Cultural Adaptation of the Actionable Health App Evaluation in Japan: Protocol for a Web-Based Modified Delphi Expert Consensus Study.

BACKGROUND: With an increase in both the number of mental health disorders people are experiencing and the difficulty in accessing mental health care, the demand for accessible mental health care services has increased. The use of mobile devices has allowed people to receive care in their daily lives without restrictions on time or location. However, the majority of publicly available mobile health apps are not evidence-based, and the top-rated apps are not always safe or user-friendly and may not offer clinically beneficial results. OBJECTIVE: This study aims to create a cultural adaptation of the American Psychiatric Association's comprehensive app evaluation framework in Japan using a web-based modified Delphi expert consensus. METHODS: A web-based modified Delphi study includes developing the Japanese version of the comprehensive app evaluation framework and 3 Delphi rounds. In the first round, our working group sends a questionnaire to the panelists, who then complete it. In the second and third rounds, the working group sends a questionnaire and a summary of the panelists' answers based on each of the previous rounds. The panelists answer the questionnaires based on this summary. The summarization procedure is automated to help reduce the biases that can be generated when panelists' answers are summarized and when the panelists receive them. The working group sends only the result of the summarization with the next round's questionnaire. All interactions between the working group and the panelists will be conducted on Qualtrics (Qualtrics Japan LLC), a questionnaire platform. To culturally validate the comprehensive mental health app evaluation framework, participants from the following three categories will be recruited in Japan: (1) researchers, (2) practitioners, and (3) app developers. RESULTS: This study received funding from a crowdfunding campaign in Japan (April 2023). The Delphi study began in January 2023 and will be completed in December 2023. We had already completed the translation of the 105 original app evaluation item questions by December 2022. CONCLUSIONS: While the need for treatment using mental health apps is increasing, no framework that can be used to develop a centralized database for health apps is available or accessible, and no consensus has been reached among stakeholders in Japan about an appropriate framework. The results of the web-based modified Delphi method presented in this paper may provide direction for the development and use of mental health apps in the future among the relevant stakeholders. Furthermore, this study will enhance recognition of the framework among researchers, clinicians, mental health app developers, and users, in addition to devising new instruments to help users or practitioners efficiently choose the right app for their situations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44469.

The Differences of Gambling-Related Harms Among Low-Investment and Normal-Investment Pachinko/Pachislot Players in Japan: A Cross Sectional Study.

Pachinko and pachislot are popular types of gambling activities in Japan. Prior studies in Japan have reported a concerning prevalence of problem gambling among adult players. While these studies have identified various gambling-related harms, Japanese research on harm-minimization strategies is scarce. Therefore, the present study aimed to compare differences of gambling-related harms among normal-, half-, and quarter-pachi players to the usefulness of low-investment pachinko and pachislot as a harm-reduction strategy. We considered gamblers who played games that cost the typical amount of money to be "normal-pachi players." Those who played low-investment games were categorized as "half-pachi players" and "quarter-pachi players," reflecting those who played games at half or one quarter the cost of a typical machine, respectively. To assess the harm-reduction effect, a one-way ANCOVA was conducted to compare the impact of the groups (normal-pachi players [n = 101], half-pachi players [n = 104], and quarter-pachi players [n = 100]) on dependent variables, namely the number of days players had gambled during the prior month; total time and amount of money spent on gambling; debts caused by gambling; gambling severity; cognitive distortion; depressive symptoms; and problems in work, family, and social life. We demonstrated that the amount of money spent by quarter-pachi players on gambling during the past month was lower than that of normal-pachi players. However, we did not find significant differences with respect to any other gambling-related harms among normal-, half-, and quarter-pachi players. Low-investment pachinko and pachislot players spends less the amount of money spent on gambling. Low-investment pachinko and pachislot would thus partly act as a harm-minimization strategy. Moreover, the results of the present study indicate that the problems at work affect various outcomes for gamblers. Given that 90% of the participants in this study were employed, the results of this study may have important implications for employed gamblers.

The Effects of the Presence of Others on Risky Betting in a Laboratory Gambling Task Among High-Risk Gamblers: A Cross-over Randomized Controlled Trial.

We explored the effects of the presence of and cooperation with others on risky betting in a laboratory-based gambling task among high-risk gamblers. Specifically, we compared risky betting under solo, parallel, and cooperation conditions using a stratified randomized, cross-over design. Stratification was conducted according to participant age and gender. The participants were 40 Japanese adults (20 women, 20 men; mean age = 46, SD = 12.80). In the experiment, each participant conducted the Game of Dice Task (GDT) individually (solo condition), in parallel with another participant (parallel condition), and working together with another participant (cooperation condition). Linear mixed modeling results showed that when we controlled for previously specified covariates, there were no significant differences among the solo, parallel, and cooperation conditions regarding risky betting (parallel: estimates = 0.10, SE = 0.79, p = .900; cooperation: estimates = 0.95, SE = 0.79, p = .232). However, post-hoc analysis showed a significant difference between the solo and cooperation conditions regarding the number of times participants chose the riskiest bet (parallel: estimates = 0.18, SE = 0.52, p = .739; cooperation: estimates = 1.13, SE = 0.53, p = .035). Thus, we found that neither the presence of nor cooperation with others decreased risky betting in the GDT among high-risk gamblers. However, we did observe that participants displayed the riskiest betting behavior (i.e., selecting the single choice) in the GDT during the cooperation condition, compared with the solo condition.

Development of the function of autobiographical memories evoked by odor scale for older Japanese people.

Odor-evoked autobiographical memory and related psychological changes have been evaluated based on several factors, such as emotionality, clarity, and re-experience. We developed the Function of Autobiographical Memories Evoked by Odor Scale (FAMOS) for older Japanese people as a new method for comprehensively evaluating the functions of odor-evoked autobiographical memory. We used the diary method; participants were instructed to record the contents of everyday involuntary autobiographical memories triggered by odor and complete the FAMOS. In Study 1, 600 older adults were surveyed to select items for the FAMOS and examine the factor structure. An exploratory factor analysis with PROMAX rotation using the maximum likelihood method resulted in four factors: (1) Evoking positive emotion, (2) Identity, (3) Facilitating communication, and (4) Coping with negative emotion. Sufficient reliability was demonstrated. In Study 2, the FAMOS's validity was examined in 600 older adults. We found significant correlations (Pearson) with the affective valence of odors, the Odor-evoked Autobiographical Memory Questionnaire, and other scales, confirming the validity of the FAMOS. In Study 3, the FAMOS was administered to 600 younger and 600 older adults; generational differences were compared for further validity. Older adults had higher "Evoking positive emotion," "Identity," and "Facilitating communication" scores on the FAMOS than younger adults, suggesting a fair degree of reliability and validity of the FAMOS.

The validation and reliability of a Japanese version of the Problematic Online Gaming Questionnaire (POGQ-J).

BACKGROUND: The Problematic Online Gaming Questionnaire (POGQ) is an 18-item self-rated measure designed to assess the degree of problematic online gaming. This study translated the POGQ into Japanese (POGQ-J) and examined the POGQ-J's factor structure, validity, and reliability for a Japanese population. METHOD: A total of 285 undergraduate students (128 males, 157 females, Mage = 19.66, SD = 1.36) participated in this study. RESULTS: A confirmatory factor analysis indicated the appropriateness of the POGQ-J's six-factor structure, χ2(129) = 106.027, p < .931; CFI = .957; RMSEA = .040; SRMR = .054. Regarding convergent validity, the POGQ-J was found to be related to the time spent on online gaming (r = .309), the Game Addiction Scale for Adolescents (r = .824), and Young's Internet Addiction Test (r = .581). Finally, the POGQ-J was found to have a high test-retest reliability. CONCLUSIONS: The POGQ-J is valid and reliable for assessing problematic online gaming in a Japanese population.

Psychosocial Adjustment and Mental Distress Associated With In-Game Purchases Among Japanese Junior High School Students.

In-game purchases, including microtransactions and loot box spending, are the monetization systems of free-to-play online games. Although some studies have suggested that excessive in-game purchases increase the risk of psychosocial maladjustment and mental distress as well as predict future problematic gaming and gambling practices, empirical studies on problematic behavioral patterns related to in-game purchasing among adolescents are lacking. This study sought to explore whether knowing the style of in-game purchases (non-purchase, planned purchase, or unplanned purchase) could be useful when characterizing maladaptive behavior among adolescents from the perspective of psychosocial adjustment and mental distress. A total of 335 junior high school students (aged 12-15 years) participated in the survey and completed a questionnaire assessing daily online gaming usage, in-game purchases, psychosocial adjustment, and mental distress. The results showed that (1) 30.7% of students had previously made in-game purchases, and at least 14.0% had made unplanned in-game purchases; (2) 19.2% of the users who had made unplanned purchases had spent greater than or equal to their actual monthly allowance within the past month, and (3) unplanned purchase gamers exhibited more behavioral problems and peer problems regarding psychosocial adjustment compared to planned purchase gamers, and more overall difficulties compared to non-purchasers. Meanwhile, more hyperactivity/inattention was seen among in-game purchasers compared to non-purchasers, regardless of whether the purchase was planned or unplanned. These findings support that understanding whether adolescents make unplanned in-game purchases could be a useful approach to describing the characteristics of online gamers with maladaptive tendencies.

Characteristics of Gamers who Purchase Loot Box: a Systematic Literature Review.

PURPOSE OF REVIEW: Research has indicated that loot boxes are risky gaming components that could exacerbate Internet gaming disorder due to a link between loot box purchasing and gambling. We conducted a systematic review to identify the characteristics of people who purchase loot boxes with real money, focusing on the relationships (a) between loot boxes and gaming, (b) between loot boxes and gambling, and (c) between loot boxes and other variables. RECENT FINDINGS: Of the 201 studies examined for eligibility, we reviewed 20 studies that met the predefined criteria, which were extracted by searching electronic databases (PsycINFO, PubMed, Ovid, EBSCO, and Web of Science) and the reference lists of included studies, and that were published up to March 27, 2021. Overall, this review identified positive relationships among Internet gaming disorder-related symptoms, disordered gambling symptoms, and engagement with, or investment in, loot boxes. In addition to gaming and gambling, the relationships among some variables, such as mood, gender, physiological state, motivation, and loot box engagement, were examined. SUMMARY: The present review clarified relationships between loot box engagement, gaming, gambling, and other variables, such as mood, gender, physiological state, and motivation, and partially identified the characteristics of people who purchase loot boxes using real money. Specifically, those who spend more money in-game on loot boxes exhibit Internet gaming-related and/or disordered gambling symptoms and behaviors. Finally, we discussed future directions for clinical psychological studies on loot boxes.

Gamified Mobile Computerized Cognitive Behavioral Therapy for Japanese University Students With Depressive Symptoms: Protocol for a Randomized Controlled Trial.

BACKGROUND: Evidence shows that computerized self-help interventions are effective for reducing symptoms of depression. One such intervention, SPARX, is a gamified mobile computerized cognitive behavioral therapy (cCBT) developed for adolescents in New Zealand, which was shown to be as effective as usual care for young people with mild-to-moderate symptoms of depression. However, gamified cCBT has not yet been tested in Japan. OBJECTIVE: This trial is designed to investigate whether a Japanese-adapted version of SPARX improves depressive symptoms in Japanese university students with mild-to-moderate depressive symptoms. METHODS: In this 7-week, multicenter, stratified, parallel-group, superiority randomized trial, participants will be allocated to either a treatment condition (SPARX) or a wait-list control condition. SPARX is a fully automated program, which will be delivered to the mobile phone or tablet device of the participants. SPARX is designed as an interactive fantasy game to guide the user through seven modules that teach key CBT strategies. All participants will be recruited from universities via advertisements on online bulletin boards, the campus newspaper, and posters. Participants in the treatment condition will use the SPARX program weekly. The primary outcome is the reduction of depressive symptoms (using Patient Health Questionnaires-9) measured at baseline and weekly: once after the 7-week intervention and once at a 1-month follow-up. Secondary outcomes include satisfaction with the program and satisfaction with life, measured by the Satisfaction With Life Scale; positive and negative moods, measured by the Profile of Mood States Second Edition; social functioning, measured by the EuroQol Instrument; rumination, measured by the Ruminative Responses Scale; and coping, measured by the Brief Coping Orientation to Problem Experienced Inventory. RESULTS: This study received funding from The Research Institute of Personalized Health Sciences, Health Sciences University of Hokkaido, and obtained institutional review board approval in September 2019. Data collection began in April 2019. CONCLUSIONS: Results of this trial may provide further evidence for the efficacy of gamified cCBT for the treatment of depression and, specifically, provide support for using SPARX with Japanese university students. TRIAL REGISTRATION: Japan Primary Registries Network UMIN000034354; https://tinyurl.com/uu7xd77. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15164.

Gambling symptoms, behaviors, and cognitive distortions in Japanese university students.

BACKGROUND: This study was conducted to investigate the relationship between symptoms of gambling problems, gambling behaviours, and cognitive distortions among a university student population in Japan ages 20 to 29 years. We aimed to address the gap in knowledge of gambling disorders and treatment for this population. METHODS: Data were obtained from 1471 Japanese undergraduate students from 19 universities in Japan. Descriptive statistics and hierarchical multivariate regression analysis were used to investigate whether the factors of gambling cognitive distortions would have predictive effects on gambling disorder symptoms. RESULTS: Results indicated that 5.1% of the participants are classifiable as probable disordered gamblers. The bias of the gambling type to pachinko and pachislot was unique to gamblers in Japan. Of the students sampled, 342 self-reported gambling symptoms via the South Oaks Gambling Screen. Hierarchical multivariate regression analysis indicated that one domain of gambling cognitive distortions was associated significantly with gambling symptoms among the 342 symptomatic participants: gambling expectancy (ß = 0.19, p < .05). The multivariate model explained 47% of the variance in the gambling symptoms. CONCLUSION: This study successfully contributed to the sparse research on university student gambling in Japan. Specifically, our results indicated a statistically significant relationship between gambling cognitive distortions and gambling disorder symptoms. These results can inform the development of preventive education and treatment for university students with gambling disorder in Japan. The report also describes needs for future research of university students with gambling disorder.

Relationship between cognitive behavioral variables and mental health status among university students: A meta-analysis.

Cognitive behavioral therapy is an effective treatment for improving mental health problems among university students. However, intervention components have different effects on mental health problems. This paper is a meta-analysis of the data concerning the relationship between cognitive behavioral variables and mental health status among university students. A total of five electronic databases were reviewed, and 876 articles met the initial selection criteria. Reviewers applied standardized coding schemes to extract the correlational relationship between cognitive behavioral variables and mental health status. A total of 55 articles were included in the meta-analysis. Correlations were found for three cognitive behavioral variables (attention, thought, and behavior) across nine mental health domains (negative affect, positive affect, happiness, social function, stress response, psychological symptom, quality of life, well-being, and general health). Across each cognitive behavioral process and all mental health domains, the estimated mean correlation was medium (r = .32 - .46), and varied by the domain of mental health.

Relationship Between Dispositional Mindfulness and Living Condition and the Well-Being of First-Year University Students in Japan.

The present study was conducted to examine how dispositional mindfulness and living conditions are related to well-being among first-year university students in Japan. Participants were 262 Japanese first-year students (156 females and 106 males; M age = 18.77 years, SD age = 0.85). Dispositional mindfulness was measured using the Mindful Attention Awareness Scale (MAAS), and living condition was operationalized as living at home or living alone after having left their home. Hierarchical multivariate regression analysis was used to analyze whether the factors of living condition and dispositional mindfulness had predictive effects on well-being. The results showed that dispositional mindfulness positively correlated with well-being in first-year university students; however, living condition had no significant correlation. On the other hand, the interaction between living condition and dispositional mindfulness significantly correlated with well-being. Simple slope analysis revealed that higher levels of dispositional mindfulness had a protective effect in the relationship between living condition and well-being. These results suggest that an intervention to promote dispositional mindfulness could be effective in protecting the well-being of first-year university students, especially for those who have left their home and are living alone. Further research will be necessary to examine, longitudinally, how mental health changes depending on the level of dispositional mindfulness of first-year university students.

[The psychological effects of taking in "Shikohin": A cross-sectional exploratory study].

This study explores the psychological effects that Japanese people experience when consuming their "Shikohin", such as alcohol, tea, coffee, and tobacco. We'conducted a cross-sectional study among 542 people, from 20-to 69-year-old; who regularly consumed any one of "Shikohin" in Tokyo, Kanagawa, Saitama, and Chiba. The participants responded to an anonymous questionnaire concerning the consumption patterns of their "Shikohin" and the psychological effects that they experienced in taking in their "Shikohin". Results obtained using the K-J methods showed three common psychological effects in each "Shikohin". These effects included an increase in relaxation response, the promotion of social relationships, and an increase in positive mood. Our findings suggest that Japanese people may get some common effects through consumption of different "Shikohin".