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Background Technology use may be one strategy to promote mental health and wellbeing among young adults in post-secondary education settings experiencing increasing distress and mental health difficulties. The JoyPop™ app is mobile mental health tool with a growing evidence base. The objectives of this research are to (1) evaluate the effectiveness of the JoyPop™ app in improving emotion regulation skills (primary outcome), as well as mental health, wellbeing, and resilience (secondary outcomes); (2) evaluate sustained app use once users are no longer reminded and determine whether sustained use is associated with maintained improvements in primary and secondary outcomes; (3) determine whether those in the intervention condition have lower mental health service usage and associated costs compared to those in the control condition; and (4) assess users’ perspectives on the quality of the JoyPop™ app. Methods A pragmatic, parallel arm randomized controlled trial will be used. Participants will be randomly allocated using stratified block randomization in a 1:1 ratio to the intervention (JoyPop™) or control (no intervention) condition. Participants allocated to the intervention condition will be asked to use the JoyPop™ app at least twice daily for 4 weeks. Participants will complete outcome measures at four assessment time-points (first [baseline], second [after 2 weeks], third [after 4 weeks], fourth [after 8 weeks; follow-up]). Participants in the control condition will be offered access to the app after the fourth assessment time-point. Discussion Results will determine the effectiveness of the JoyPop™ app for promoting mental health and wellbeing among post-secondary students. If effective, this may encourage more widespread adoption of the JoyPop™ app by post-secondary institutions as part of their response to student mental health needs. Trial registration ClinicalTrials.gov NCT06154369 . Registered on November 23, 2023.

Background Indigenous youth in Northwestern Ontario who need mental health supports experience longer waits than non-Indigenous youth within the region and when compared to youth in urban areas. Limited access and extended waits can exacerbate symptoms, prolong distress, and increase risk for adverse outcomes. Innovative approaches are urgently needed to provide support for Indigenous youth in Northwestern Ontario. Using a randomized controlled trial design, the primary objective of this study is to determine the effectiveness of the JoyPop app compared to usual practice (UP; monitoring) in improving emotion regulation among Indigenous youth (12–17 years) who are awaiting mental health services. The secondary objectives are to (1) assess change in mental health difficulties and treatment readiness between youth in each condition to better understand the app’s broader impact as a waitlist tool and (2) conduct an economic analysis to determine whether receiving the app while waiting for mental health services reduces other health service use and associated costs. Methods A pragmatic, parallel arm randomized controlled superiority trial will be used. Participants will be randomly allocated in a 1:1 ratio to the control (UP) or intervention (UP + JoyPop) condition. Stratified block randomization will be used to randomly assign participants to each condition. All participants will be monitored through existing waitlist practices, which involve regular phone calls to check in and assess functioning. Participants in the intervention condition will receive access to the JoyPop app for 4 weeks and will be asked to use it at least twice daily. All participants will be asked to complete outcome measures at baseline, after 2 weeks, and after 4 weeks. Discussion This trial will evaluate the effectiveness of the JoyPop app as a tool to support Indigenous youth waiting for mental health services. Should findings show that using the JoyPop app is beneficial, there may be support from partners and other organizations to integrate it into usual care pathways. Trial registration https://clinicaltrials.gov/study/NCT05898516 [registered on June 1, 2023].

The minimal clinically important difference (MCID) is an important threshold to consider when evaluating the meaningfulness of improvement following an intervention. The JoyPop app is an evidence-based smartphone app designed to improve resilience and emotion regulation. Information is needed regarding the JoyPop app's MCID among culturally diverse youth. This study aims to calculate the MCID for youth using the JoyPop app and to explore how the MCID may differ for a subset of Indigenous youth. Youth (N=36; aged 12-18 years) were recruited to use the JoyPop app for up to 4 weeks as part of a larger pilot evaluation. Results were based on measures completed after 2 weeks of app use. The MCID was calculated using emotion regulation change scores (Difficulties in Emotion Regulation-Short Form [DERS-SF]) and subjective ratings on the Global Rating of Change Scale (GRCS). This MCID calculation was completed for youth overall and separately for Indigenous youth only. A significant correlation between GRCS scores and change scores on the DERS-SF supported face validity (r=-0.37; P=.04). The MCID in emotion regulation following the use of the JoyPop app for youth overall was 2.80 on the DERS-SF. The MCID for Indigenous youth was 4.29 on the DERS-SF. In addition, most youth reported improved emotion regulation after using the JoyPop app. These MCID findings provide a meaningful threshold for improvement in emotion regulation for the JoyPop app. They provide potential effect sizes and can aid in sample size estimations for future research with the JoyPop app or e-mental health technologies in general. The difference between overall youth and Indigenous youth MCID values also highlights the importance of patient-oriented ratings of symptom improvement as well as cultural considerations when conducting intervention research and monitoring new interventions in clinical practice.

Transitional-aged youth have a high burden of mental health difficulties in Canada, with Indigenous youth, in particular, experiencing additional circumstances that challenge their well-being. Mobile health (mHealth) approaches hold promise for supporting individuals in areas with less access to services such as Northern Ontario. The primary objective of this study is to evaluate the effectiveness of the JoyPop app in increasing emotion regulation skills for Indigenous transitional-aged youth (aged 18-25 years) on a waitlist for mental health services when compared with usual practice (UP). The secondary objectives are to (1) evaluate the impact of the app on general mental health symptoms and treatment readiness and (2) evaluate whether using the app is associated with a reduction in the use (and therefore cost) of other services while one is waiting for mental health services. The study is a pragmatic, parallel-arm randomized controlled superiority trial design spanning a 4-week period. All participants will receive UP, which involves waitlist monitoring practices at the study site, which includes regular check-in phone calls to obtain any updates regarding functioning. Participants will be allocated to the intervention (JoyPop+UP) or control (UP) condition in a 1:1 ratio using stratified block randomization. Participants will complete self-report measures of emotion regulation (primary outcome), mental health, treatment readiness, and service use during 3 assessments (baseline, second [after 2 weeks], and third [after 4 weeks]). Descriptive statistics pertaining to baseline variables and app usage will be reported. Linear mixed modeling will be used to analyze change in outcomes over time as a function of condition assignment, while a cost-consequence analysis will be used to evaluate the association between app use and service use. Recruitment began September 1, 2023, and is ongoing. In total, 2 participants have completed the study. This study will assess whether the JoyPop app is effective for Indigenous transitional-aged youth on a waitlist for mental health services. Positive findings may support the integration of the app into mental health services as a waitlist management tool. ClinicalTrials.gov NCT05991154; https://clinicaltrials.gov/study/NCT05991154. DERR1-10.2196/64745.

IntroductionMobile health (mHealth) apps are a promising adjunct to traditional mental health services, especially in underserviced areas. Developed to foster resilience in youth, the JoyPop™ app has a growing evidence base showing improvement in emotion regulation and mental health symptoms among youth. However, whether this novel technology will be accepted among those using or providing mental health services remains unknown. This study aimed to evaluate the JoyPop™ app's acceptance among (a) a clinical sample of youth and (b) mental health service providers.MethodA qualitative descriptive approach involving one-on-one semi-structured interviews was conducted. Interviews were guided by the Technology Acceptance Model and were analyzed using a deductive-inductive content analysis approach.ResultsAll youth ( n  = 6 females; M age = 14.60, range 12–17) found the app easy to learn and use and expressed positive feelings towards using the app. Youth found the app useful because it facilitated accessibility to helpful coping skills (e.g., journaling to express their emotions; breathing exercises to increase calmness) and positive mental health outcomes (e.g., increased relaxation and reduced stress). All service providers ( n  = 7 females; M age = 43.75, range 32–60) perceived the app to be useful and easy to use by youth within their services and expressed positive feelings about integrating the app into usual care. Service providers also highlighted various organizational factors affecting the app's acceptance. Youth and service providers raised some concerns about apps in general and provided recommendations to improve the JoyPop™ app.DiscussionResults support youth and service providers' acceptance of the JoyPop™ app and lend support for it as an adjunctive resource to traditional mental health services for youth with emotion regulation difficulties.

Background/PurposeAnxiety sensitivity (AS) is a transdiagnostic risk factor for mental health disorders. While its lower order factors – social, physical, and cognitive concerns – and their associations with emotional disorders have been examined independently of each other, research has not fully appreciated that these factors might appear to different degrees in individuals, with psychopathology implications.MethodsWe used cluster analysis to investigate how the lower order AS factors appear in treatment-seekers with high AS and how these manifestations of AS (i.e., the different clusters) are uniquely associated with psychopathology. Participants (N = 154; from two studies) were high AS treatment-seeking adults with anxiety and/or depressive disorders who completed a diagnostic interview and self-report measures of AS and anxiety and depression symptoms.ResultsA four-cluster solution emerged including a Multidimensional cluster (33.8% of the sample) and Social (28.6%), Physical (21.4%), and Cognitive (16.2%) clusters. Validation analyses revealed cross-cluster differences in age, gender, ethnicity, and psychopathology, the latter reflecting known associations between AS and mental health (e.g., depression symptoms were significantly highest in the Cognitive and Multidimensional clusters).ConclusionsResults provide valuable insight into the heterogeneity of high AS as it appears clinically, with implications for best matching treatment approaches for this population.

Although prior studies have indicated athletic identity plays a role in alcohol use among college athletes, this research has largely drawn on a unidimensional conceptualization. Addressing this gap, the current study utilized a sample of 8,550 university athletes (Mage = 19.70 years, SD = 1.33, 50.8% men) from 203 U.S. post-secondary institutions to examine the associations between athletic identity dimensions (i.e., social identification, negative affectivity, and exclusivity) and alcohol use for athletes across gender, sport type, and division. The results indicated that negative affectivity and social identification were associated with higher levels of alcohol use, whereas exclusivity was associated with lower levels of alcohol use. Further, the association between dimensions of athletic identity and alcohol use varied across competitive level (i.e., Division I, II, and III). The findings implicate the need for (a) future research to approach athletic identity as a multidimensional concept when examining its association with alcohol use outcomes, and (b) post-secondary alcohol prevention professionals to integrate dimensions of athletic identity in alcohol prevention approaches.

Drinking motives have been theorized as “the final common pathway” to alcohol use, and have been found to be associated with certain drinking patterns and related outcomes. Given the importance of the context in which people drink, researchers have also begun to pay close attention to motives that are specific to participation in a drinking game. The present study builds on this burgeoning body of work by testing how sociability and liquid courage alcohol outcome expectancies and valuations are indirectly associated with drinking game behaviors by way of drinking game motives. Participants consisted of 686 students from eight U.S. colleges/universities (ages 18–23, mean age = 19.45; 73.8% female; 68.2% white) who completed a self-report questionnaire which asked about drinking game behaviors and motives for playing, alcohol outcome expectancies and valuations, general drinking motives, and typical alcohol use. Controlling for demographics, general drinking motives, and typical alcohol use, results indicated that liquid courage (alcohol outcome expectancies) and sociability (alcohol outcome expectancies and valuations) were indirectly associated with drinking game behaviors by way of enhancement/thrills and social lubrication motives for playing drinking games, respectively. Findings suggest that motives specific to playing drinking games operate similarly to general drinking motives as the “final common pathway” to drinking game behaviors. Implications for motivation-matched and expectancy challenge strategies aimed at reducing drinking games participation on college campuses are discussed.

Pregaming (a.k.a., “prepartying,” “pre-funking,” or “predrinking”) consists of drinking before going to a social function or gathering where alcohol may or may not be served. Existing research suggests that pregaming in high school and pre-college (i.e., the period between high school graduation and the start of college) is widespread. Moreover, pregaming prevalence appears to rapidly increase after students graduate from high school and transition into college. Thus, the purpose of this brief review is threefold: (a) to summarize the existing (albeit limited) research on pregaming among high school students and incoming college freshmen, (b) to present an overview of the risk factors that have been identified for participation in pregaming, and (c) to discuss the implications for practice that may be particularly relevant for school-employed/affiliated nurses as well as health practitioners who work in college settings. [Pregaming (a.k.a., “prepartying,” “pre-funking,” or “predrinking”) consists of drinking before going to a social function or gathering where alcohol may or may not be served. Existing research suggests that pregaming in high school and pre-college (i.e., the period between high school graduation and the start of college) is widespread. Moreover, pregaming prevalence appears to rapidly increase after students graduate from high school and transition into college. Thus, the purpose of this brief review is threefold: (a) to summarize the existing (albeit limited) research on pregaming among high school students and incoming college freshmen, (b) to present an overview of the risk factors that have been identified for participation in pregaming, and (c) to discuss the implications for practice that may be particularly relevant for school-employed/affiliated nurses as well as health practitioners who work in college settings. [ Journal of Psychosocial Nursing and Mental Health Services , 51(10), 14–17.]