OBJECTIVE: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with onset in infancy. Early intervention is critical to improve the prognosis for these children. E-health interventions have tremendous potential. This review aimed to determine the status and effectiveness of family interventions for parents of children aged 0-6 years with ASD in the context of e-health.
METHODS: The review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, Web of Science, and China National Knowledge Infrastructure were searched from inception to June 2022. The searches were limited to children with ASD of the age range between 0 and 6 years. We collated the available information and used descriptive statistics to analyze the synthesized data.
RESULTS: Our initial search identified 3,672 articles, of which 30 studies met the inclusion criteria. The 30 articles selected were released between 2012 and 2022. All articles are in English. Most articles reviewed were from high-income countries (27/30, 90.0%), especially from the United States (16/30, 53.3%). Four major themes emerged from the 30 studies that matched the inclusion criteria, as follows: 1) type of e-health interventions, 2) duration of interventions, 3) clinical aspects of e-health interventions, and 4) evidence for intervention effectiveness, looking into the positive, negative, and mixed findings of previous studies.
CONCLUSIONS: These findings suggest that a wide variety of e-health interventions may actually help support both children with ASD aged 0-6 years and their parents.

BACKGROUND: Returning to work after long-term sick leave can be challenging, particularly in small- and medium-sized enterprises (SMEs) where support may be limited. Recognizing the responsibilities and challenges of SME employers, a web-based intervention (hereafter the SME tool) has been developed. The SME tool aims to enhance the employer\'s intention and ability to support the sick-listed employee. Based on the Self-Determination Theory, it is hypothesized that this intention is enhanced by intervening in the employer\'s autonomy, competences, and relatedness targeted at, e.g., communication with sick-listed employee, involvement of other stakeholders, and practical support. This is achieved by means of providing templates, communication videos, and information on legislation. This article describes the design of an effect and process evaluation of the SME tool.
METHODS: A randomized controlled trial (RCT) with a 6-month follow-up will be conducted with a parallel-group design with two arms: an intervention group and a control group. Sick-listed employees (≤ 8 weeks) of SMEs (≤ 250 employees) at risk of long-term sick leave and their employers will be recruited and randomly allocated as a dyad (1:1). Employers randomized to the intervention group receive unlimited access to the SME tool, while those in the control group will receive care as usual. The primary outcome is the satisfaction of the employee with the return to work (RTW) support provided by their employer. Secondary outcomes include social support, work performance, and quality of work life at the employee level and self-efficacy in providing RTW support at the employer level. Outcomes will be assessed using questionnaires at baseline and 1, 3, and 6 months of follow-up. Process evaluation measures include, e.g., recruitment and use of and perceived usefulness of the SME tool. Additionally, semi-structured interviews with employers, employees, and occupational physicians will explore the interpretation of the RCT results and strategies for the national implementation of the SME tool.
CONCLUSIONS: The SME tool is hypothesized to be valuable in addition to usual care helping employers to effectively support the RTW of their long-term sick-listed employees, by improving the employers\' intention and ability to support.
BACKGROUND: ClinicalTrials.gov, NCT06330415. Registered on February 14, 2024.

UNASSIGNED: Nurses, who care for patients with various traumas, may also experience post-traumatic stress disorder due to indirect or direct exposure to traumatic situations. This study examined the effectiveness of an Internet-based trauma recovery intervention for Korean nurses.
UNASSIGNED: This randomized controlled trial was conducted with 112 nurses aged 23-40 years who were randomly assigned to the intervention (n = 56) or control group (n = 56) from May 7 to December 20, 2020. Nurses in the intervention group attended eight sessions, and the same intervention was administered to the control group. Repeated measures were collected at pre-test, post-test 1 (immediately after the intervention), and post-test 2 (4 weeks after the intervention). A total of 102 nurses (intervention group: n = 49; control group: n = 53) were completed because 10 nurses dropped out before the first session. Data were analyzed using the χ2 test, Fisher\'s exact test, t-test, Mann-Whitney U test, and repeated measures ANOVA (intention-to-treat and per protocol).
UNASSIGNED: There were significant changes in functional health, resilience, post-traumatic stress, depressive symptoms, state anxiety, and trait anxiety over time and in the group-by-time interactions (intention-to-treat and per protocol). There was a significant difference in social support in the group-by-time interactions, but there were no significant changes between the two groups or over time (intention-to-treat and per protocol).
UNASSIGNED: The Internet-based trauma recovery nursing intervention is effective in clinical and community settings for nurses who cannot participate in fixed-schedule programs due to shift work. This study\'s findings are relevant for implementing Internet-based trauma recovery programs for nurses and the general population, including survivors and relatives of patients who suffered from COVID-19. This program will also be very useful for people in other high-stress situations. Nurse leaders should consider different populations and situations when offering effective coping strategies suitable for changing environments.

BACKGROUND: Internet-delivered cognitive behavioral therapy (ICBT) is an effective and accessible treatment for various mental health concerns. ICBT has shown promising treatment outcomes among public safety personnel (PSP), who experience high rates of mental health problems and face barriers to accessing other mental health services. Client engagement and clinical outcomes are better in ICBT with therapist guidance, but ICBT is easier to implement on a large scale when it is self-guided. Therefore, it is important to identify strategies to improve outcomes and engagement in self-guided ICBT and other self-guided digital mental health interventions. One such strategy is the use of online discussion forums to provide ICBT clients with opportunities for mutual social support. Self-guided interventions accompanied by online discussion forums have shown excellent treatment outcomes, but there is a need for research experimentally testing the impact of online discussion forums in ICBT.
OBJECTIVE: We aimed to evaluate a transdiagnostic, self-guided ICBT intervention tailored specifically for PSP (which had not previously been assessed), assess the impact of adding a therapist-moderated online discussion forum on outcomes, and analyze participants\' feedback to inform future research and implementation efforts.
METHODS: In this randomized trial, we randomly assigned participating PSP (N=107) to access an 8-week transdiagnostic, self-guided ICBT course with or without a built-in online discussion forum. Enrollment and participation were entirely web-based. We assessed changes in depression, anxiety, and posttraumatic stress as well as several secondary outcome measures (eg, treatment engagement and satisfaction) using questionnaires at the pre-enrollment, 8-week postenrollment, and 20-week postenrollment time points. Mixed methods analyses included multilevel modeling and qualitative content analysis.
RESULTS: Participants engaged minimally with the forum, creating 9 posts. There were no differences in treatment outcomes between participants who were randomly assigned to access the forum (56/107, 52.3%) and those who were not (51/107, 47.7%). Across conditions, participants who reported clinically significant symptoms during enrollment showed large and statistically significant reductions in symptoms (P<.05 and d>0.97 in all cases). Participants also showed good treatment engagement and satisfaction, with 43% (46/107) of participants fully completing the intervention during the course of the study and 96% (79/82) indicating that the intervention was worth their time.
CONCLUSIONS: Previous research has shown excellent clinical outcomes for self-guided ICBT accompanied by discussion forums and good engagement with those forums. Although clinical outcomes in our study were excellent across conditions, engagement with the forum was poor, in contrast to previous research. We discuss several possible interpretations of this finding (eg, related to the population under study or the design of the forum). Our findings highlight a need for more research evaluating the impact of online discussion forums and other strategies for improving outcomes and engagement in self-guided ICBT and other digital mental health interventions.
BACKGROUND: ClinicalTrials.gov NCT05145582; https://clinicaltrials.gov/study/NCT05145582.

Our aim was to study enrollment and completion levels for the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention, for parents of young children with disruptive behavior before and after the COVID-19 lockdown period. Population-based screening was carried out on 39,251 children during routine check- ups at 4 years of age. The parents of children scoring at least 5 on the Strengths and Difficulties Questionnaire were assessed against inclusion and exclusion criteria. Associations with enrollment or completion were analyzed using logistic regression models. The effects of COVID-19 restrictions on these were estimated using interrupted timeseries analysis. Of 39,251 families, 4894 screened positive and met the eligibility criteria. Of those, 3068 (62.6%) decided to enroll in the SFSW program and 2672 (87.1%) of those families completed it. The highest level of disruptive behavior (OR 1.33, 95% CI 1.12-1.57, p < 0.001) and overall severity of difficulties (OR 2.22, 95% CI 1.91-2.57, p < 0.001) were independently associated with enrollment. Higher parental education was associated with enrollment and completion. Higher paternal age was associated with enrollment, and parent depressive symptoms with non-completion. The SFSW enrollment did not significantly change following the COVID-19 restrictions, while the completion rate increased (COVID-19 completion OR 1.75, 95% CI 1.22-2.50, p = 0.002). Guided digital parenting interventions increase the sustainability of services, by addressing the child mental health treatment gap and ensuring service consistency during crisis situations.

BACKGROUND: Numerous studies have demonstrated the effectiveness of digital interventions for improving the mental health of university students. However, low rates of engagement with these interventions are an ongoing challenge and can compromise effectiveness. Brief, transdiagnostic, web-based video interventions are capable of targeting key mental health and related issues affecting university students and may be more engaging and accessible for this population.
OBJECTIVE: This study used a 2-arm randomized controlled trial to evaluate the effectiveness of Uni Virtual Clinic-Lite (UVC-Lite), a fully automated, transdiagnostic, web-based video intervention, relative to an attention-control condition. The primary outcomes were symptoms of depression and generalized anxiety disorder. The secondary outcomes included psychological distress, social anxiety symptoms, body appreciation, quality of life, well-being, functioning, general self-efficacy, academic self-efficacy, and help seeking. Program use (intervention uptake and engagement) and satisfaction were also assessed.
METHODS: University students (n=487) with mild to moderate symptoms of distress were recruited from universities across Australia and randomly allocated to receive access to the UVC-Lite intervention or an attention-control condition targeting general health for a period of 6 weeks. UVC-Lite includes 12 modules, each comprising a brief animated video and an accompanying exercise. Of the 12 modules, 7 also included a brief symptom screening quiz. Outcomes were assessed at baseline, postintervention, and 3- and 6-months postintervention.
RESULTS: The primary and secondary outcomes were analyzed on an intention-to-treat basis using mixed models repeated measures ANOVA. The intervention was not found to be effective relative to the control condition on any of the primary or secondary outcomes. While 67.9% (114/168) of participants accessed at least 1 module of the intervention, module completion was extremely low. Subgroup analyses among those who engaged with the program (completed at least 1 video) and those with higher baseline distress (Distress Questionnaire-5 score ≥15) did not reveal any differences between the conditions over time. However, uptake (accessing at least 1 video) and engagement (completing at least 1 video) were higher among those with higher baseline symptoms. Satisfaction with the intervention was high.
CONCLUSIONS: The UVC-Lite intervention was not effective relative to a control program, although it was associated with high satisfaction among students and was not associated with symptom deterioration. Given the challenges faced by universities in meeting demand for mental health services, flexible and accessible interventions such as UVC-Lite have the potential to assist students to manage symptoms of mental health problems. However, low uptake and engagement (particularly among students with lower levels of symptomatology) are significant challenges that require further attention. Future studies should examine the effectiveness of the intervention in a more highly symptomatic sample, as well as implementation pathways to optimize effective engagement with the intervention.
BACKGROUND: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380146.

BACKGROUND: Global aging presents socioeconomic and health challenges. Dementia, a growing concern, affects millions of older adults, intensifying the burden on family caregivers. E-health interventions offer hope through technological solutions, although current research is limited. This study evaluated the effectiveness of internet-based or mobile app interventions for family caregivers of older adults with dementia.
METHODS: A systematic review with a narrative synthesis was conducted using databases (PubMed, CINAHL, Scopus, LILACS, and PsycInfo) and the bibliographies of retrieved articles, with no restrictions on time or language.
RESULTS: The search yielded 2092 results, of which 22 studies met the inclusion criteria, encompassing a total of 2761 family caregivers. Twenty-one different outcomes were evaluated and classified into three main types of interventions: psychoeducational, psychotherapeutic, and multicomponent.
CONCLUSIONS: The study highlights the importance of internet-based and mobile app interventions in supporting family caregivers of older adults with dementia. These interventions positively affect many aspects of caregiver well-being, suggesting their utility in addressing this group\'s emotional, social, and self-care needs.

BACKGROUND: Most mental disorders have their onset in adolescence. Preventive interventions during this period are important; however, help-seeking behavior is generally poor in this age group resulting in low treatment rates. Internet interventions are expected to be an effective, low-threshold, and scalable approach to overcome barriers to help-seeking, particularly for individuals experiencing subclinical symptoms. Internet-delivered indicated prevention seems promising as it targets individuals with minimal symptoms of mental disorders who might need care but are not help-seeking yet. Previous indicated prevention-approaches have mainly targeted specific risk-syndromes. However, this contradicts the increasing recognition of emerging psychopathology as a complex system characterized by co-occurrence and rapid shifts of subclinical symptoms cutting across diagnostic categories. Therefore, this study will investigate the efficacy, mediators, moderators, and core symptomatic changes of a transdiagnostic Internet-delivered indicated prevention program (EMPATIA program) for adolescents.
METHODS: This randomized controlled trial (RCT) will be conducted in a general population sample (planned n = 152) of adolescents aged 12-18 years with subclinical symptoms but without any current or past mental disorder. Participants will be randomly assigned to the EMPATIA program or a care as usual (CAU) control condition. The 8-week guided EMPATIA program encompasses 8 modules targeting the following transdiagnostic mechanisms: repetitive negative thinking, self-perfectionism, emotion regulation, intolerance of uncertainty, rejection sensitivity, and behavioral avoidance. Participants will be asked to answer online self-report questionnaires at baseline, after 8 weeks, and at 6-, 9-, and 12-month follow-up. Diagnostic telephone interviews will be conducted at baseline and at 12-month follow-up. Additionally, intervention-specific constructs (motivation, alliance, negative effects, satisfaction, adherence) will be assessed during and after the EMPATIA program. The level of self-reported general psychopathology post-intervention is the primary outcome.
CONCLUSIONS: Results will be discussed considering the potential of Internet interventions as a scalable, low-threshold option for indicated prevention in adolescents experiencing subclinical symptoms. The EMPATIA program introduces a novel Internet prevention program targeting six transdiagnostic mechanisms associated with various mental health outcomes. Thereby, this trial pursues a very timely and important topic because it may contribute to narrow the current care gap for adolescents, to prevent mental health problems and related negative consequences, and to promote mental health in the long-term.
BACKGROUND: The trial was approved by Swissmedic (Registration Number: 10001035, 08/22/2022) and the Ethics Committee of Bern (Registration Number: 2022-D0036, 08/22/2022). The trial was registered at ClinicalTrials.gov NCT05934019 on 07-03-2023.

BACKGROUND: Innovations in technology offer potential solutions to address pain care inequities. To maximize impacts, greater understanding is needed regarding preferences and priorities of people experiencing or treating pain.
OBJECTIVE: This study conducted focus groups to investigate the perspectives of people with pain and healthcare workers regarding online resources for pain management. Researchers asked about barriers to current pain management and what resources would be most desired in an online format to meet needs.
METHODS: Participants were a randomly selected sub-sample of adults from a northwestern region of the United States who participated in an online, survey-based study. Eligible participants identified as either a person who had received treatment for pain or a healthcare worker who cared for people with pain. Of the 199 survey respondents, 30 participated in one of three focus group sessions. Focus groups were conducted using videoconferencing technology, then recorded, transcribed, and analyzed using thematic analysis.
RESULTS: Focus group participants included 22 adults who identified as a person treated for pain of any type and 8 healthcare workers. Themes relating to eHealth use reflected desires for (1) freely accessible and vetted pain management information in one place, (2) reliable information tailored to need and pain type, and (3) easy-to-use resources. Findings revealed that some effective pain management resources do exist, yet obstacles including inflexible and inequitable healthcare practices and lack of knowledge about options may limit access to these resources.
CONCLUSIONS: Including preferences of user groups can assist in creating resources that are likely to be useful for those with pain and their caregivers. Innovations are needed to address persisting gaps in care.

UNASSIGNED: Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT.
UNASSIGNED: This study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD.
UNASSIGNED: The development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS.
UNASSIGNED: Participants in the shame WCBT group experienced significant reductions in shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation -12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation -9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS.
UNASSIGNED: This is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The shame WCBT group showed a significant reduction in both shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT.