Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 12 appraisals
PloS one
Optimizing treatment for depressed parents of children with emotional and behavioral disorders: A multi-site feasibility trial.
BACKGROUND: Behavioral parent training (BPT) programs are effective for reducing disruptive behavior of many children with emotional and behavioral disorders (EBD) and improving skills and competencies of their parents. However, these interventions are not sufficiently effective for parents who themselves have depression. This study assessed the feasibility of the Addressing Depression and Positive Parenting Techniques (ADAPT) Program-a novel BPT that includes aspects of cognitive behavioral therapy and dialectical behavior therapy. We identified whether recruitment was possible, attendance was acceptable, participants were satisfied, and facilitators adhered to the protocol. Additionally, we measured trends in changes in parent and child outcomes with intervention. METHODS: Participants were 28 parents and their children with EBD, referred to two hospital-based clinics. Parents were eligible if they (1) had a child aged 6-10 experiencing emotional and behavioral difficulties and (2) were experiencing elevated depressive symptoms. ADAPT took place virtually over 10 weeks. Participants completed measures before, weekly and after treatment. Clinicians recorded attendance and completed weekly treatment fidelity checklists. RESULTS: We found that recruitment was possible, the intervention showed high parental satisfaction, and facilitators reported high program fidelity. Further, secondary outcome measures showed evidence of sensitivity to change in the intended direction. CONCLUSION: Given that a priori progression criteria were met and we found preliminary indication of efficacy, we conclude that an RCT of ADAPT to determine efficacy is warranted.
11 July 2026
Read appraisal →JMIR medical education
Youth-Elder Co-Learning Model in Psychiatric Long-Term Care Education: Mixed Methods Evaluation of Communication and Empathy Outcomes
BACKGROUND: Taiwan is projected to become a "super-aged" society by 2025, leading to an increasing demand for community psychiatric long-term care (LTC). This demographic shift necessitates frontline professionals equipped with specialized communication skills and deep empathy. However, traditional didactic teaching often fails to adequately prepare students for the complex emotional and practical challenges of real-world psychiatric caregiving. OBJECTIVE: This study aimed to evaluate the effectiveness of the innovative youth-elder co-learning instructional model, which uniquely integrates micro-movie discussions and an intergenerational empathy board game, on adult learners' professional knowledge, communication competence, empathic development, and overall learning satisfaction. METHODS: A mixed methods, single-group, pre-post design was used. The educational intervention was implemented within an 18-week elective community psychiatric LTC course. Participants included 38 adult learners and continuing education students (aged 19-64 years). Notably, the majority of the cohort (n=29, 76.3%) had no prior practical experience in LTC. Quantitative data were collected using self-assessed and peer-evaluated scales for professional knowledge, communication competence, and empathy at pre-, mid-, and post-course time points, alongside an end-of-semester course student feedback survey. Qualitative data were systematically gathered through structured reflective journals and analyzed using a rigorous 6-phase thematic analysis framework. RESULTS: Students reported high course satisfaction rates, ranging from 92.4% to 95.3%. Quantitative analysis revealed a notable divergence: there were significant improvements in peer-evaluated outcomes (P<.001) and self-assessed communication competence (P=.004), but there was more conservative, statistically nonsignificant growth in self-assessed scores for professional knowledge (P=.14) and empathy (P=.09). This discrepancy likely reflects adult learners' heightened awareness of professional complexity and self-reflective humility. Furthermore, the qualitative thematic analysis uncovered the following three narrative shifts: (1) the dismantling of generational stereotypes through authentic, face-to-face interaction with real older adults; (2) an empathic awakening regarding the often-invisible burden of family caregivers, catalyzed by the micro-movies; and (3) the successful translation of theoretical nonviolent communication concepts into real-time clinical problem-solving during board game role-plays. CONCLUSIONS: The youth-elder co-learning model shows promise as an innovative, experiential pedagogical approach. By bridging theoretical frameworks with authentic intergenerational contact, the intervention supported students in translating general empathic concepts into actionable communication competencies. However, given the exploratory nature of this study and the absence of a control group, the quantitative findings must be interpreted cautiously. Future research using randomized controlled trial designs across multiple institutions is warranted to establish definitive causal impacts.
10 July 2026
Read appraisal →Journal of affective disorders
Interventions to reduce loneliness in children and adolescents (4-18 years): A systematic review and meta-analysis with narrative synthesis of study-level characteristics
Loneliness in youth is linked to poor mental and physical health, yet the effectiveness of interventions remains unclear. Given its distinct developmental presentation, this meta-analysis synthesises interventions targeting loneliness in individuals aged 4-18 to inform age-appropriate strategies. It examines the effects of interventions on loneliness and includes a narrative synthesis of intervention and sample characteristics. We conducted a systematic literature review and meta-analysis of quantitative studies up to March 2024, focusing on interventions where loneliness was the primary target in school-aged youth. Nineteen studies were included in the SLR, of which 18 were included in the meta-analysis (6 RCTs, 6 multi-cohort, and 6 single-cohort studies). RCTs showed a small, non-significant reduction in loneliness (Hedges' g = -0.20, 95% CI [-0.42, 0.02], p = .07), with social and emotional skills training interventions being most effective. Multi-cohort studies showed a negligible effect (Hedges' g = -0.01, 95% CI [-0.08, 0.07], p = .84). Single-cohort studies indicated a moderate, non-significant effect (Hedges' g = -0.55, 95% CI [-1.29, 0.18], p = .14). Interventions targeting loneliness show promise in reducing loneliness, particularly when they incorporate social and emotional learning. Future research should integrate qualitative approaches and consider loneliness within broader mental health and well-being frameworks to support the development of more comprehensive, youth-centred interventions.
16 June 2026
Read appraisal →JMIR formative research
Usability, Relevance, and User Engagement of a Government-Sponsored and Community Co-Designed Digital Mental Health Website During the COVID-19 Pandemic: A Pilot Study on Latino/a/x Adults
BACKGROUND: Latino/a/x adults have higher rates of unmet mental health needs than other racial and ethnic groups. One promising solution to help bridge this gap in care is digital mental health tools. Digital tools, such as self-help websites, have demonstrated the ability to enhance mental health literacy, reduce stigma, and improve mental health symptoms. Despite the potential benefits, engagement remains a critical challenge, and there has been a large oversight of unique considerations for Latino/a/x adults as end users. OBJECTIVE: Guided by the Technology Acceptance Model and the Behavioral Model for Vulnerable Populations, the study's overarching objective is to characterize within-group variation of Latino/a/x adults' engagement with a government-funded, prevention-focused mental health website that was co-designed with community partners during the COVID-19 pandemic. METHODS: The Together for Wellness/Juntos Por Nuestro Bienestar (T4W/Juntos) website offered free digital mental health resources to help Californians cope with the COVID-19 pandemic. A pilot evaluation of the website involved baseline and 4-week follow-up surveys about demographics, behavioral health needs, and overall website user experience. This current subanalysis focused on a stratified sample of Latino/a/x adult participants (baseline N=131; baseline and follow-up n=68). The baseline sample was mostly female (106/130, 81.5%); 66.9% (87/130) preferred to use the website in English and 30% (39/130) preferred Spanish. Behavioral health needs were assessed using the Patient Health Questionnaire-2, Generalized Anxiety Disorder 2-item scale, and a COVID-19 stressors checklist. We measured usability, comfort using the website, relevance of the website, and past-month use of resources. Data were analyzed using ordered and standard logistic regression methods. RESULTS: Latino/a/x adults who preferred using the website in English (odds ratio [OR] 13.76, P<.001) compared with Spanish were more comfortable using the website. Compared with adults aged 18-30 years, adults aged 41-50 years had significantly lower odds of agreeing that the website was easy to use. Sensitivity analyses revealed that participants who found the website easier to use (OR 2.22, P=.001) and those with greater behavioral health needs (OR 1.22, P=.045) were more likely to perceive the website's topics as relevant. Participants with higher behavioral health needs at baseline were more likely to use the website and engage with resources for anxiety or stress at follow-up (OR 1.42, P=.047). CONCLUSIONS: This study addresses gaps in understanding Latino/a/x adults' experiences with a prevention-focused mental health website. The language-based disparity in comfort highlights the need to significantly improve the user experience for Latino/a/x Spanish speakers. Still, the website can be a helpful resource for Latino/a/x adults with high behavioral health needs, bridging a critical gap in support. A collaborative approach to developing resource-rich websites with trusted community organizations is vital for effectively reaching Latino/a/x communities and tailoring resources to address their unique needs.
12 June 2026
Read appraisal →JMIR mental health
Efficacy of a World Health Organization-Guided Self-Help Intervention for Reducing Psychological Distress in Afghan Refugees: Randomized Controlled Trial
BACKGROUND: Common mental health disorders are highly prevalent among refugees. There is an urgent need to address the mental health burden in this population. OBJECTIVE: This study tested the efficacy of an individually supported self-help stress-management intervention developed by the World Health Organization-Doing What Matters in Times of Stress (DWM)-in reducing psychological distress and improving functioning among refugees in Indonesia, a major transit country in the Asia-Pacific region. METHODS: A single-blind randomized controlled trial with 303 Farsi-speaking refugees was conducted between June 2024 and June 2025. Participants with moderate to high psychological distress (Kessler Psychological Distress Scale [K10] score≥20) were randomly allocated to the facilitator-guided individual DWM condition (n=202) or a repeated assessment control condition (n=101). The primary outcome was psychological distress (K10 score) at the posttreatment assessment. Secondary outcomes were posttraumatic stress disorder symptoms, functional impairment, social functioning, and personally identified problems. RESULTS: Intent-to-treat analysis indicated that participants in the DWM condition showed greater reductions in K10 scores than those in the repeated assessment control condition (posttreatment: β=-.563, SE=0.124; P<.001; Cohen d=0.56; 1-month follow-up: β=-.447, SE=0.140; P=.002; Cohen d=0.45). Similarly, those participants in the DWM condition reported greater improvements in posttraumatic stress disorder symptoms, well-being, social functioning, functional impairment, and personally identified psychological problems. No serious adverse events were reported. CONCLUSIONS: The findings provide the first evidence for the effectiveness of DWM in reducing psychological distress and improving overall functioning among urban refugees living in a transit setting. Individually supported self-help interventions such as DWM mayoffer an effective, feasible, and scalable approach to improving mental health for refugees.
21 May 2026
Read appraisal →Psychological medicine
Effectiveness of a one-year smoking cessation intervention for people with severe mental illness: results of the KISMET cluster-randomized controlled trial
BACKGROUND: This study evaluated the effectiveness of a one-year smoking cessation intervention for people with severe mental illness compared with treatment as usual (TAU) in outpatient mental healthcare. METHODS: The KISMET study is a pragmatic cluster-randomized controlled trial conducted in 21 outpatient mental healthcare teams in the Netherlands. Eleven teams delivered the KISMET intervention comprising cognitive-behavioral and peer support, combined with optional pharmacological reatment. Ten teams participated in the TAU condition. We collected data between October 2022 and July 2024. The primary outcome was self-reported smoking cessation at 12 months, verified through exhaled carbon monoxide levels below 10 parts per million. Secondary outcomes included depression and anxiety (HADS), severity of psychotic symptoms (PANSS-6), quality of life (SF-12), disease self-management (PAM-13), lipid profile, blood pressure, body mass index, glucose level, and physical fitness. Crude and adjusted linear and multivariable logistic regression and mixed model analyses were performed. RESULTS: Eighty-nine participants were included in the KISMET intervention and 44 in TAU. Smoking cessation rates were significantly higher in the KISMET group at 3 months (OR 12.1, 95% CI 1.4 to 103.7) and at 12 months (OR 4.2, 95% CI 1.0 to 17.2) but not at 6 months (OR 1.9, 95% CI 0.5 to 6.9). No significant differences between groups were found for secondary outcomes. Dropout rates were 58% in the intervention and 32% in the TAU group. CONCLUSIONS: The KISMET intervention shows potential without signs of physical or psychopathological complications. However, results must be interpreted with the high dropout rates in mind.
17 May 2026
Read appraisal →Current psychiatry reports
The Type of Providers Delivering Practice Elements Used in Child Mass Trauma Interventions: A Systematic Review
PURPOSE OF REVIEW: This review identified the relative frequency of use of various types of providers delivering practice elements in 130 child mass trauma interventions and compared the use of these providers across events, populations, and settings. RECENT FINDINGS: Mental health professionals (MHPs) more frequently delivered cognitive, self-monitoring, exposure, and narrative elements than other providers while non-specialist providers (NSPs) and teachers and school personnel (TSPs) delivered support networking and social skills training more frequently. MHPs administered interventions to targeted populations more frequently, and TSPs administered interventions to universal populations more frequently. Only MHPs administered interventions at clinical facilities; NSPs delivered a majority of interventions at community sites. Understanding the specific practice elements delivered by providers with different backgrounds and training can inform efforts to enhance the reach and impact of mass trauma services. Future publications should report greater detail about providers and their training and about specific practice elements used.
14 May 2026
Read appraisal →JMIR formative research
Access to Technology-Mediated Community Mental Health Care Among Low-Socioeconomic Status Consumers With Serious Mental Illness: Qualitative Study
BACKGROUND: Access to mental health care is critical for the effective management of serious mental illness (SMI), but consumers with low socioeconomic status (SES) have lower rates of service usage and worse retention in care. Digital technologies are often lauded as a way to bridge access gaps; however, little is known about how technology-mediated care may influence care access among low-SES consumers and how consumers use technology in care access. OBJECTIVE: This study aimed to examine the applicability of Levesque et al's access framework to technology-mediated care for SMI and analyze how low-SES consumers use technology to facilitate care access. Furthermore, the study assesses whether and how technologies are involved in care access at multiple points within the process of accessing care. METHODS: This study used 2 qualitative methods: ethnographic observations at a mental health treatment court and interviews with low-SES consumers with SMI using community mental health care (n=14) and key informant interviews with health and service providers working with this population (n=14). Observations occurred from July 2022 through September 2023, and interviews occurred between January 2022 and May 2024. Data analysis involved both inductive and deductive coding approaches. Data from both the interviews and observations were analyzed in NVivo and further triangulated through analytic memos. RESULTS: Levesque et al's framework required several extensions to accommodate technology-mediated care related to SMI for low-SES consumers: (1) a cyclical rather than linear trajectory; (2) simultaneous care acquisition from multiple health and service providers; (3) staying in care long-term; (4) identification of both one-time and ongoing health needs; and (5) an emergency pathway for entering care. Consumers often faced challenges related to the varied digital requirements of each provider and a dearth of integrative, patient-facing tools like portals. Within this context, some consumers use mobile apps, communication, and telehealth technologies across various care access stages. Consumers used technology by figuring out how to navigate technology-mediated care, especially by leaning on others, such as case managers, for support. These others provided consumers with temporary technologies, showed them how to use technologies, and accompanied them through the process of using technology for accessing care. CONCLUSIONS: This study highlights that accessing care is iterative and ongoing, involving multiple forms of co-occurring service provision. A theoretical contribution of this work is its extension of Levesque et al's care access framework to better reflect technology-mediated care for SMI among low-SES consumers. This work also underscores ongoing challenges for accessing technology-mediated care and the importance of human support in addressing access difficulties. Clinical implications include incorporating digital readiness assessments and providing comprehensive guidance on how consumers can effectively use technologies for care. Future work should investigate how technology-mediated care can make care access easier rather than harder.
24 Apr 2026
Read appraisal →JMIR mental health
Determinants of Digital Health Literacy Among Patients With Serious Mental Illness: Cross-Sectional Survey
BACKGROUND: Individuals with serious mental illness increasingly use digital devices and the internet to access health information and services but often face challenges when navigating digital tools, which may limit the benefits they receive from online health resources and digital health care services. OBJECTIVE: The objective of our study was to assess digital health literacy among individuals with serious mental illness and identify factors influencing this literacy. METHODS: Participants were recruited, using convenience sampling, from 2 psychiatric clinics, 1 day-care center, and 4 halfway houses in Taipei, Taiwan, between May 2024 and February 2025. Self-reported data were collected using a survey that incorporated the eHealth Literacy Scale, the Attitudes Toward Computer/Internet Questionnaire, and the Mobile Device Proficiency Questionnaire. Generalized linear modeling was applied to identify factors associated with digital health literacy. RESULTS: Among 255 participants included in the analysis, 83.5% (n=213) reported owning at least 1 digital device. Digital health literacy was significantly lower among individuals who reported greater perceived difficulty in using digital tools (B=-1.533, 95% CI -2.350 to -0.717; P<.001) and higher distrust in online information (B=-0.986, 95% CI -1.916 to -0.056; P=.04). By contrast, greater mobile device proficiency (B=0.144, 95% CI 0.008-0.281; P=.04) and self-efficacy (B=1.777, 95% CI 0.376-3.177; P=.01) were positively associated with digital health literacy. CONCLUSIONS: Despite widespread device ownership, digital health literacy was varied and generally suboptimal among patients with serious mental illness. Perceived difficulty and distrust emerged as major barriers; proficiency and self-efficacy facilitated higher literacy. These findings highlight the need for mental health professionals to integrate tailored digital skills training, confidence-building strategies, and ongoing support into digital health interventions for individuals with serious mental illnesses.
16 Apr 2026
Read appraisal →Journal of medical Internet research
Views of People With Psychosis About Algorithm-Based Relapse Prediction and Data Sharing: Qualitative Study
BACKGROUND: Preventing relapses of psychosis is difficult and important. Digital remote monitoring (DRM) systems are being developed and tested to support this. Increasingly, these systems use algorithm-based relapse prediction. Hence, understanding stakeholder views about algorithmic prediction is crucial. Existing qualitative work has explored health professionals' views, but very few studies have examined the perspectives of people with psychosis on this topic. OBJECTIVE: This paper aimed to provide an in-depth examination of the views of people with psychosis regarding algorithmic relapse prediction within a DRM system that incorporates active symptom monitoring and passive sensing data. METHODS: People with psychosis (n=58) were recruited from 6 geographically distinct areas of the United Kingdom. They participated in semistructured qualitative interviews exploring their views about using a DRM system that predicts psychosis relapse based on a machine learning algorithm. Transcripts were analyzed using reflexive thematic analysis. People with lived experience of psychosis were involved extensively in study design, analysis, and reporting. RESULTS: Findings were described across 4 themes. First, accuracy was a prominent theme. Participants emphasized that transparency about algorithm sensitivity and specificity is crucial and discussed the risks of the relapse prediction algorithm producing false positives (flagging that someone was relapsing when they were not) and false negatives (missing actual relapses). In both cases, participants said that errors may be partially mitigated through a human-in-the-loop approach (theme 2), with DRM blended with human oversight, from clinicians or a dedicated digital monitoring team, and calibrated based on service user, carer, and clinician feedback. The third theme, trust, fears, and choice, noted the interplay between users' trust in the DRM system and their relationship with the clinical team. This theme described participants' fears about potential overreactions (hospitalization or excessive medication) or underreactions (no additional support) from the clinical team in response to algorithm-generated relapse predictions. It emphasized the importance of retaining choice around the use of relapse detection algorithms and the sharing of personal data. The final theme described participants' views about the benefits of using a relapse prediction algorithm, including facilitating early intervention, triaging care according to need, minimizing human bias in assessment, and efficiency in saving staff time. CONCLUSIONS: People with psychosis acknowledged potential benefits of algorithm-assisted relapse prediction for receiving timely or efficient care, but with several caveats. Algorithm-generated relapse alerts need to be sufficiently accurate and must be interpreted, with understanding of their limitations, by a trustworthy human who is aware of the relevant context. Algorithm-based relapse predictions should only be used with valid consent, in a way that promotes and respects the autonomy and voice of service users and avoids increasing the use of excessive restriction.
11 Apr 2026
Read appraisal →JMIR research protocols
Cultural Adaptation of a Digital Mobile App for Bipolar Disorder (PolarUs): Protocol for a Qualitative Co-Design Study
BACKGROUND: Bipolar disorder (BD) affects approximately 40 million people worldwide and is a chronic, potentially disabling mood disorder. Although effective treatments exist, access to evidence-informed psychosocial care remains limited, particularly for culturally and linguistically diverse populations, contributing to persistent global treatment gaps. Digital mental health interventions (DMHIs), such as smartphone apps, offer a promising means to improve access to self-management support and quality of life (QoL), an outcome prioritized by people with BD and in clinical guidelines. However, most apps for BD lack quality and are not culturally adapted or co-designed with people with BD, limiting relevance and engagement. PolarUs (mobile app) is an evidence-informed DMHI developed using co-design with people with BD. The app is structured on the core 14 domains from the Quality of Life in BD scale, the only BD-tailored scale, combined with psychoeducation on self-management strategies and QoL. A recent pilot study demonstrated promising QoL, clinical, and feasibility outcomes. OBJECTIVE: This study aims to culturally and linguistically adapt the PolarUs app into French, Chinese, and Spanish for the North American context using qualitative and co-design methods. METHODS: Guided by community-based participatory research principles, whereby end users are engaged throughout the research process, and the Ecological Validity Framework of Bernal et al, we will engage advisory groups of people with lived experience from each linguistic community throughout the cultural adaptation process. Semimonthly virtual meetings will support systematic cultural adaptation of the self-management strategies, affirmations, and resources while maintaining fidelity to core evidence-based components. This will include cultural tailoring of app content and the identification of culturally appropriate resources. Advisory groups will also contribute to the cointerpretation of findings and the co-design of culturally appropriate recruitment and implementation strategies of PolarUs for a future clinical trial. Meetings will be recorded and coanalyzed as research data with advisory groups using qualitative reflexive thematic analysis to capture advisory group perspectives and experiences. RESULTS: This study was funded in October 2024. As of January 31, 2026, we enrolled 7 participants, and the results are expected to be published in the fall of 2026. CONCLUSIONS: The findings will support the development of a culturally appropriate DMHI for BD for additional linguistic communities, advance cultural adaptation methodologies, and inform preparation for a future clinical trial. This study will produce the first culturally adapted, BD-specific DMHI developed through co-design using a community-based participatory research approach with multilingual end users from traditionally underserved communities, advancing equitable access, engagement, and scalability of DMHIs for BD and digital health care more broadly.
10 Apr 2026
Read appraisal →Psychological medicine
The effect of managed transition on the proportion of young people transitioning from CAMHS to AMHS: Analysis of the Milestone Cluster Randomised Clinical Trial
BACKGROUND: Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is poorly managed, with discontinuity of care commonplace, leading to poorer outcomes, while evidence-based interventions to improve transition are scarce. This study is a secondary analysis of the MILESTONE trial, aiming to determine whether managed transition increases the proportion of young people who appropriately transition from CAMHS to AMHS. METHODS: The MILESTONE trial was a multicenter, two-arm, cluster-randomized controlled trial across eight countries at 40 CAMHS sites to compare usual care (UC) to managed transition (MT). MT consisted of training, identification, and assessment of transition readiness and appropriateness. Eligible participants were receiving CAMHS care, IQ ⩾ 70 and within 1 year of their service transition boundary. CAMHS sites were randomized 2:1 between UC and MT. The main outcome was whether participants were receiving care from AMHS at 15 months follow up. RESULTS: The MILESTONE study included 793 participants, 552 receiving UC and 241 receiving MT. In the MT group, 24.9% transitioned to AMHS at 15 months compared to 14.2% in the UC group (p = 0.002), and appropriate transitions (in those with a need for transition at baseline or ongoing clinical need at 15 months) were 32.3% in the MT group compared to 16.4% in the UC group (p < 0.001). CONCLUSIONS: A higher proportion of the MT group transitioned to AMHS at 15 months, and there was a higher proportion of appropriate transitions compared to UC. Clinicians and services should consider the incorporation of MT into routine clinical care.
7 Apr 2026
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