary outcome procrastination. Methods The iCBT StudiCare procrastination was optimized by principles of the Persuasive System Design (PSD). A total of 233 college students were randomly assigned to either StudiCare procrastination guided by a digital coach (intervention group, IG) or by a human eCoach (control group, CG). All participants were assessed at baseline, 4-, 8- and 12-weeks post-randomization. Symptom change and between-group differences were assessed with latent growth curve models and supported by effect size levels. The non-inferiority margin was set at Cohen’s d  = − 0.3. Results The primary outcome procrastination measured by the Irrational Procrastination scale (IPS) significantly decreased across groups (γ = − 0.79, p  < .001, Cohen’s d = -0.43 to -0.89) from baseline to 12-weeks post-randomization. There were no significant differences between groups (γ = -0.03, p  = .84, Cohen’s d = -0.03 to 0.08). Regarding symptoms of depression, no significant time x group effect was found (γ = 0.26, p  = .09; Cohen’s d = -0.15 to 0.21). There was also no significant time x group effect on the improvement of symptoms of anxiety (γ = 0.25, p  = .09). However, Cohen’s d s were above the non-inferiority margin 8-weeks (Cohen’s d  = 0.51) and 12-weeks post-randomization (Cohen’s d  = 0.37), preferring the CG. Of the IG, 34% and of the CG, 36% completed 80% of the modules. Conclusions The PSD optimized version of StudiCare procrastination is effective in reducing procrastination. The digital coach was not inferior to human guidance. Guidance by a digital coach in iCBT against procrastination for college students could be a resource-saving alternative to human guidance. Trial registration The trial was registered at the WHO International Clinical Trials Registry Platform via the German Clinical Trial Register (ID: DRKS00025209, 30/04/2021).

Objective To create and validate a micro-costing methodology that surgeons and hospital administrators can use to evaluate the cost of implementing innovative surgical technologies. Methods Our analysis is broken down into several elements of fixed and variable costs which are used to effectively and easily calculate the cost of surgical operations. As an example of application, we use data from 86 robot assisted gastric bypass operations made in our hospital. To validate our methodology, we discuss the cost reporting approaches used in 16 surgical publications with respect to 7 predefined criteria. Results Four formulas are created which allow users to import data from their health system or particular situation and derive the total cost. We have established that the robotic surgical system represents 97.53 % of our operating room’s medical device costs which amounts to $4320.11. With a mean surgery time of 303 min, personnel cost per operation amounts to $1244.73, whereas reusable instruments and disposable costs are, respectively, $1539.69 and $3629.55 per case. The literature survey demonstrates that the cost of surgery is rarely reported or emphasized, and authors who do cover this concept do so with variable methodologies which make their findings difficult to interpret. Conclusion Using a micro-costing methodology, it is possible to identify the cost of any new surgical procedure/technology using formulas that can be adapted to a variety of operations and healthcare systems. We hope that this paper will provide guidance for decision makers and a means for surgeons to harmonise cost reporting in the literature.