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      Preliminary Effectiveness of a Smartphone App to Reduce Depressive Symptoms in the Workplace: Feasibility and Acceptability Study

      research-article
      , BPsy (Hons), PhD 1 , , , MClinPsych 1 , 2 , , PhD 3 , , MA, MSc, MBBS, MRCPsych, FRANZCP, PhD 4 , , BHA, MMDes 5 , , PhD 5 , , MBBS, MRCGP, MRCPsych, FRANZCR, PhD 1
      (Reviewer), (Reviewer), (Reviewer), (Reviewer)
      JMIR mHealth and uHealth
      JMIR Publications
      depression, workplace, mHealth, smartphone, eHealth, pilot

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          Abstract

          Background

          The workplace represents a unique setting for mental health interventions. Due to range of job-related factors, employees in male-dominated industries are at an elevated risk. However, these at-risk groups are often overlooked. HeadGear is a smartphone app–based intervention designed to reduce depressive symptoms and increase well-being in these populations.

          Objective

          This paper presents the development and pilot testing of the app’s usability, acceptability, feasibility, and preliminary effectiveness.

          Methods

          The development process took place from January 2016 to August 2017. Participants for prototype testing (n=21; stage 1) were recruited from industry partner organizations to assess acceptability and utility. A 5-week effectiveness and feasibility pilot study (n=84; stage 2) was then undertaken, utilizing social media recruitment. Demographic data, acceptability and utility questionnaires, depression (Patient Health Questionnaire-9), and other mental health measures were collected.

          Results

          The majority of respondents felt HeadGear was easy to use (92%), easily understood (92%), were satisfied with the app (67%), and would recommend it to a friend (75%; stage 1). Stage 2 found that compared with baseline, depression and anxiety symptoms were significantly lower at follow-up ( t 30=2.53; P=.02 and t 30=2.18; P=.04, respectively), days of sick leave in past month ( t 28=2.38; P=.02), and higher self-reported job performance ( t 28=−2.09; P=.046; stage 2). Over 90% of respondents claimed it helped improve their mental fitness, and user feedback was again positive. Attrition was high across the stages.

          Conclusions

          Overall, HeadGear was well received, and preliminary findings indicate it may provide an innovative new platform for improving mental health outcomes. Unfortunately, attrition was a significant issue, and findings should be interpreted with caution. The next stage of evaluation will be a randomized controlled trial. If found to be efficacious, the app has the potential to reduce disease burden and improve health in this at-risk group.

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          Most cited references37

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          Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

          Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement. Copyright 2003 Wiley-Liss, Inc.
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            Constructions of masculinity and their influence on men's well-being: a theory of gender and health.

            Men in the United States suffer more severe chronic conditions, have higher death rates for all 15 leading causes of death, and die nearly 7 yr younger than women. Health-related beliefs and behaviours are important contributors to these differences. Men in the United States are more likely than women to adopt beliefs and behaviours that increase their risks, and are less likely to engage in behaviours that are linked with health and longevity. In an attempt to explain these differences, this paper proposes a relational theory of men's health from a social constructionist and feminist perspective. It suggests that health-related beliefs and behaviours, like other social practices that women and men engage in, are a means for demonstrating femininities and masculinities. In examining constructions of masculinity and health within a relational context, this theory proposes that health behaviours are used in daily interactions in the social structuring of gender and power. It further proposes that the social practices that undermine men's health are often signifiers of masculinity and instruments that men use in the negotiation of social power and status. This paper explores how factors such as ethnicity, economic status, educational level, sexual orientation and social context influence the kind of masculinity that men construct and contribute to differential health risks among men in the United States. It also examines how masculinity and health are constructed in relation to femininities and to institutional structures, such as the health care system. Finally, it explores how social and institutional structures help to sustain and reproduce men's health risks and the social construction of men as the stronger sex.
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              Advantages and limitations of Internet-based interventions for common mental disorders.

              Several Internet interventions have been developed and tested for common mental disorders, and the evidence to date shows that these treatments often result in similar outcomes as in face-to-face psychotherapy and that they are cost-effective. In this paper, we first review the pros and cons of how participants in Internet treatment trials have been recruited. We then comment on the assessment procedures often involved in Internet interventions and conclude that, while online questionnaires yield robust results, diagnoses cannot be determined without any contact with the patient. We then review the role of the therapist and conclude that, although treatments including guidance seem to lead to better outcomes than unguided treatments, this guidance can be mainly practical and supportive rather than explicitly therapeutic in orientation. Then we briefly describe the advantages and disadvantages of treatments for mood and anxiety disorders and comment on ways to handle comorbidity often associated with these disorders. Finally we discuss challenges when disseminating Internet interventions. In conclusion, there is now a large body of evidence suggesting that Internet interventions work. Several research questions remain open, including how Internet interventions can be blended with traditional forms of care. Copyright © 2014 World Psychiatric Association.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                December 2018
                04 December 2018
                : 6
                : 12
                : e11661
                Affiliations
                [1 ] Black Dog Institute Faculty of Medicine University of New South Wales Sydney Australia
                [2 ] Medical Research Council Cognition and Brain Sciences Unit University of Cambridge Cambridge United Kingdom
                [3 ] School of Systems, Management and Leadership Faculty of Engineering and IT University of Technology Sydney Australia
                [4 ] Brain and Mind Centre, Central Clinical School Faculty of Medicine and Health University of Sydney Sydney Australia
                [5 ] School of Electrical and Information Engineering University of Sydney Sydney Australia
                Author notes
                Corresponding Author: Mark Deady m.deady@ 123456unsw.edu.au
                Author information
                http://orcid.org/0000-0002-5230-2401
                http://orcid.org/0000-0001-6237-5527
                http://orcid.org/0000-0002-0596-7814
                http://orcid.org/0000-0002-0476-9146
                http://orcid.org/0000-0002-4767-4198
                http://orcid.org/0000-0003-2238-0684
                http://orcid.org/0000-0001-9580-3743
                Article
                v6i12e11661
                10.2196/11661
                6299234
                30514694
                f355ed60-370f-439c-b7c9-6fcbd54004b7
                ©Mark Deady, David Johnston, David Milne, Nick Glozier, Dorian Peters, Rafael Calvo, Samuel Harvey. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 04.12.2018.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

                History
                : 25 July 2018
                : 2 September 2018
                : 14 September 2018
                : 14 September 2018
                Categories
                Original Paper
                Original Paper

                depression,workplace,mhealth,smartphone,ehealth,pilot
                depression, workplace, mhealth, smartphone, ehealth, pilot

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