2026-03-10
Marileen MTE Kouijzer, Laura AM Koenis, David Huizinga, Saskia M Kelders, Yvonne HA Bouman, Hanneke Kip
Background: Despite the potential of virtual reality (VR) for treatment and assessment in mental health care, its practical implementation remains limited. Much implementation research explores barriers and facilitators; fewer studies actually evaluate targeted implementation strategies and track how their effects evolve over time in mental health care practice. Objective: This study aims to examine how a structured VR training program functioned as an implementation strategy in routine mental health care and to identify how therapists’ adoption trajectories and implementation needs shifted across stages of the process. Methods: Eleven therapists from a Dutch mental health care organization completed a 6-session VR training. Semistructured interviews were conducted at 3 time points: pretraining, immediately posttraining, and 3 months posttraining. Data were deductively analyzed using theoretical thematic analysis based on the capability, opportunity, motivation – behavior model and the Theoretical Domains Framework to map stage-specific changes in implementation needs relating to VR use. Results: The training improved therapists’ perceived knowledge, skills, and confidence in using VR. Nonetheless, actual uptake of VR in clinical routines remained limited. Enduring barriers included workflow misalignment, hierarchical decision-making structures, and the absence of a shared organizational vision and sustained leadership support. The longitudinal design revealed a dynamic pattern: early adoption hinged on individual capability and motivation, whereas maintenance depended on organizational opportunity and communicated support. These stage-specific shifts clarify why training alone does not translate into routine use and which organizational levers are most important when. Conclusions: VR training for therapists is a necessary but insufficient implementation strategy in mental health care. A longitudinal approach shows that successful implementation requires pairing training with organization-level changes that address opportunity barriers over time. By shifting from static evaluations of whether training works to a process-oriented focus on what support is needed at each stage of implementation, this study advances implementation science in digital mental health and offers actionable guidance for embedding VR in routine care.
2026-03-09
Johanna Keeler, Laura Conde Ludtke, Qingyu Yang, Valentina Raschke Rameh, Rebecca Ward, Janet Treasure, Ben Carter
Background: The ubiquitous use of smartphones has given rise to maladaptive patterns of use, often termed “problematic smartphone use” (PSU), which disproportionately impacts children and young people and is associated with poor mental health. Emerging evidence suggests that patterns of smartphone use (eg, PSU and high smartphone screen time) may also influence eating patterns and contribute to symptoms associated with eating disorders (ED), although the nature of this relationship remains poorly understood. Objective: The aim of this systematic review was to examine the association between PSU and ED psychopathology or ED-related outcomes (eg, body dissatisfaction, emotional eating, and food addiction) in clinical and nonclinical populations and explore potential moderators and mediators. Methods: This preregistered systematic review conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines searched 3 databases (PubMed, Embase, and Web of Science) for studies published after January 2011 reporting data on PSU and ED psychopathology. Results: Thirty-five studies met the prespecified eligibility criteria, with almost all reporting cross-sectional data in nonclinical populations (n=52,584; mean age 17.0, SD 5.5 years). Most studies were assessed as being of good quality (n=28, 78%) according to a modified version of the Newcastle-Ottawa Scale. In these nonclinical samples, the vast majority of studies reported a positive association between PSU and ED psychopathology, which was largely consistent across age groups and countries. Identified mediators of this relationship included greater emotional regulation difficulties and anxious and depressive symptoms. Positive associations were also found across studies between PSU and several ED-related outcomes including food addiction, body dissatisfaction, uncontrolled eating, and emotional overeating. Daily smartphone screen time was consistently related to higher ED psychopathology. According to a GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) assessment of the evidence, most outcomes were rated as low certainty, largely due to the cross-sectional nature of evidence, which contributed to a high risk of bias. Conclusions: PSU and greater daily smartphone screen time are associated with higher ED symptoms, body image dissatisfaction, and broader disordered eating behaviors. Due to a paucity of studies in clinical populations, these conclusions are generalizable only to nonclinical populations (ie, those without a formal diagnosis of an ED). Further longitudinal research in clinical populations is needed to fully contextualize the impact of PSU and smartphone screen time on ED risk and severity.
2026-03-06
Syeda Umme Salma, Chandra Rekha Renduchintala, Isa Siddique, Evelina Sterling, Sweta Sneha, Nazmus Sakib
Background: Caregivers supporting individuals with Alzheimer disease and related dementias (AD/ADRD) frequently encounter prolonged emotional strain, psychological distress, and social isolation, yet their needs are largely overlooked in current technological and clinical interventions. The special routines and obligations of caregivers of individuals with AD/ADRD are frequently not well-suited to the many artificial intelligence–driven (AI-driven) mental health solutions that are currently available. This reveals a critical need for sophisticated, customized solutions created especially to help the mental health of caregivers for patients with AD/ADRD. Objective: To address the existing limitations of personalized mental health interventions, we aimed to identify existing literature on personalized mental health interventions using AI for specific purposes and to develop a new framework for the caregivers of individuals with AD/ADRD. Methods: We followed an iterative approach to design the new framework. First, we did a systematic literature review of current literature to identify data analysis, AI methods, and personalized interventions. Second, we focused on the underlying gaps of this research, and by synthesizing our findings from the review, we proposed a conceptual framework. Results: The systematic literature review identified 73 unique results, and from external sources, we found 3 unique potential papers. Of these, 28 papers were eligible for inclusion, on which we performed our analysis. Based on the findings, we developed a new conceptual framework with 3 special features that are specifically for caregivers of patients with AD/ADRD. The 3 unique features are a personalized daily routine scheduler, which will take both patients with AD/ADRD and caregiver’s information to make it personalized, a daily reward system to keep patients motivated, and an educational repository to get the bite-sized knowledge for the lesson of handling patients in an efficient manner and taking care of one’s own mental health. Conclusions: The proposed framework provides a chance for caregivers to receive mental health care, which will be personalized. The framework is developed with more updated methods than existing approaches, with a lack of personalization in this sector. This framework can be implemented with a goal of personalization and explainable approaches and can undergo further iterations to ensure it is appropriate for specific purposes.
2026-02-18
George Aalbers, Andrea Costanzo, Raj Jagesar, Femke Lamers, Martien J H Kas, Brenda W J H Penninx
2026-02-10
Alexander Refisch, Lara Gutfleisch, Daniel Emden, Vincent Holstein, Marius Gruber, Janik Goltermann, Maike Richter, Janette Ratzsch, Anna Fleuchhaus, Elisabeth Leehr, Susanne Meinert, Tiana Borgers, Kira Flinkenfügel, Frederike Stein, Florian Thomas-Odenthal, Paula Usemann, Lea Teutenberg, Nina Alexander, Ronny Redlich, Igor Nenadić, Tilo Kircher, Udo Dannlowski, Tim Hahn, Nils Opel
Background: The benefits of physical activity (PA) for both physical and mental health, including major depressive disorder (MDD), are well established. Mobile devices, such as smartphones, offer a scalable way to monitor PA and its relationship with depressive symptoms in daily life. Objective: This study aimed to investigate the association between passive smartphone-recorded step counts and current depressive symptoms in individuals with and without a lifetime diagnosis of MDD, using a naturalistic bring-your-own-device (BYOD) approach. Methods: We used the Remote Monitoring Application in Psychiatry (ReMAP) to collect passive step count data from participants’ personal smartphones. The sample included 181 individuals with a lifetime MDD diagnosis, assessed via the Structured Clinical Interview for DSM-IV (SCID), and 195 healthy controls (HC). Current depressive symptoms were assessed using the Beck Depression Inventory (BDI). Physical activity was operationalized as daily and weekly step counts, passively recorded via smartphone sensors. Hierarchical models were applied to examine the association between PA and depression severity. Results: Patients with MDD exhibited lower overall step counts and reduced diurnal variability compared to HC. Furthermore, higher step counts were associated with lower BDI scores in both groups. Analysis of weekly patterns additionally revealed that total weekly step counts significantly correlated with lower concurrent BDI scores. Conclusions: These findings underscore the potential of mobile devices as effective tools for monitoring physical activity in patients with MDD, supporting more customized and adaptive approaches to prevention and treatment. They also emphasize the importance of incorporating physical activity into the clinical management of depression.