Eltern mit psychischen Erkrankungen stehen in ihrer Elternrolle vor spezifischen Herausforderungen, die in der psychotherapeutischen Versorgung häufig unzureichend berücksichtigt werden. Digitale, zielgruppenspezifische Angebote können eine niedrigschwellige Ergänzung sein, um elterliche Kompetenzen zu stärken und Belastungen zu reduzieren. Ziele waren die partizipative Entwicklung eines transdiagnostischen digitalen Elterntrainings (TEPSY) für psychisch belastete Eltern sowie die erste Untersuchung der Nutzungserfahrungen. Gemeinsam mit psychisch belasteten Eltern wurde eine App mit 10 Modulen zu elternschaftsrelevanten Themen wie Stress, Emotionsregulation und Kommunikation entwickelt. In einer qualitativen Machbarkeitsstudie wurden die Rückmeldungen der Teilnehmenden zu den Inhalten in Bezug auf Akzeptanz, Verständlichkeit und Nutzen untersucht. Die Rückmeldungen zeigten eine hohe Akzeptanz und Verständlichkeit der Inhalte. Ansprache und Inhalte der App wurden als entlastend wahrgenommen. Gleichzeitig wurden Hinweise auf Weiterentwicklungsbedarf identifiziert, insbesondere hinsichtlich einer stärkeren Berücksichtigung unterschiedlicher Altersgruppen von Kindern und einer inhaltlichen Vertiefung einzelner Module. Die Ergebnisse unterstreichen das Potenzial partizipativ entwickelter digitaler Interventionen zur Unterstützung psychisch belasteter Eltern. Sie können die psychotherapeutische Versorgung ergänzen, zur Selbsthilfe genutzt werden und einen wertvollen Beitrag zur Unterstützung belasteter Eltern leisten. Durch weitere Anpassungen könnte die Zufriedenheit der Nutzenden gesteigert werden.

Abstract Background Expectations are considered an important mechanism of change in psychotherapeutic interventions, including internet- and mobile-based interventions (IMI). This study aims to investigate whether two expectation-focused microinterventions can enhance the effects of an IMI for participants with elevated depression. Methods All participants will receive an established IMI consisting of six evidence-based cognitive behavioral modules. In this 2×3 factorial design, 720 adult participants will be randomized to receive (1) either the IMI in standard or personalized framing (first randomization factor), in combination with (2) an expectation-focused telephone call mid-treatment, a supportive phone call or no phone call (second randomization factor). The primary outcome is depression at mid- and post-treatment (BDI-II). Secondary measures include expectations, adherence, state and trait anxiety and depression, disability, negative effects, and satisfaction with treatment. Discussion This study will increase knowledge about applying micro-interventions to modify expectations and improve the effects of IMI in the treatment of depressive symptoms. Scalable IMI has the potential to improve healthcare but ways to further improve their effects and adherence need to be explored. Trial registration The trial was prospectively registered under DRKS00032982. Registered on July 11, 2023.

Since the introduction of the dimensional assessment of personality functioning (PF) in DSM-5 and ICD-11, impairments in PF have consistently been related to transdiagnostic risk-factors for mental health. However, ecological momentary assessment (EMA) investigating PF in relation to affect-event dynamics and other psychopathology are scarce. Leveraging EMA data from 16,038 mental health app users, this study examines how baseline impairments in PF, within-person affect-event dynamics, and depression predict longitudinal outcomes in PF impairment and depression severity. We hypothesized a central role of PF in these relationships. Within the first month of usage, on average, 69.3 (range 31-142) mood assessments and 63.3 (range 25 - 133) event assessments were available per user. Dynamic structural equation models (DSEM) showed that baseline depression was associated with weakened or even negative concurrent and cross-lagged links between mood and positive events, including lower inertia and reduced likelihood of positive events. In contrast, baseline PF impairment was associated with persistence, emotional impact and volatility of interpersonal conflict events as well as with greater mood instability. Over a one-year follow-up (N = 1,464; M = 1,236 assessments per user), DSEM identified different patterns: Future PF impairment and depression were both predicted by less concurrent mood-positive event associations, less positive event volatility, and baseline average mood/events. Among affect-event dynamics, cross-lagged effects of interpersonal conflicts on mood explained the highest unique variance of future PF impairment (ΔR2 5.9%). Notably, baseline PF exhibited the strongest overall predictive utility (ΔR2 = 19.5%), followed by baseline depression symptoms (ΔR2 = 11.9%) with PF showing higher variance explanation in future depression severity than vice versa. Results offer specific targets for interventions: assessment of PF could help to inform decisions regarding duration, goals, and intervention strategies beyond the treatment of personality disorders. We contextualize the results within the limitations of the study, notably the use of a single method.

Since the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and the 11th revision of the International Classification of Diseases introduced dimensional assessment of personality functioning (PF), PF impairments have been linked to transdiagnostic mental-health risk factors. Using ecological momentary assessment data from 16,038 mental health app users, we tested whether baseline PF impairment, affect-event dynamics, and depression predict future PF impairment and depression severity, hypothesizing a central role of PF. In the first month, users completed 69.3 mood (range 31-142) and 63.3 event assessments (25-133) on average. Dynamic structural equation models linked baseline depression to lower concurrent and cross-lagged mood-positive event links, lower inertia, and reduced likelihood of positive events. In contrast, baseline PF impairment related to persistence, emotional impact, and volatility of interpersonal conflict and greater mood instability. Over 1-year follow-up (N = 1,464, M = 1,236 assessments per user), future PF impairment and depression were predicted by weaker concurrent mood-positive event links, lower volatility of positive events, and baseline average mood/events. Among affect-event dynamics, cross-lagged effects of interpersonal conflicts on mood explained the highest unique variance in future PF impairment (ΔR2 = 5.9%). Baseline PF showed the strongest overall predictive utility (ΔR2 = 19.5%), followed by baseline depression (ΔR2 = 11.9%); PF explained more variance in future depression than vice versa. PF assessment may inform duration, goals, and strategies of treatments beyond those focused on personality disorders. Results are interpreted considering limitations, particularly the single-method design. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Parents with mental health conditions often face specific challenges in their parental role that are not adequately addressed in psychotherapeutic care. Target group-specific digital interventions can provide a low-threshold addition to strengthen parenting skills and reduce stress. Objective: The aim was to develop a participatory transdiagnostic digital parenting training (TEPSY) for parents experiencing psychological distress and to conduct an initial examination of user experiences. Material and methods: In collaboration with parents experiencing psychological distress, an app comprising 10 modules on parenthood-relevant topics, such as stress, emotion regulation and communication, was developed. A qualitative feasibility study analyzed participants' feedback on the contents of the app with respect to acceptability, comprehensibility and perceived usefulness. Results: The feedback indicated that the content was highly acceptable and comprehensible. The tone and content of the app were both perceived as supportive and reassuring; however, areas for further development were also identified, particularly regarding greater consideration of different age groups of children and deeper elaboration of selected modules. Conclusion: The findings underscore the potential of participatory digital interventions in supporting parents experiencing psychological distress. The training could complement psychotherapeutic care and serve as self-help tools. Further refinement and effectiveness studies are warranted. Overall, the study suggests that participatory digital parenting training can be valuable in supporting this target group.

Abstract Background Syrian refugees across diverse host countries, including high-income European countries, face increased mental health needs. Digital interventions can scale support, but global scalability limits human guidance and contextual adaptations. We evaluated the effectiveness of a potentially scalable digital intervention (Step-by-Step; SbS) with minimal contact-on-demand (COD) in reducing psychological distress and functional impairment among Syrian refugees in Germany and Sweden. These trials were conducted in parallel with SbS studies in Egypt and Lebanon, using the same content to test broader contextual applicability without further adaptations. Methods Separate two-arm pragmatic RCTs were conducted in Germany (N = 559) and Sweden (N = 184) with Syrians screening positive for elevated distress (K10 > 15) and impaired functioning (WHODAS 2.0 > 16). Participants were randomized to SbS (five sessions) + care-as-usual (CAU) or CAU-only. Primary outcomes were psychological distress (HSCL-25) and functioning (WHODAS 2.0) at 3-month follow-up. Secondary outcomes were PTSD symptoms (PCL-5 short) and self-defined problems (PSYCHLOPS). Intention-to-treat (ITT) analyses were run separately by trial. Exploratory per-protocol analyses combined datasets. Results ITT analyses showed no statistically significant time × condition effects for any primary or secondary outcome in both trials. Dropout was high (Germany: 86.3%; Sweden: 82.1%). In per-protocol analyses (participants completing ≥ 4 of 5 sessions), the SbS + CAU arm showed significantly lower standardized mean scores at 3 months for psychological distress (HSCL-25; Hedges’ g = 0.31; p = .03) and PTSD symptoms (PCL-5 short; Hedges’ g = 0.27; p < .05). COD use was low (Germany: 15.1%; Sweden: 8.4%), leaving the intervention effectively unguided for most participants. Conclusions While limiting guidance and contextual tailoring can enhance scalability across borders, digital interventions may struggle with engagement, adherence, and contextual relevance. In high-income settings, an unguided approach for refugees may not work, showing that prioritizing scalability could potentially compromise clinical impact in this population. Some level of human guidance may be necessary to balance scalability and effectiveness, and it remains unclear how minimal that guidance can be without compromising outcomes. Trial registration German Register for Clinical Studies (Germany: DRKS00022143—registered June 29th, 2020, and Sweden: DRKS00022144—registered July 1st, 2020).

BACKGROUND:Although psychosocial interventions delivered by non-specialist providers effectively treat common mental disorders such as depression and anxiety, the treatment-specific elements driving their efficacy remain largely unknown. Our aim was to compare and rank the efficacy of the individual active components of task-shared psychosocial interventions and to predict efficacy using individual participant characteristics. METHODS:We performed a systematic review and Bayesian individual participant data component network meta-analysis of RCTs comparing different task-shared psychosocial interventions with control conditions for the treatment of adults with common mental disorders. We searched MEDLINE, Embase, PsycINFO, and CENTRAL from database inception to March 15, 2023. We included additional datasets published up to May 29, 2026 and unpublished RCTs. We sought individual participant data from the trial authors. A purpose-built taxonomy of treatment-specific elements was used to dismantle interventions into their constituent components. The primary outcome was efficacy in reducing symptoms of common mental disorders, as measured at study endpoint. We used incremental mean difference to indicate the added benefit (or detrimental effect) of adding a component to a treatment. We assessed the risk of bias of the included studies with the revised Cochrane Risk of Bias tool. The protocol was published in a peer-reviewed journal. FINDINGS:We included 34 RCTs, from which 30 trials (89%) contributed individual participant data from 10 612 participants. Of these participants, 7662 were women (72·2%) and 2950 were men (27·8%). The mean age of participants was 36·7 years (SD 5·5). Findings identified strengthening social support (incremental mean difference -9·48; 95% credible interval [CrI] -13·29 to -6·60), behavioural activation (-4·15; -7·48 to -0·05), and problem management (-4·08; -5·37 to -2·83) as the most beneficial components. Relaxation (7·97; 3·35 to 12·11) and, less clearly, cognitive reframing (5·17; 0·78 to 9·15) were identified as detrimental components. Interaction analyses revealed that component effects vary systematically by baseline severity and other sociodemographic characteristics. Ethnicity data were not available. Individuals with lived experience contributed to the interpretation of results. Personalised effect estimates can be computed via a freely accessible web application. INTERPRETATION:Strengthening social support, problem management, and behavioural activation were associated with the greatest incremental benefit within task-shared psychosocial interventions for adults with depression or anxiety. FUNDING:European Commission.

Background:Refugees are a particularly vulnerable target group in healthcare. Innovative digital treatment options offer the opportunity to reduce or even close gaps in care for this particular group. Despite promising evidence, only a few digital interventions have been used in inpatient psychiatric care in Germany to date. The I-REACH project investigated the implementation of "blended care" (the use of a digital support in addition to face-to-face (F2F) routine care services) in inpatient psychiatric care for refugees. The aim was to describe the factors promoting and hindering implementation from the perspective of professionals in order to support implementation efforts. Methodology:As part of the I-REACH project, a qualitative survey was conducted to explore support factors and barriers to the implementation of a blended care application ("blended Almamar-App" in combination with face-to-face diagnostics and therapy). Between August and November 2024, 15 guided interviews were conducted with eight healthcare professionals and seven local study coordinators from the participating study centres. The interviews were coded and evaluated using a qualitative content analysis according to Kuckartz. Results:Key promoting factors and barriers were identified deductively and inductively in accordance with the interview guide from the perspective of professionals involved in the project. Technical, patient-related, practitioner-related, organizational, and structural factors were described. Conclusion:In order to integrate digital interventions such as the "blended Almamar-App" into routine care, technical requirements such as existing devices and reliable network connectivity, continuous information and training for users, and structured organization are particularly important. It is advisable to integrate data into existing digital hospital information systems wherever possible and to provide resource-oriented support to practitioners in implementing digital treatment options.

INTRODUCTION:Cognitive behavioural therapy (CBT) serves as a first-line treatment for internalising disorders (ID), encompassing depressive, anxiety or obsessive-compulsive disorders. Nonetheless, a substantial proportion of patients do not experience sufficient symptom relief. Recent advances in wearable technology and smartphone integration enable new, ecologically valid approaches to capture dynamic processes in real time. By combining ecological momentary assessment (EMA) with passive sensing of behavioural and physiological information, this project seeks to track daily fluctuations in symptom-associated constructs like affect, emotion regulation (ER) and physical activity. Our central goal is to determine whether dynamic, multimodal markers derived from EMA and passive sensing can predict treatment non-response and illuminate key factors that drive or hinder therapeutic change. METHODS AND ANALYSIS:PREACT-digital is a subproject of the Research Unit FOR 5187 (PREACT), a large multicentre observational study in four outpatient clinics. PREACT channels state-of-the-art machine learning techniques identify predictors of non-response to CBT in ID. The study is currently running and will end in June 2026. Patients seeking CBT at one of four participating outpatient clinics are invited to join PREACT-digital. They can take part in (1) a short version with a 14-day EMA and passive sensing phase prior to therapy, or (2) a long version in which the short version's assessments are extended throughout the therapy. It is estimated that 468 patients take part in PREACT-digital, of which 350 opt for the long version of the study. Participants are provided with a smartwatch and a customised study app. We collect passive data on heart rate, physical activity, sleep and location patterns. EMA assessments cover affect, ER strategies, context and therapeutic agency. Primary outcomes on (non)-response are assessed after 20 therapy sessions and therapy end. We employ predictive and exploratory analyses. Predictive analyses focus on classification of non-response using basic algorithms (ie, logistic regression and gradient boosting) for straightforward interpretability and advanced methods (LSTM, DSEM) to capture complex temporal and hierarchical patterns. Exploratory analyses investigate mechanistic links, examine the interplay of variables over time and analyse change trajectories. Study findings will inform more personalised and ecologically valid approaches to CBT for ID. ETHICS AND DISSEMINATION:The study has received ethical approval from the Institutional Ethics Committee of the Department of Psychology at Humboldt Universität zu Berlin (Approval No. 2021-01) and the Ethics Committee of Charité-Universitätsmedizin Berlin (Approval No. EA1/186/22). Written informed consent will be obtained from all participants prior to enrolment. Results will be disseminated through peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER:DRKS00030915; OSF PREACT: http://osf.io/bcgax; OSF PREACT-digital: https://osf.io/253nb.

Since the introduction of the dimensional assessment of personality functioning (PF) in DSM-5 and ICD-11, impairments in PF have consistently been related to transdiagnostic risk-factors for mental health. However, ecological momentary assessment investigating PF in relation to affect event dynamics and other psychopathology are scarce. Leveraging ecological momentary assessment (EMA) data from 16,038 mental health app users, this study examines how within-person affect-event dynamics, baseline impairments in PF, and depression predict longitudinal outcomes in PF impairment and depression severity. We hypothesized a central role of PF in these relationships. Within the first month of usage, on average, 69.3 [range 31-142] mood assessments and 63.3 [range 25 - 133] event assessments were available per user. Dynamic structural equation models showed substantial associations of baseline depression with weakened concurrent, lagged and cross-lagged links between events and mood, especially for positive events, including reduced likelihood of positive events. In contrast, baseline PF impairment was associated with persistence, emotional impact and volatility of interpersonal conflict events as well as with greater mood instability. Over a one-year follow-up (N=1,464; ø 1235,69 assessments per user), dynamic structural equation models identified distinct patterns: Lower concurrent mood-positive event associations, higher negative and lower positive event unpredictability, and baseline average mood/events were predictive of future PF impairment. Among affect-event dynamics, stronger cross-lagged effects of interpersonal conflicts on mood explained highest unique variance of future PF impairment (ΔR2 5.9%). Notably, baseline PF exhibited the strongest predictive utility (ΔR2 = 19.5%), followed by baseline depression symptoms (ΔR2 = 11.9%) with PF showing higher variance explanation in future depression severity than vice versa. Total average variance explanation was 71.2% for future depression severity and 75.2% for future PF impairment. Results offer specific targets for interventions: assessment of PF could therefore help to inform decisions regarding duration, goals, and intervention strategies also beyond treatment of PD. We contextualize the results within the limitations of the study, notably the use of single method self-reports.

Althhough cognitive behavioral therapy is considered a first-line treatment, a substantial proportion of patients does not experience sufficient symptom relief. Recent advances in wearable technology and smartphone integration enable new, ecologically valid approaches to capture dynamic processes in real time. By combining ecological momentary assessment (EMA) with passive sensing of behavioral and physiological information, this project seeks to track daily fluctuations in symptom-associated constructs like affect, emotion regulation and physical activity. Our central goal is to determine whether dynamic, multimodal markers derived from EMA and passive sensing can predict treatment non-response and illuminate key factors that drive or hinder therapeutic change. PREACT-digital is a subproject of the Research Unit FOR 5187 (PREACT), a large multicenter observational study in four outpatient clinics. PREACT channels state of the art machine learning techniques to identify predictors of non-response to cognitive behavioral therapy (CBT) in internalizing disorders. The study is currently running and will end in May 2026. Patients seeking cognitive behavioral therapy at one of four participating outpatient clinics are invited to join PREACT-digital. They can take part in (1) a short version with a 14-day EMA and passive sensing phase prior to therapy, or (2) a long version in which assessments are extended up to a year. Participants are provided with a smartwatch and a customized study app. We collect passive data on heart rate, physical activity, sleep, and location patterns. EMA assessments cover affect, emotion regulation strategies, context and therapeutic agency. Primary outcomes on (non)-response are assessed after 20 therapy sessions and therapy end. We employ predictive and exploratory analyses. Predictive analyses focus on classification of non-response, using basic algorithms (i.e. logistic regression, gradient boosting) for straightforward interpretability, and advanced methods (LSTM, DSEM) to capture complex temporal and hierarchical patterns. Exploratory analyses investigate mechanistic links, examine the interplay of variables over time, and analyze change trajectories. Study findings will inform more personalized and ecologically valid approaches to cognitive behavioral therapy for internalizing disorders. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The work was funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG, project number: 442075332) with a grant spanning four years, from July 1, 2022, to June 30, 2026. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study has received ethical approval from the Institutional Ethics Committee of the Department of Psychology at Humboldt Universitaet zu Berlin (Approval No. 2021-01) and the Ethics Committee of Charite-Universitaetsmedizin Berlin (Approval No. EA1/186/22). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes One year after the last patient out, data will be fully anonymized to allow for open science practices and data sharing, while at the same time securing patients data protection rights.

BackgroundUpon arriving in host countries, forcibly displaced people face psychological, cultural, as well as sociostructural challenges. Access to mental health and psychosocial support (MHPSS) remains limited, affecting both refugees and host country structures. Digital services offer promise in addressing these challenges, given their potential for scalability and accessibility. Despite the increasing use of digital MHPSS, cultural and contextual adaptation remains insufficiently documented, requiring systematic documentation. ObjectiveThis study aims (1) to assess the psychosocial needs of newly arrived refugees in Switzerland and identify potential digital support solutions and (2) to participatorily develop and culturally adapt the Sui app to address those needs for Arabic-speaking refugees. MethodsWe used a 2-phase adaptation process, structured using the RECAPT (Reporting Cultural Adaptation in Psychological Trials) framework to ensure systematic documentation. The preparation phase (2019-2021) included a desk review, needs assessment interviews, and conceptualization discussions. The development phase (2021-2022) included iterative development loops with a user advisory board (UAB) and a beta test, followed by final adjustments. ResultsThe desk review provided 5 key insights guiding development: mental health stigma, health literacy, sociostructural aspects, adherence to digital interventions, and task-shifting approaches. Findings from the needs assessment with 22 asylum care interviewees, 2 intercultural interpreters, and 4 target group interviewees confirmed the importance of integrating sociostructural and psychological factors. Through conceptualization discussions with a consultancy agency and 4 UAB (n=9) meetings, the scope of the Sui app was drafted: 9 relevant, everyday life topics (eg, asylum process, housing, and work), 5 psychological topics (eg, stress, sleep, and emotion regulation), and 1 peer-guided chat support feature. A multilevel translation process, involving 5 Arabic speakers from different countries, ensured linguistic accessibility. This allowed the UAB to focus on surface, content, and delivery during 19 development loops. The app’s content was delivered in various formats, including text, illustrations, video testimonies, and audio exercises. The beta test revealed high acceptability, with most users engaging with the app several times a week. However, technical challenges such as slow loading times hindered the full exploration of the features. Participants valued the peer support function, highlighting the importance of faster response times and personalized messages. Based on the beta test, technical and content refinements were made to prepare the app for a future quantitative evaluation. ConclusionsThrough engagement with stakeholders and adherence to the RECAPT framework, we carefully considered the cultural and contextual circumstances of Arabic-speaking refugees newly arrived in Switzerland. The iterative participatory development process, spanning a preparation and development phase, ensured usability, accessibility, and relevance, while highlighting challenges in technical implementation and peer support. This study contributes to the existing knowledge of mental health and the needs of refugees and provides insights for future cultural adaptation of MHPSS interventions.

Introduction: Refugees’ quality of life (QOL) is significantly impacted by the challenging post-migration context. Digital mental health and psychosocial support (MHPSS) services offer scalable, culturally adaptable solutions. This study evaluates the Sui app, co-developed with Arabic-speaking refugees in Switzerland to address barriers to mental healthcare and promote psychosocial well-being. Methods: A mixed-methods randomised controlled trial assessed the app’s impact on QOL and mental health outcomes among Arabic-speaking refugees. Participants were randomised (2:2:1) into app-only (Sui, n = 68), app with peer support (Sui+, n = 68), or waitlist (WL, n = 34). The primary outcome was QOL (WHOQOL-BREF), secondary outcomes included mental health indicators (e.g., depressive, anxiety, post-traumatic stress and somatic symptoms). Quantitative data were collected at baseline, post (8 weeks), and follow-up (16 weeks). Semi-structured interviews explored user experiences. Ethical approval was obtained, and all participants gave informed consent. Results: Intention-to-treat analyses (N = 170) using linear mixed-effects models revealed no significant group-by-time interaction effects, indicating that changes over time did not differ significantly between the three groups for QOL (e.g., psychological domain: F(2134.67) = 1.85, p = .16) and for any of the secondary outcomes at post-assessment. Small but significant effects emerged at follow-up between active groups. Median app usage for was 13.1 min, with 95 participants successfully logging in. Qualitative findings identified barriers such as unclear onboarding, technical issues, and limited applicability. Nonetheless, participants expressed general satisfaction with the app’s content and peer support. Conclusions: The Sui app was well-accepted and its context-sensitive design offers promise for digital MHPSS services for refugees. However, lack of significant outcome improvements and limited engagement underscore the need for technical refinements, stronger onboarding, and more visible peer support.

Personalization of various Internet- and mobile-based intervention (IMI) components is common, but inconsistent terminology and selective reporting hinder research and practice. This paper introduces the Adjustable Content &amp; Order, Direct clinical guidance, Alerts (Reminders and Communication/alerts), and Presentation Style and Tailored User Interaction in IMI (ADAPT-I) checklist. We developed ADAPT-I through an iterative, multistep process that included literature reviews, expert focus groups, and multiple rounds of revision and piloting. The final checklist was implemented in a web-based interactive application for enhanced applicability. The ADAPT-I checklist supports detailed reporting of what IMI components are personalized, on what basis, and through which decision agents. By enhancing intentionality in intervention design and transparency in reporting, ADAPT-I serves as a valuable tool for both researchers and developers of IMIs.

Background Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS systems Methods A mixed-methods rapid appraisal methodology guided by an adapted WHO Health System Framework was used to assess HSR in eight countries (Egypt, Germany, Jordan, Lebanon, Netherlands, Sweden, Switzerland, and Türkiye). Quantitative and qualitative analysis of primary and secondary data was used. Data collection and analysis were performed iteratively by multiple researchers. Country reports were used for comparative analysis and synthesis. Results We found numerous constraints in HSR: i) Too few appropriate mental health providers and services; ii) Travel-related barriers impeding access to services, widening rural-urban inequalities in the distribution of mental health workers; iii) Cultural, language, and knowledge-related barriers to timely care likely caused by insufficient numbers of culturally sensitive providers, costs of professional interpreters, somatic presentations of distress by Syrian refugees, limited mental health awareness, and stigma associated to mental illness; iv) High out-of-pocket costs for psychological treatment and transportation to services reducing affordability, particularly in middle-income countries; v) Long waiting times for specialist mental health services; vi) Information gaps on the mental health needs of refugees and responsiveness of MHPSS systems in all countries. Six recommendations are provided to address these issues. Conclusions All eight host countries struggle to provide responsive MHPSS to Syrian refugees. Strengthening the mental health workforce (in terms of quantity, quality, diversity, and distribution) is urgently needed to enable Syrian refugees to receive culturally appropriate and timely care and improve mental health outcomes. Increased financial investment in mental health and improved health information systems are crucial.

Upon arriving in host countries, forcibly displaced people face a multitude of psychological, cultural, as well as socio-structural challenges. The urgent need for psychological and psychosocial support remains substantially unmet, impacting practically all asylum seekers and refugees. Beyond the direct impact on individuals, this care gap also affects host countries’ existing structures, necessitating holistic approaches in parallel to an expansion of specialised care. Digital services offer promise in addressing these challenges, given their potential for scalability and accessibility. The latter is particularly relevant for refugee groups as they often face geographical, structural, and linguistic barriers. However, the understanding and implementing cultural and contextual adaptation in interventions remain limited and require systematic processes and reporting. This article presents the participatory development process of the culture- and context-sensitively adapted “Sui App”. Sui is a digital low-threshold psychosocial support service tailored to recently arrived refugees in Switzerland, focusing on those from Arabic-speaking backgrounds. The app can be utilised independently or augmented with peer support through an in-app chat feature. We employed a user-centred participatory approach across the project's preparation, development, and finalisation phases. Cultural and contextual considerations were documented using the RECAPT framework. We conducted a desk review, qualitative interviews, iterative advisory group meetings, and a beta test to finalise a version of the app for a subsequent evaluation in a randomised controlled trial (RCT). To enhance the psychological well-being of recently arrived asylum seekers and refugees in Switzerland, both socio-structural and psychological factors should be included. A digital service aimed at meeting their needs in everyday life should incorporate those factors. In the iterative development process, the app Sui evolved. The app contains practical information on nine relevant, everyday life topics and five psychological topics to promote overall well-being in a resource-oriented way. Additionally, users can be supported by trained peers through an in-app chat. Essential for the participatory process was the multi-levelled translation process through which a widely understandable translation could be provided, allowing the advisory groups to focus on the content. The written content is accompanied by illustrations of fictional protagonists, video testimonies from other refugees telling their stories, and various audio exercises. Through engagement with stakeholders and adherence to the RECAPT framework, we carefully considered the cultural and contextual circumstances of Arabic-speaking refugees who have newly arrived in Switzerland. Our iterative development process, spanning a preparation, development, and finalisation phase, highlighted the importance of integrating socio-structural factors along with low-threshold psychological health promotion in a new digital support service. Despite encountering challenges such as technical issues during beta testing, our findings underscore the potential of digital services in bridging care gaps for marginalised populations.

Background Refugee populations have an increased risk for mental disorders, such as depression, anxiety, and posttraumatic stress disorders. Comorbidity is common. At the same time, refugees face multiple barriers to accessing mental health treatment. Only a minority of them receive adequate help. The planned trial evaluates a low-threshold, transdiagnostic Internet-based treatment. The trial aims at establishing its efficacy and cost-effectiveness compared with no treatment. Methods N = 131 treatment-seeking Arabic- or Farsi-speaking patients, meeting diagnostic criteria for a depressive, anxiety, and/or posttraumatic stress disorder will be randomized to either the intervention or the waitlist control group. The intervention group receives an Internet-based treatment with weekly written guidance provided by Arabic- or Farsi-speaking professionals. The treatment is based on the Common Elements Treatment Approach (CETA), is tailored to the individual patient, and takes 6–16 weeks. The control group will wait for 3 months and then receive the Internet-based treatment. Discussion The planned trial will result in an estimate of the efficacy of a low-threshold and scalable treatment option for the most common mental disorders in refugees. Trial registration German Registry for Clinical Trials DRKS00024154. Registered on February 1, 2021.

Purpose To assess gender differences in COVID-19 related changes in home and work responsibilities longitudinally, and determine whether these differences, together with other potential risk and protective factors, are associated with depression, anxiety, and post-traumatic stress disorder (PTSD) symptomatology. Method Symptoms of depression, anxiety, and PTSD were measured using an online survey instrument, between May 2020 and April 2021, in four waves completed at 3-monthly intervals. Analyses were based on data from the COvid MEntal healTh (COMET) survey which investigated the mental health effects of the COVID-19 outbreak spanning 13 countries on five continents in N = 7,909 participants. Results From the first to the last wave, women reported a greater increase in home and work responsibilities, and had higher depression, anxiety and PTSD scores compared to men. Women who reported a reduction in income due to the pandemic had higher depression scores. Working harder and experiencing a reduction in income were also associated with higher anxiety scores in women but not in men. Women were more likely to score above the cut-off for depression (32.5% vs 23.6%, p < .001), anxiety (21.2% vs 14.4%, p < .001) and PTSD (21.2% vs 14.4%, p < .001) than men during the first wave. Stronger reliance on socially supported coping mechanisms was a risk factor for depression, anxiety and PTSD in men and women. Conclusion Women were more likely to report mental health problems which may be related to the gender disproportionate increase in home and work responsibilities but not necessarily due to COVID-19 stressors.

BackgroundThere is evidence from meta-analyses and systematic reviews that digital mental health interventions for depression, anxiety, and stress-related disorders tend to be cost-effective. However, no such evidence exists for guided digital mental health care in low and middle-income countries (LMICs) facing humanitarian crises, where the needs are highest. Step-by-Step (SbS), a digital mental health intervention for depression, anxiety, and stress-related disorders, proved to be effective for Lebanese citizens and war-affected Syrians residing in Lebanon. Assessing the cost-effectiveness of SbS is crucial because Lebanon’s overstretched health care system must prioritize cost-effective treatment options in the face of continuing humanitarian and economic crises. ObjectiveThis study aims to assess the cost-effectiveness of SbS in a randomized comparison with enhanced usual care (EUC). MethodsThe cost-effectiveness analysis was conducted alongside a pragmatic randomized controlled trial in 2 parallel groups comparing SbS (n=614) with EUC (n=635). The primary outcome was cost (in US $ for the reference year 2019) per treatment response of depressive symptoms, defined as >50% reduction of depressive symptoms measured using the Patient Health Questionnaire (PHQ). The secondary outcome was cost per remission of depressive symptoms, defined as a PHQ score <5 at last follow-up (5 months post baseline). The evaluation was conducted first from the health care perspective then from the societal perspective. ResultsTaking the health care perspective, SbS had an 80% probability to be regarded as cost-effective compared with EUC when there is a willingness to pay US $220 per additional treatment response or US $840 per additional remission. Taking the wider societal perspective, SbS had a >75% probability to be cost-saving while gaining response or remission. ConclusionsTo our knowledge, this study is the first cost-effectiveness analysis based on a large randomized controlled trial (n=1249) of a guided digital mental health intervention in an LMIC. From the principal findings, 2 implications flowed, from the (1) health care perspective and (2) wider societal perspective. First, our findings suggest that SbS is associated with greater health benefits, albeit for higher costs than EUC. It is up to decision makers in health care to decide if they find the balance between additional health gains and additional health care costs acceptable. Second, as seen from the wider societal perspective, there is a substantial likelihood that SbS is not costing more than EUC but is associated with cost-savings as SBS participants become more productive, thus offsetting their health care costs. This finding may suggest to policy makers that it is in the interest of both population health and the wider Lebanese economy to implement SbS on a wide scale. In brief, SbS may offer a scalable, potentially cost-saving response to humanitarian emergencies in an LMIC. Trial RegistrationClinicalTrials.gov NCT03720769; https://clinicaltrials.gov/ct2/show/NCT03720769 International Registered Report Identifier (IRRID)RR2-10.2196/21585