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Suicidal ideation (SI) is a significant public health concern with increasing prevalence. Therapist-supported digital mental health interventions (DMHI) are an emergent modality to address common mental health problems like depression and anxiety, although less is known about SI. This study examined SI trajectories among 778 patients who participated in a therapist-supported DMHI using multilevel models during and up to 6-months post-treatment. Estimates of associated suicide attempts and deaths by suicide were calculated using published data linking PHQ-9-assessed SI to records of suicide attempts and deaths by suicide. The proportion of participants reporting no SI significantly increased between baseline and end-of-treatment (78.02% to 91.00%). Effect sizes of SI changes between baseline and end-of-treatment, 3-month, and 6-month follow-ups were 0.33 (95%CI = 0.27–0.38), 0.32 (95%CI = 0.27–0.38), and 0.32 (95%CI = 0.27–0.38), respectively. Results also indicated an estimated 30.49% reduction (95%CI = 25.15%-35.13%) in suicide attempts and death by suicide across treatment. This study provides preliminary evidence of the effectiveness of a therapist-supported DMHI in reducing SI. [ABSTRACT FROM AUTHOR]

Purpose: This study examined treatment outcomes (depression and anxiety symptoms) up to 24 months after completion of a therapist‐supported digital mental health intervention (DMHI). Methods: The sample consisted of 380 participants who participated in an eight‐week DMHI from February 6, 2017 to May 20, 2019. Participants reported depression and anxiety symptoms at eight timepoints from baseline to 24 months. Mixed‐effects modelling was used to investigate symptom changes over time. The proportion of participants meeting criteria for treatment response, clinically significant change, and remission of depression and anxiety symptoms were calculated, including proportions demonstrating each outcome sustained up to each timepoint. Results: Multivariate analyses yielded statistically significant reductions in depression (β = −5.40) and anxiety (β = −3.31) symptoms from baseline to end of treatment (8 weeks). Symptom levels remained significantly reduced from baseline through 24 months. The proportion of participants meeting criteria for clinical treatment outcomes remained constant over 24 months, although there were linear decreases in the proportions experiencing sustained clinical outcomes. Conclusions: Treatment gains were made for depression and anxiety symptoms at the end of treatment and up to 24 months. Future studies should determine the feasibility of integrating post‐treatment programmes into DMHIs to address symptom deterioration. [ABSTRACT FROM AUTHOR]

Heart rate variability biofeedback (HRVB) is an efficacious treatment for depression and anxiety. However, translation to digital mental health interventions (DMHI) requires computing and providing real‐time HRVB metrics in a personalized and user‐friendly fashion. To address these gaps, this study validates a real‐time HRVB feedback algorithm and characterizes the association of the main algorithmic summary metric—HRVB amplitude—with demographic, psychological, and health factors. We analyzed HRVB data from 5158 participants in a therapist‐supported DMHI incorporating slow‐paced breathing to treat depression or anxiety symptoms. A real‐time feedback metric of HRVB amplitude and a gold‐standard research metric of low‐frequency (LF) power were computed for each session and then averaged within‐participants over 2 weeks. We provide HRVB amplitude values, stratified by age and gender, and we characterize the multivariate associations of HRVB amplitude with demographic, psychological, and health factors. Real‐time HRVB amplitude correlated strongly (r =.93, p <.001) with the LF power around the respiratory frequency (~0.1 Hz). Age was associated with a significant decline in HRVB (β = −0.46, p <.001), which was steeper among men than women, adjusting for demographic, psychological, and health factors. Resting high‐ and low‐frequency power, body mass index, hypertension, Asian race, depression symptoms, and trauma history were significantly associated with HRVB amplitude in multivariate analyses (p's <.01). Real‐time HRVB amplitude correlates highly with a research gold‐standard spectral metric, enabling automated biofeedback delivery as a potential treatment component of DMHIs. Moreover, we identify demographic, psychological, and health factors relevant to building an equitable, accurate, and personalized biofeedback user experience. Heart rate variability biofeedback (HRVB) is an efficacious treatment for depression and anxiety, although translation to digital mental health interventions (DMHI) is hindered by the lack of normative data for real‐time HRVB metrics. This research demonstrates the utility of HRVB algorithms tailored to age and gender for DMHIs. The translation of precision care HRVB algorithms into DMHIs and other real‐world settings will improve engagement and real‐world effectiveness of biofeedback interventions for common mental health symptoms. [ABSTRACT FROM AUTHOR]

Aim: Evidence consistently links psychiatric symptoms, reduced neurocognitive functioning (NCF) and sleep problems to the initiation of a wide range of risk behaviours. Less is known, however, about the associations between sleep problems with psychiatric symptoms and NCF among early adolescents yet to engage in substance use. Methods: The present study examined baseline data from an ongoing prospective study of 529 youth aged 10‐12 years who completed a battery of instruments measuring symptom counts for four psychiatric disorders, performance on six tests of NCF and five types of sleep behaviour on week days. We used latent class analysis to classify the 473 substance‐naïve youth into subtypes characterized by probabilistic patterns of psychiatric symptoms and poorer NCF. Results: Four subtypes emerged: normative (24% of the sample); nonspecific mental health symptoms (27%); lower neurocognitive function (24%) and comorbid psychiatric symptoms and lower neurocognitive function (25%). In a multivariable latent regression model, three or more sleep arousals per night, sleep phase of two or more hours and sleep latency of 20 minutes or more were significantly associated with the two classes having higher symptom counts. Lack of family support was significantly associated with the two classes having lower neurocognitive function and comorbid psychiatric symptoms. Conclusions: The youth subtypes in this study provide an important baseline characterization to subsequently understand how these neuropsychiatric relationships may change when substance use and other risk behaviours develop during adolescence. Implications for preventing and treating sleep problems associated with psychiatric comorbidity and neurocognitive dysfunctions are discussed. [ABSTRACT FROM AUTHOR]

Food products containing cannabis extract (edibles) have emerged as a popular and lucrative facet of the legalized market for both recreational and medicinal cannabis. The many formulations of cannabis extracts used in edibles present a unique regulatory challenge for policy makers. Though edibles are often considered a safe, discreet, and effective means of attaining the therapeutic and/or intoxicating effects of cannabis without exposure to the potentially harmful risks of cannabis smoking, little research has evaluated how ingestion differs from other methods of cannabis administration in terms of therapeutic efficacy, subjective effects, and safety. The most prominent difference between ingestion and inhalation of cannabis extracts is the delayed onset of drug effect with ingestion. Consumers often do not understand this aspect of edible use and may consume a greater than intended amount of drug before the drug has taken effect, often resulting in profoundly adverse effects. Written for the educated layperson and for policy makers, this paper explores the current state of research regarding edibles, highlighting the promises and challenges that edibles present to both users and policy makers, and describes the approaches that four states in which recreational cannabis use is legal have taken regarding regulating edibles.