Therapeutic games represent a promising and efficient format by which access to, and engagement with evidence-based content can be enhanced. REThink Game is such an online CBT-based intervention which was tested to be efficient in addressing the youngers mental health needs. In the current study, we recruited 85 children from an urban school (51 girls, Mage of 10.95, SD= 1.64) and were offered the REThink Game to play each level for a period of 4 weeks. Using a stepped-down adaptive design approach, those participants who did not register a reliable change after playing the game were further instructed to use a CBT-based ecological momentary intervention app, called PsyPills, while the rest were instructed to continue with monitoring their affective state using an ecological momentary assessment app, called MoodWheel. Results showed that after the participants played the game, their levels of mental health symptoms and irrational beliefs have significantly improved (d = 0.30, 95% CI [0.07, 0.53], and d = 0.27, 95% CI [0.04, 0.50], respectively). Participants who did not initially show reliable change achieved additional improvement over time and displayed outcomes comparable to those of early responders at post-intervention and 3-month follow-up. When examining potential moderators of intervention effects, the results suggested a consistent pattern: among participants with greater difficulties in attachment security, the game-based intervention combined with the PsyPills app appeared to be more effective. In conclusion, digital interventions can be used to enhance and tailor the intervention’s content based on children’s needs.

Given the growing data accumulated in the research of personal values change, we explored the existence and intensity of values change following major life events, whether individual or cumulative. A second objective of our research was to identify which of the major life events are studied, which study populations and their effects on personal values change. A total of 35 studies met the criteria to be included in the present meta-analysis with an average sample of 5289 participants. The mean effect size obtained was small with a great heterogeneity and thus subgroup analyses required grouping personal values in their clusters. The results show that traumatic events (e.g., war) and economic events of the region had the largest effect on mean-level changes in conservation cluster values analysis, while the directed interventions brought medium level changes in the self-enhancement and self-transcendence cluster values, followed by economic events and education. Education and time were associated with small level changes in all value clusters.

In today's world, children have high exposure to near-ubiquitous digital media in their homes. However, early use has been linked with developmental and emotional delays. In this context, the aim of our research was to examine specific emotional parental factors (i.e. anxiety-depressive and stress symptoms and parental reactions to children's negative emotions) that may be associated with the amount of screen time toddlers have during weekdays and weekends. A total of 100 parents of toddlers aged 12-36 months participated in the study, completing questionnaires. The findings revealed that parents' anxiety-depressive and stress symptoms were linked to their toddlers' digital media use, particularly on weekends. Additionally, parents' reactions to their children's negative emotions were most strongly associated with weekend television usage. Overall, regardless of the type of screen or time of use, higher exposure to TV or mobile devices was associated with the greater likelihood of parents using screens as a response to their children's negative emotions and a reduced likelihood of encouraging emotional expression. Moreover, associations between parental anxiety-depressive and stress symptoms and toddler weekday and weekend screen time were mediated by using screens to help children regulate emotions. This research enhances our understanding of the factors that may influence toddlers' screen exposure. Targeted interventions addressing these factors could be developed to prevent or mitigate early and extensive screen use in young children.

Children’s mental health issues can have a lasting effect into adulthood, including enhanced risks for their social and emotional development, as well as their academic performance and overall behavior. Worldwide nearly 1 billion children are affected by the bullying phenomenon, with social, emotional, and economic consequences. In this vein, our study aimed to analyze the effect of the therapeutic game RE Think on the improvement of emotion regulation abilities and the reduction of both bullying behavior and victimization in primary school children. Our sample consisted of 75 children who were voluntarily enrolled by their parents, and randomly assigned to the intervention group ( n = 38) or to the control group ( n = 37). They completed the baseline assessment consisting of emotion regulation, irrationality, bullying and victimization behavior measurements, then the children from the intervention group played the therapeutic game RE Think. Four weeks later, after completing each level twice, every participant had completed the same questionnaires at the post-test assessment. The results indicated significant changes across victimization for children who were exposed to verbal, physical or social bullying, increased emotional control and lower levels of irrationality, low frustration tolerance to work and demandingness, with small to medium effect size improvements for the RE Think game group compared to the control group. The RE Think therapeutic game proved to be a promising intervention tool for reducing victimization effects and irrationality, and improving emotion regulation abilities in primary school children. Future research could improve on these results by addressing the timeline stability limit.

PURPOSE:Despite generally positive perceptions from potential users, there remains a scarcity of studies examining the usability of mHealth apps from the perspective of end-users themselves, using validated measures. The PsyPills app, was first developed in 2019 for iOS devices and its efficacy documented on a proof-of-concept study showcasing a significant reduction in distressing emotions among users over a six-month period. Subsequently, the app was updated to function on both iOS and Android platforms, incorporating besides the already validated psychological pills, assessment instruments, and additional physiological and behavioural parameters. The aim of the present study was to assess the usability of the newly updated version of PsyPills. MATERIALS AND METHOD:Thus, 133 participants, aged 18-65 with smartphone access, completed the System Usability Scale (SUS) after using the app for a period of 2-4 weeks. RESULTS:Our results showed a mean SUS score of 70.94 (SD = 16.78) indicated above-average usability, positioning it at the end of grade C to C + on the Sauro-Lewis CGS. Learnability and Usability factors showed above-average performance, with no established interpretation guidelines. CONCLUSION:In conclusion, our results show that PsyPills has favourable usability, further complementing its promising potential to alleviate psychological distress. The study suggests that PsyPills, with its above-average usability across both iOS and Android platforms, can serve as a widely accessible tool for individuals experiencing psychological distress.

Digital mental health interventions (online, mobile, game-based) can reduce psychological difficulties, but attrition, especially in mobile apps, remains high. Personalizing treatment using predictors of uptake and dropout may improve engagement. We developed prognostic models of app uptake and study attrition using baseline demographic, psychological, and app usage data from two samples: distressed college students (N = 322) and adults from the general population (N = 450), using two distinct apps, the PsyPills and OCAT apps. Multivariate logistic regressions showed consistent patterns across studies: higher usage frequency predicted lower attrition, while male gender predicted lower uptake. Study-specific effects also emerged: higher depression predicted lower uptake in students, whereas symptoms did not predict uptake in the general population. Overall, our results showed that engagement is shaped by both individual and intervention-level factors, underscoring the need for personalized, ecologically responsive interventions.

Background: Mental disorders are highly prevalent among students worldwide. This study aims to examine comorbidity and temporal associations between mental disorders among students. Methods: The study included 72,288 students from 18 countries as part of the World Mental Health International College Student (WMH-ICS) Initiative, with cross-sectional data collected between 2017 and 2023. Screening for common DSM-5 disorders was conducted using validated screening measures. Latent variables were examined using exploratory principal axis factor analysis on a correlation matrix among the lifetime mental disorders. Based on age-of-onset information, multivariable poisson regression models were used to examine associations of prior disorders with the first onset of other disorders. Results: 27.0 % of students screened positive for only one lifetime disorder, 17.1 % for two, 10.9 % for three, and 10.6 % for 4+ disorders. In the factor analysis, three latent variables were found, comprising: internalizing disorders (generalized anxiety disorder, major depressive episode, post-traumatic stress disorder, and panic disorder), substance use disorders (drug use disorder and alcohol use disorder), and externalizing disorders (attention deficit/hyperactivity disorder and mania/hypomania). Prior internalizing and externalizing disorders were associated with the subsequent first onset of all other disorders with risk ratios ranging from 1.5-7.5. Substance use disorders were less consistently associated with the subsequent first onset of other disorders, but alcohol use disorder was associated with the first onset of drug use disorder and vice versa. Conclusions: Mental disorder comorbidity is common among students, and students with disorders across the internalizing and externalizing spectrum have an increased risk of future mental disorder comorbidities.

Background: Digital applications, such as in smartphone apps format, have shown high suggestive evidence for their efficacy in reducing general distress, but rigorous studies of their efficacy in symptom change and the mechanisms involved are still needed. Methods: In the current multi-arm parallel-group randomized trial, participants aged 18-65 with smartphone access were recruited through social media. They were randomly assigned to two app interventions (PsyPills and OCAT) or an active placebo group (shamOCAT). The primary outcome was psychological distress measured up to one month. Results: A total of 229 participants from diverse regional and demographic groups of the general population of Romania were randomly allocated into the three groups (PsyPills n = 80; OCAT n = 70; shamOCAT n = 79) and included in intention-to-treat analyses. Both the PsyPills (MD =-522; 95%CI =-10.00 to-0.44; d = 0.48) and OCAT (MD =-6.30; 95%CI =-11.39 to-1.21; d = 0.58) reduced significantly, with medium effect sizes, the psychological distress levels compared with the control group at follow-up. For the separate outcomes, only PsyPills showed significant medium reduction effects for anxiety symptoms (MD =-2.17; 95%CI =-3.83 to-0.50; d =-0.60), while OCAT showed reduction effects of small size for depression (MD =-1.50 (95%CI =-3.53 to 0.54, d =-0.34), that was however statistically nonsignificant. Limitations: We registered high attrition and low adherence rates. Also, lower-than-planned effects might have been statistically underpowered to detect. Conclusion: The results support the high potential of both apps as scalable tools to provide low-intensity self- guided interventions for common psychological problems in the general population and expand opportunities for further research (e.g., confirm and capitulate on the differential effects).

BACKGROUND:The prevalence of mental health problems among college students has increased over the past decade. Even when mental health services are available, many students still struggle to access these services. This systematic review and meta-analysis aimed to identify the rates at which students actively seek or consider using formal help and to determine the main reasons for not seeking help. METHODS:A comprehensive literature search was conducted on PubMed, PsycINFO, and Embase to identify studies on help-seeking behaviors, intentions, and barriers to help-seeking among college students with mental health problems. Random effect models were used to calculate the pooled proportions. RESULTS:Of the 8,919 identified studies, 62 met the inclusion criteria and were included (n = 53 on help-seeking behaviors, n = 21 on help-seeking intentions, and n = 14 on treatment barriers). The pooled prevalence of active help-seeking behaviors was 28% (179,915/435,768 individuals; 95% CI: 23%-33%, I2 = 99.6%), and the aggregated prevalence of help-seeking intentions was 41% (62,456/80161 individuals; 95% CI: 26%-58%, I2 = 99.8%). Common barriers reported by students included a preference to address issues on their own, time constraints, insufficient knowledge of accessible resources, and a perceived lack of need for professional help. CONCLUSIONS:The findings highlight the gap between the mental health needs of the students and their actual help-seeking rates. Although personal barriers are common, systemic or contextual challenges also affect college students' help-seeking behaviors.

OBJECTIVE:We examined psychopathological conditions accounting for the highest risk of role impairment among university students. METHOD:Cross-sectional online survey of first-year students (60 universities, 10 countries) assessing role impairment due to emotional problems in previous 30 days with the 3-item emotional subscale of the VR-36. Cross-tabulations and Poisson regression examined associations between 12 psychopathological conditions (8 probable mental disorders and 4 SITB) and socio-demographics with "significant role impairment" ("most"/"all of the time" in 2+ VR-36 items). We used machine learning methods to predict probabilities (risk) of significant role impairment based on the 12 psychopathological conditions. Observed prevalence of significant role impairment was examined within and across the 20 population ventiles to assess risk concentration using sensitivity (SN) and positive predictive value (PPV). RESULTS:43,990 students responded to the survey (median age = 19, IQR = 18-23). 27.1 % had significant role impairment due to emotional problems and 65.8 % had at least one psychopathological condition. Students with one or more of these conditions were more likely to have significant impairment than those without (RR = 3.9; 95 %CI: 3.6-4.2). In multivariable analyses, probable Depression and Bipolar disorders were the strongest correlates of significant impairment. Most (69.6 %) of the observed significant role impairment occurred among the roughly 35 % of respondents with highest predicted risk (PPV = 53.2 %). CONCLUSION:Significant role impairment due to emotional problems is highly prevalent among university students. High risk of significant role impairment concentrates in one third of the students, those with several psychopathological conditions. Assessing these conditions should help identifying highest role impairment risk university students.

Digital interventions, such as mental health apps, online or game-based interventions become nowadays vital tools in providing accessible and immediate support for individuals struggling with mental health issues. These technologies offer innovative ways to monitor and improve mental well-being and overcome many barriers of traditional therapy. The present paper introduces a new game-based intervention designed to train emotion regulation abilities in children, adolescents and young adults. The intervention, named the REThink Life online game, is composed of four levels, each training a distinct emotion regulation ability and is based on the Rational Emotive Behavioral Therapy (REBT). The game has several adjustable features, and an embedded assessment system that offers personalized recommendations for playing the game. The REThink Life online game can be used as a standalone intervention or as an adjuvant to another CBT based intervention. Implications for youths’ mental health are discussed.

PURPOSE:This study investigates associations of childhood adversities (CAs) with lifetime prevalence, 12-month prevalence, and 12-month persistence of mental disorders in a large cross-national sample of university students. METHODS:Data came from epidemiologic surveys carried out by the World Mental Health International College Student (WMH-ICS)Initiative across 18 countries (n=60,719). The web-based surveys screened for lifetime and 12-month prevalence and age-of-onset of common DSM-5 disorders (Major Depressive Disorder, Bipolar I/II Disorder, Generalized Anxiety Disorder, Panic Disorder, Posttraumatic Stress Disorder, Alcohol and Drug Use disorders, Attention-Deficit/Hyperactivity Disorder) and five types of CAs (family dysfunction, emotional abuse, physical abuse, sexual abuse, neglect). Multivariable Poisson regression models estimated associations of CA type, number, and frequency with disorders. RESULTS:The majority of incoming students reported exposure to at least one CA (64.9%), including 50.0 % family dysfunction, 42.2 % emotional abuse, 21.2 % physical abuse, 18.8 % neglect, and 5.0 % sexual abuse. Lifetime and 12-month disorders were significantly associated with CAs in multivariable models, although associations with disorder persistence were weaker. Population attributable risk proportions of 12-month disorders associated with CAs were in the range of 40.7-61.0 % for anxiety and mood disorders and 13.5-55.2 % for substance use disorders. CONCLUSION:Six out of ten university students arrive at university having been exposed to CAs. These students have substantially higher risk of mental disorders than other students, primarily due to associations with lifetime risk rather than persistence. Given the considerable distress and impairment caused by mental disorders, these results underscore the need for primary and secondary prevention efforts.

Semantic priming has been studied for nearly 50 years across various experimental manipulations and theoretical frameworks. Although previous studies provide insight into the cognitive underpinnings of semantic representations, they have suffered from small sample sizes and a lack of linguistic and cultural diversity. In this Registered Report, we measured the size and the variability of the semantic priming effect across 19 languages (N = 25,163 participants analyzed) by creating the largest available database of semantic priming values based on an adaptive sampling procedure. We found evidence for semantic priming in terms of differences in response latencies between related word-pair conditions and unrelated word-pair conditions. Model comparisons showed that inclusion of a random intercept for language improved model fit, providing support for variability in semantic priming across languages. This study highlights the robustness and variability of semantic priming across languages and provides a rich, linguistically diverse dataset for further analysis.

Even though it is well known that emotion regulation skills play a crucial role in mental health outcomes, researchers are still developing and testing new interventions for training those emotion regulation abilities in line with the latest technologies. The REThink Life Game is such an intervention, it is a standalone online therapeutic game developed to train emotion regulation abilities in college students, within its four levels, and it also has an embedded assessment system. The aim of the present study was to examine the usability of the assessment system of the REThink Life Game in college student population. In this vein, we used the Serious Game Evaluation Scale that was completed by 208 first year college students that played the assessment system of the game. Overall, our results show that the assessment system of the REThink Life therapeutic online game has good usability, and can be used to evaluate emotion regulation abilities in college students.

Mental health disparities have been reported among sexual minority individuals; minority stress theory posits that such disparities are a result of stigma and discrimination. We estimated the prevalence of mental disorders across sexual orientation groups among first-year college students and whether differences across sexual orientation groups varied by gender and country-level LGBTQ+ (lesbian, gay, bisexual, transgender, queer) social acceptance. Using data (N = 53,175; 13 countries) from the World Mental Health Surveys International College Surveys, we performed multilevel logistic regressions to estimate the associations between sexual orientation (i.e., heterosexual, heterosexual with same-gender attraction [SGA], gay/lesbian, bisexual, asexual, questioning, and other) and five twelve-month DSM-5 disorders (major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder). Heterosexual students with SGA (AORs 1.30-2.15), gay/lesbian (AORs 1.49-2.70), bisexual (AORs 2.26-3.49), questioning (AORs 1.38-2.04), and "other" (AORs 1.76-2.94) students had higher odds of all disorders compared to heterosexual students with no SGA; asexual students did not. Significant interactions with gender show that the gender difference in prevalence was greater among bisexual individuals for most disorders and among all sexual minorities (except "other") for drug use disorder. Significant interactions with country level LGBT+ social acceptance showed some sexual minority groups had lower odds (AORs 0.83-0.95) of disorder as country-level acceptance increased. These findings provide further evidence of mental disorder disparities across a wide range of sexual orientations and how these disparities vary by gender and societal LGBTQ+ acceptance in students from diverse countries.

OBJECTIVE:To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. METHOD:Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. RESULTS:Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4-7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5-7.7]), followed by MDx (RR range 1.3-3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3-2.6]; ideation-to-attempt transition RR=1.5 [1.3-1.8]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9-2.2]), major depressive disorder (RR=2.0 [1.9-2.1]), and bipolar disorder (RR=1.8 [1.6-2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3-1.7]), bipolar disorder (RR=1.4 [1.2-1.7]), and sexual abuse (RR=1.4 [1.2-1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0-1.8]). CONCLUSION:CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.

Youth with a chronic medical condition (CMC) are often affected by comorbid mental disorders. Resilience-strengthening interventions can protect youth’s mental health, yet evidence-based programs remain scarce. To address this lack, this study aimed to evaluate the feasibility of a dual approach combining app-based resilience training and cognitive behavioral group coaching. Fifty-one youths with CMC treated at a German university children’s hospital aged 12–16 years were recruited. They were randomly assigned to a combined app game and coaching intervention or sole app gameplay. At pre-, post-intervention, and at a 2-month follow-up resilience, automatic negative thoughts and an app and coaching evaluation were assessed. Feasibility was defined as a recruitment rate of 70%, an 85% adherence rate for the REThink game, and 70% participation in both coaching sessions. Feasibility criteria were reached for coaching participation but not for recruitment or app adherence. While both the REThink game app and coaching intervention had high acceptance rates among youth with CMC, participants receiving additional coaching sessions showed higher satisfaction and adherence rates. Participants preferred remote to in-person meetings. The findings support a combination of a gamification app approach with online group coaching. Group coaching can improve adherence while online options increase accessibility. Future research should focus on testing in diverse participant samples, language, and age-adapted updates of the REThink game app. These findings provide guidance for increasing adherence in future intervention studies in youth with CMC cohorts.

Background Adolescents with a chronic medical condition (CMC) are often affected by mental health disorders coexisting with their physical conditions. Resilience-strengthening interventions can be beneficial for the adolescents’ mental health. However, evidence-based programs among this target group remain scarce. Here, we evaluated the wishes and needs of adolescents with CMC for resilience trainings to improve adherence. Methods This qualitative study analyzed the experience of 46 adolescents aged 12–16 years receiving resilience training at a German University Hospital. They were randomly assigned to a combined app and cognitive-behavioral coaching intervention (CBT) or stand-alone resilience app game (REThink). Postintervention semi-structured qualitative interviews were conducted and analyzed by the standards of qualitative content analysis. Results Both the REThink game app and coaching were considered helpful by the participants. Adolescents’ preferable resilience strengthening methods were coping skills training, mental health education, building of self-esteem and mindfulness exercises. Adolescents emphasized the importance of age-adapted difficulty levels, graphical design and native language content. Appointment scheduling was identified as a major barrier leading to a preference for online coachings. Conclusions This study highlighted key preferences of adolescents with CMC for resilience trainings. Adolescents acknowledged the value of both the app game and coaching format. Insights on coaching and app design preferences emphasize the importance of age-adapted and customizable interventions. The identified resilience training criteria provide a solid foundation for the development of forthcoming interventions. Trial registration number: DRKS00027870, registered 24.01.2022.

Objective: Emotional problems in the youth population are a major issue that can have a significant negative impact for their future development as adults. Their emotion regulation (ER) abilities represent a preventive measure for those emotional problems. REThink is an online therapeutic game that was proved to be effective in rigorous studies, and is based on the rational emotive behavioral therapy, with seven levels built to train various emotional regulation skills. Each level has a section that can be used for the assessment of the targeted skills within the level. The present study aimed at investigating the reliability and validity of the evaluation modules from the REThink game regarding the assessment of ER abilities in children/adolescents. Methods: In accordance with established guidelines, 110 children and adolescents aged 8-14 years old were recruited. Following parental informed consent, the participants filled out the standard questionnaires and, subsequently, they played the evaluation module of the REThink game. The reliability aspect was investigated by evaluating internal consistency, while validity was evaluated by using concurrent and predictive validity analyses. Results: The results revealed statistically significant positive associations between the game scores obtained by the participants and the emotion regulation scale. In terms of predictive validity, there were significant negative associations between game scores and the presence of emotional and behavioral problems. Moreover, in terms of the reliability of the REThink game, an acceptable value for the internal consistency was observed. Conclusion: In conclusion, the REThink therapeutic game was proved to be a valid measure for assessing emotion regulation abilities in children and adolescents. Clinical Trial Registration No. NCT04788901.

Parenting support to enhance parent and child mental health is increasingly offered on websites, apps, and through videocall. This development raises the question of how online parenting support compares to traditional in-person parenting support. Is online support non-inferior to traditional in-person support? Or should online support be used as a supplement to in-person support? In the COST Action EurofamNet (CA18123), we sought to answer these questions by systematically searching for randomized trials comparing online to in-person parenting support (Study 1) and trials comparing in-person parenting support augmented with online support elements to in-person parenting support only (Study 2). We registered our review in PROSPERO (CRD42022354393) and searched PsycINFO, MEDLINE, Web of Science, and Cochrane in May 2022. Our outcomes of interests were children’s mental health, parenting practices, parental mental health, and parents’ satisfaction with the program. For Study 1, multilevel meta-analysis of seven eligible randomized trials (101 effect sizes; N = 957) showed consistent non-inferiority of online support and a trend that parents were more satisfied with online support. For Study 2, narrative synthesis of two eligible trials (N = 279) suggests that adding online support elements to in-person support can improve program satisfaction and short-term benefits, but does not contribute significantly to program benefits above and beyond in-person support. Our findings suggest that, provided appropriate online formats and sufficient guidance from professionals, online parenting support is non-inferior to in-person support. The additive value of online support elements to in-person support seems limited, but may still be meaningful. Future research should identify the circumstances under which parents prefer, and benefit more from, in-person versus online parenting support.