Adolescent depressive symptoms represent a significant public health concern, with negative life events and dysfunctional attitudes playing pivotal roles in their development. A cross-sectional study by Yu et al assessed the interplay between dysfunctional attitudes, social support, and depressive symptoms in 795 Chinese adolescents (49.9% male, mean age 15.2 ± 1.8 years, age range 11-18 years) from five middle schools in Shandong Province. Using the Dysfunctional Attitudes Scale, Adolescent Life Events Scale, Beck Depression Inventory, and Social Support Rating Scale, the study identified that dysfunctional attitudes, particularly over-autonomy and over-perfectionism, mediate the relationship between negative life events and depressive symptoms. Social support moderated this relationship, significantly reducing depressive symptoms. These findings underscore the need for preventive and therapeutic strategies targeting dysfunctional attitudes and enhancing social support to address adolescent depressive symptoms. In this article, we extend their findings to highlight the significance of culturally tailored interventions that incorporate familial and community dynamics in mitigating depressive symptoms, particularly in collectivist societies.

• Adolescent depression
• Dysfunctional attitudes
• Social support
• Negative life events
• Over-autonomy
• Over-perfectionism

• CFIR
• Implantable cardioverter defibrillator
• Nursing role
• Online communication
• eHealth

• characteristics
• concepts
• digital interventions
• implementation
• public health

• Humans
• Public Health
• Qualitative Research

• Female
• Humans
• Adult
• Mindfulness/methods
• Internet-Based Intervention
• Libido
• Sexual Behavior/psychology
• Cognition

• Humans
• Self Care
• Concept Formation
• Delivery of Health Care
• Heart Failure/therapy

• cognitive-behavioral therapy
• death anxiety
• depression
• heart failure

Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients’ health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care.

• Ministry of Health

• Cardiovascular disease
• Depression
• Internet-based CBT
• Patient experiences
• Qualitative research
• Thematic analysis

• autism spectrum disorder
• cognitive behavioral treatment
• content analysis
• interview
• patient experience

• Region Örebro län

• Anxiety
• Cardiac rehabilitation
• Depression
• E-health
• Internet-based cognitive behavioural therapy
• Ischaemic heart disease

Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions.

This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs.

A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included.

A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health.

Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.

• anxiety
• behavior
• depression
• eHealth
• mHealth
• mental health
• mobile phone

• cardiovascular disease
• cognitive behavior therapy
• depression
• internet
• randomized controlled trial

• cognitive behavioral therapy
• effect
• heart failure
• randomized controlled trial
• systematic review

• Adult
• Aged
• Anxiety/etiology
• Anxiety/therapy
• Cognitive Behavioral Therapy/methods
• Depression/etiology
• Depression/therapy
• Female
• Heart Failure/psychology
• Humans
• Male
• Middle Aged
• Randomized Controlled Trials as Topic
• Research Design
• Systematic Reviews as Topic
• Treatment Outcome

Even though technology is becoming increasingly common in rehabilitation programs, insufficient data are as yet available on rehabilitees’ perceptions and experiences. It is important to understand their abilities when using technology for remote rehabilitation.

This is a qualitative study on technology experiences of persons affected by cardiovascular disease assessed before remote rehabilitation. The aim of the study was to explore rehabilitees’ experiences and attitudes toward technology before 12 months of remote rehabilitation.

Qualitative interviews were conducted with 39 rehabilitees in four focus groups. The subjects were aged 34 to 77 years (average age 54.8 years) and 74% (29/39) of them were male. They had been diagnosed with coronary artery disease and were undergoing treatment in a rehabilitation center. The interviews were conducted between September 2015 and November 2016. Data were analyzed using Glaser’s mode of the grounded theory approach.

The result of the study was an “identifying e-usage” experience category, which refers to the rehabilitees’ notions of the use of information and communication technologies (e-usage) in the process of behavior change. The main category comprises four subcategories that define the rehabilitees’ technology experience. These subcategories are “feeling outsider,” “being uninterested,” “reflecting benefit,” and “enthusiastic using.” All rehabilitees expected that technology should be simple, flexible, and easy to use and learn. The results reflecting their technology experience can be used in e-rehabilitation programs. Rehabilitees who feel like outsiders and are not interested in technology need face-to-face communication for the major part of rehabilitation, while rehabilitees who reflect benefit and are enthusiastic about the use of technology need incrementally less face-to-face interaction and feel that Web-based coaching could offer sufficient support for rehabilitation.

The findings show that persons affected by heart disease had different experiences with technology and expectations toward counseling, while all rehabilitees expected technology to be easy to use and their experiences to be smooth and problem-free. The results can be used more widely in different contexts of social and health care for the planning of and training in remote rehabilitation counseling and education.

ISRCTN Registry ISRCTN61225589; http://www.isrctn.com/ISRCTN61225589 (Archived by WebCite at http://www.webcitation.org/74jmrTXFD)

• coronary disease
• e-health
• e-rehabilitation
• focus group
• grounded theory
• qualitative study
• rehabilitees’ experience
• remote rehabilitation
• secondary prevention
• telerehabilitation

• Adolescents
• Chronic fatigue syndrome
• Myalgic encephalomyelitis
• Skype
• Video-conferencing

• DRF-2016-09-021 Department of Health
• MR/K025643/1 Medical Research Council
• SRF-2013-06-013 Department of Health