DIGITAL PUBLIC MENTAL HEALTH

The transferability, uptake, sustainability and, hence, public health impact of evidence-based innovations in mental health remains limited. Our work is at the forefront of research to address this challenge using cutting-edge digital mHealth and eHealth technology for real-world delivery of digital diagnostics and intervention programs (DDIPs) in our digital public mental health core at ZIHUb.

 

This covers three domains of public mental health provision:  

(1) mental health promotion (AI4U, INTERACTOR, StudiCare, SISU, CCSchool, Corona-Health), stigma reduction (iStigma) and mental health literacy (4S online, child protection hotline, INABI), including quality assurance and transparency of mobile mental health apps (i.e., MHAD Mobile Health App Database),

(2) prevention, including
a)    indicated prevention targeted at high-risk individuals (EMIcompass, ACT-DL)
b)    selective prevention targeted at subpopulations at raised risk (i.e., childhood adversity (SELFIE, GRK2350), ethnic minority groups/refugees (RELATER, AI4U), youth of parents with mental disorder (iCHIMPS), and chronic diseases (HowIMIWork, SmartReha, perPAIN), and 
c)    system-level prevention targeted at a diverse range of settings (i.e., households (Citizen Lab), families (STEMMEN), institutional care (Ankommen), education (AI4U, ProHEAD), workplace/employment (EmoWork, 3for1), cities (BALANCE)),

(3) real-world mental health service delivery for people with mental disorder, including:
a)    digital diagnostics (i.e., digital monitoring, feedback and smart-sensing based prediction) for use in routine clinical care pathways (i.e., IMMERSE, INTERACTOR, RehaCat+)
b)    digital strategies for clinical guideline-based (PreVCo, UserGuide) and trauma-sensitive (UBSKM Contact Point) care
c)    DDIPs to reduce stigma's impact (digiHOP) and address disadvantaged groups (i.e., the unemployed (3for1), disadvantaged youth (Dazugehören BaWü), youth in institutional care (ProTransitionBaWü))
d)    DDIPs for cross-sectoral coordination and delivery of care (i.e., at the interface of primary/mental health care (PROVIDE, GetSleep), primary/institutional care (ProTransitionBaWü), primary care/occupational settings (Primarycare4work))
e)    DDIPs for hard-to-reach (RELATER, 3for1, DigihanceRural, DiHealthWays, INABI) and complex (DiSERVE@home, DynAC) populations.


AI4U

Youth are particularly affected by mental health problems, but their use of, and access to, preventive interventions remains limited. The recent rapid advances in Artificial Intelligence (AI) and digitization enable the development of novel digital interventions. The overarching aim of the AI4U living lab is to investigate the digital transformation in public mental health provision based on the novel application of AI methods to a digital mHealth training for mental health promotion and prevention in adolescents and young adults that is tailored to person, moment and context in daily life. The living lab is carried out in transdisciplinary projects involving direct participation of relevant stakeholders, users from the target population and an interdisciplinary research group. Each of these projects includes one or more real-world experiments.

StudiCare

StudiCare takes place within the WHO-WMH-ICS initiative and provides a college student platform for mental health promotion with currently 20 universities and about 1 Million students. Within this platform 17 different Internet- and mobile based interventions are currently provided and examined regarding effectiveness, cost-effectiveness, acceptance and reach in more than 20 ongoing randomised controlled trials.

SISU 
SISU is a mental health chatbot based on Acceptance and Committment Therapy theory principles pilot tested, examined and formatively further developed aiming at insights into the preconditions for a truely AI chatbot.

CCSchool
The aim of the project is to test a new form of care that enables the implementation of therapy for children and adolescents with (impending) mental impairment in everyday school life and involves the establishment of regional networks of service providers. The aim of the new care service is to reduce full/partial inpatient treatment of children and adolescents due to mental illness, to improve the participation of this patient group, especially in school and training, and to improve the quality of life of those affected and their families.

Corona-Health
Smart sensing based large-scale study examining mental health trajectories over the course of Covid-19 pandemic prevention measures and Covid-19 incidences.

iStigma
Experimental studies examining perceived stigma associated with on-site versus digital mental health care offers in case of mental disorders regularly experienced as stigmatizing (e.g. sexual dysfunction, OCD)

4S online
The project "Making schools strong against suicidal and self-injurious behavior (4S)" is aimed at all schools in Baden-Württemberg. Schools are often the first place where self-injurious behavior or suicidal behavior becomes conspicuous, for example, when classmates learn about it in conversations or teachers identify young people with problems. The projects goal is to equip teachers and counsellors who work in schools with the skills to act and to strengthen them as contact persons for young people. The project started as part of the "Mental Health Action Program for Adolescents" funded by the Baden-Württemberg Stiftung and is now further developed on an e-learning basis.

Child protection hotline
This 24/7 national child protection telephone hotline for health professionals was established in Germany in 2017 and is currently funded by the BMFSFJ. It improves communication and data-sharing between health professionals and children’s services. It is staffed by trained physicians and other professionals that provide advice on interpretation of injuries or behavioural problems, documentation of injuries, the legal framework regarding breach of patient confidentiality and information on how to discuss concerns with parents, and link health professionals to local support services. Demand for the hotline is particularly high for professionals working in emergency medicine and about 60% of callers are general practitioners. The hotline raises the awareness for child protection issues and early childhood intervention. The WHO European status report on preventing child maltreatment 2018 highlighted it as a lighthouse project.

INABI
High rates of non-adherence and dropout remain major challenges in digital mental healthcare. In an ongoing BMBF-funded qualitative study (INABI) we investigate factors that contribute to non-adherence and dropout in various innovative (mostly digital) interventions for child and adolescent mental health. Based on the results of this research, we plan to develop recommendations for the optimization of these programs as well as specific strategies that may help to enhance adherence in future interventions. The effects of these strategies will be investigated in subsequent research.

EMIcompass

Most mental disorders first emerge in youth and, as such, contribute substantially to global disease burden. In developmentally earlier stages, risk often manifests in the form of co-occurring subclinical psychotic, affective or anxiety symptoms associated with a range of subsequent severe mental health problems. Addressing this, the EMIcompass study aims to examine a mobile Health (mHealth) training for enhancing resilience in the everyday lives of help-seeking youths. Combining four training sessions with a clinical psychologist and a mHealth training via smartphone app (Ecological Momentary Intervention, EMI), participants learn various compassion-focused strategies and their application in everyday life.

ACT-DL

Individuals with Ultra-High-Risk state (UHR) and a First-Episode Psychosis (FEP) may experience distress associated with psychotic experiences, social functioning and general psychopathology. Acceptance and Commitment Therapy (ACT) is a promising, next-generation Cognitive Behavioural Therapy (CBT) that aims to modify these targets. The aim of the INTERACT study is to investigate the efficacy of a novel ecological momentary intervention (EMI) based on methods of ACT for individuals with UHR and FEP. In a multicenter randomized controlled trial, participants receive an app-based intervention teaching them to incorporate ACT-techniques in their Daily Life.

SELFIE

Targeting low self-esteem in youth exposed to childhood adversity is a promising strategy for preventing adult mental disorder. The aim of the SELFIE study is to investigate the efficacy of a novel, youth-friendly, transdiagnostic ecological momentary intervention (EMI) for improving self-esteem in youth with prior exposure to childhood adversity. In a randomized controlled trial, individuals aged 12-26 in the experimental condition receive a digital app-based guided self-help EMI blended with three training sessions with mental health professionals allowing for real-time and real-world transfer of the intervention components in individuals’ daily lives.

GRK2350 (B2)

ACE have enduring effects on human stress regulatory circuits and promotes alterations in stress sensitivity and emotion regulation in later life. The likelihood of the sensitized neural system to (de)compensate is thereby shaped by adverse and protective social influences in everyday life, but the examination is methodologically challenging. The planned doctoral projects will tackle this problem and interrogate data on prior ACE, alterations in stress sensitivity and emotion regulation and real-life social environmental exposures to identify the intermediate neural mechanisms and target fostering of the use of daily-life protective social resources in individuals exposed to childhood adversity.

RELATER

RELATER aims to remove language barriers in treating refugees and improve communication in mental health care for refugees using a medical device conform translation tool and digital monitoring platform.

iCHIMPS
Examining the effectiveness and cost-effectiveness of an Internet- and mobile-based self-management app for adolescents of parents with mental disorders.

HowIMIWork 
Examining moderators and mechanisms of change in digital health promotion and prevention interventions in at-risk populations (e.g. chronically ill patients, children with mentally ill parents).

SmartReha 
Combining patient reported outcome assessments, hospital information systems and smart sensing data for machine learning based pattern analysis aiming at prediction models for disease status and disease trajectories and course of treatment.

perPAIN

Musculoskeletal pain diseases tend to become chronic, despite adequate medical treatment. The overarching aim of the perPAIN-project is to develop and evaluate the efficacy of a mechanism-based personalized treatment approach, in order to improve treatment outcomes in patients with chronic pain. In a randomized controlled feasibility trial, symptoms of chronic pain patients in everyday life will be assessed using ambulatory ecological momentary assessment (EMA) before participants will be allocated to a personalized therapy, including an innovative app-based mobile intervention (i.e., ecological momentary intervention; EMI) aimed at digital monitoring and feedback, positive refocusing, and behavioral activation.

Citizen Lab
This interdisciplinary Citizen Science project aims to answer the question how digital tools should be designed in order to empower household members to research psychosocial and physical well-being, stress level and changes in personal roles and work/life arrangements during the Corona crisis and beyond.

STEMMEN 
National information platform for parents and their children prior, during and post divorce on legal, economic and psycho-social aspects of remaining a family with a specific focus on children’s mental health. Next to an open access information platform, our Internet- and mobile-based interventions for parents, couples and children will be developed and tested.

Ankommen
The project develops an easy-to-implement group intervention with biography work methods for young people in out-of-home care together with partners from youth welfare and to evaluate its effectiveness. The aim of the intervention is to address psycho-emotional stress in connection with out-of-home placement at an early stage and to provide targeted support for affected adolescents in biographically classifying and coping with out-of-home placement. This helps to reduce the stress associated with out-of-home placement, lower dropout rates and improve the chances of success of the assistance measure. The project name "Ankommen" (Arrival) is intended to stand for both the process of arriving in a new place of living and the need for an environment that is experienced as safe and supportive.

ProHEAD 
The potential of different digital interventions in the prevention of different forms of mental illness is currently studied in several clinical trials within the BMBF-funded consortium ProHEAD. Based on the results of the effectiveness and cost-effectiveness analyses, we plan the sustained implementation of successful interventions. These efforts will be accompanied by systematic research into the reach and effects of different dissemination strategies as well as into the intervention effectiveness under routine care conditions.

EmoWork
Workplace conflicts predict increased symptoms of depression, anxiety and stress-related psychological symptoms. The aim of this study is to support leaders in small and medium sized enterprises (SMEs) as well as team members to improve in their capability to solve interpersonal conflicts. Experience sampling methodology (ESM) will be used to identify the (specific interpersonal) context in which individual core (mal)adaptive emotion regulation strategies manifest themselves. Hybrid interventions (group seminar, ecological momentary intervention) to support employees in building new and more adaptive interpersonal emotion regulation pattern will be developed and evaluated. Intervention outcomes will be compared to a baseline control group. Primary outcome is the change in emotional and cognitive strain in the working environment from baseline to follow-up between intervention group and control group. Main secondary outcome are days off work and productivity at the workplace.

3for1
Long-term unemployment is associated with mental health problems. In cooperation with jobcenters in southwest Germany, we will develop and evaluate a complex interventions to support adults who are unemployed and have mental health problems. The intervention has three components: short-term psychotherapy in the jobcenter; supported employment; and peer support. Intervention outcomes will be compared to a baseline control group. The primary outcome is competitive employment.

IMMERSE

The aim of IMMERSE (Implementing Mobile Mental health Recording Strategy for Europe) is to advance person-centered mental health care by including individuals seeking help for mental health problems in their treatment process and decision-making. For this purpose, IMMERSE will develop a clinical digital health tool, Digital Mobile Mental Health (DMMH), fed by data from ecological momentary assessment (EMA), mobile sensing and machine learning. In close collaboration with stakeholders, the implementation of the DMMH will be evaluated at 8 sites in 4 European countries in a cluster Randomized Controlled Trial (cRCT).

INTERACTOR

aims to develop and evaluate a digital graded hybrid interaction system for promoting and maintaining public mental health during a pandemic using cutting-edge digital interaction technology, usability and research paradigms under strong regulatory conditions.

UBSKM Contact Point
Results of the contact point of the Independent Commissioner of the German Government (UBSKM) showed that many victims of (childhood) trauma report a lack of trauma sensitivity in mental health care. Routine measures for the retrospective assessment of a trauma history like the „ICAST“ tools have been developed in international collaborations and will be implemented in routine care assessments. Members of the victims council declared trauma-sensitive health care as an important development area during the consultation of the national council against sexual violence. Members of the victims council will be included in steering board of the project. The trauma follow-up costs will be taken into consideration.

digiHOP
People with mental illness have to decide whether and how to disclose their condition to others. (Non-)disclosure is a key reaction to stigma. "Honest, Open, Proud" is a peer-led group program to support people with mental illness in their disclosure decisions and stigma management. HOP has shown beneficial effects for adolescents and adults with mental illness offline. Here we will develop and evaluate a digitally enhanced version of HOP for adults with mental illness. In a pilot RCT we will test its feasibility and efficacy.

Dazugehören BaWü
Due to the limitations in the Corona pandemic, mentally disabled or addicted adolescents have fewer opportunities to manage their developmental tasks in the transition to adulthood. Baden-Württemberg as a healthcare location must respond to this with a modern, networked healthcare system to respond to this situation and to provide young people in need of help, so that a "lost generation" does not emerge. The project is implementing new approaches to digitally supported assistance planning for young people with disabilities and reinforces the necessary active participation of the young people through digital training and accompanying web-based group training to increase self-determination and mentalization skills.

ProTransitionBaWü
Developing and examining a) ProTransition e-learning courses and b) a ProTransition digital health app in order to improve the transition from child and adolescent psychiatric care to adult mental health care.

GetSleep
Large scale Cluster Randomized Controlled Trial (> 300 GPs; > 4.000 patients) examining a stepped care model for insomnia in GP health care with three different iCBT-I versions as step two compared to treatment as usual.

PROVIDE

PROVIDE aims to ImPROve cross-sectoral collaboration between primary and psychosocial care in an implementation study on VIDEo consultations (PROVIDE).

Primarycare4work
Primary care physicians (PCP) often are the first-line consultation for patients with workplace-related common mental disorders (CMD). Many of these patients are characterized by stigma-related barriers for early treatment. In this study a complex intervention will be developed and implemented: pcp will be trained in knowledge, attitude and skills regarding clinical interviewing and early treatment options. In addition, a digitally-enhanced, quality-assured cooperation with occupational health physicians, psychotherapists, and psychiatrists in the field of common mental disorders (CMD) prevention and early treatment will be established, overcoming barriers in the cooperation between the vocational setting and the health care system. Primary outcome in this cluster RCT are days off work in a 12 month follow-up.

DigihanceRural 
There is an important lack of psychotherapeutical / psychiatric treatment opportunities for patients with common mental disorders especially in rural German areas. In this study, combined and innovative, individualized online, hybrid and personal psychotherapy (intervention group) will be developed and implemented in a southwestern German area (Südwürttemberg). Intervention clusters (some rural areas) will be compared to matched control group clusters (treatment as usual, only personal psychotherapeutic). Primary outcome is clinical symptomatology, main secondary outcome is waiting time for psychotherapy in a 12 month follow-up.

DiHealthWays
Digital Mental Health has the potential to broaden our ways of reaching people in need of mental health care. However, health care models examined so far focus primarily on the integration of Digital Mental Health into our existing health care models. This projects aims at developing and evaluating mental health care models beyond the known pathways in order to exploit the full potential of digital mental health approaches.

DiSERVE@home
Ward-equivalent treatment (StäB), a form of crisis resolution and intensive home treatment in Germany, has been introduced in 2018 as a new model of mental health service delivery for people with an indication for inpatient care. The aim of this project is to model and initially evaluate novel digital forms of service delivery such as digital monitoring, feedback, and adaptive ecological momentary intervention in the daily lives of help-seeking individuals that may contribute to improving clinical and social outcomes as well as reducing direct and indirect costs. The project will model the application of these forms of care and carefully investigate their quality from the user perspective, safety, feasibility, initial process and outcome quality as well as barriers and facilitators of implementation.