Common practices for sociodemographic data reporting in digital mental health intervention research: a scoping review.

BACKGROUND: The ability of digital mental health interventions (DMHIs) to reduce mental health disparities relies on the recruitment of research participants with diverse sociodemographic and self-identity characteristics. Despite its importance, sociodemographic reporting in research is often limited, and the state of reporting practices in DMHI research in particular has not been comprehensively reviewed. OBJECTIVES: To characterise the state of sociodemographic data reported in randomised controlled trials (RCTs) of app-based DMHIs published globally from 2007 to 2022. METHODS: A scoping review of RCTs of app-based DMHIs examined reporting frequency for 16 sociodemographic domains (eg, gender) and common category options within each domain (eg, woman). The search queried five electronic databases. 5079 records were screened and 299 articles were included. RESULTS: On average, studies reported 4.64 (SD=1.79; range 0-9) of 16 sociodemographic domains. The most common were age (97%) and education (67%). The least common were housing situation (6%), residency/location (5%), veteran status (4%), number of children (3%), sexual orientation (2%), disability status (2%) and food security (<1%). Gender or sex was reported in 98% of studies: gender only (51%), sex only (28%), both (<1%) and gender/sex reported but unspecified (18%). Race or ethnicity was reported in 48% of studies: race only (14%), ethnicity only (14%), both (10%) and race/ethnicity reported but unspecified (10%). CONCLUSIONS: This review describes the widespread underreporting of sociodemographic information in RCTs of app-based DMHIs published from 2007 to 2022. Reporting was often incomplete (eg, % female only), unclear (eg, the conflation of gender/sex) and limited (eg, only options representing majority groups were reported). Trends suggest reporting has somewhat improved in recent years. Diverse participant populations must be welcomed and described in DMHI research to broaden learning and the generalisability of results, a prerequisite of DMHI's potential to reduce disparities in mental healthcare.

Engagement, Satisfaction, and Mental Health Outcomes Across Different Residential Subgroup Users of a Digital Mental Health Relational Agent: Exploratory Single-Arm Study.

BACKGROUND: Mental illness is a pervasive worldwide public health issue. Residentially vulnerable populations, such as those living in rural medically underserved areas (MUAs) or mental health provider shortage areas (MHPSAs), face unique access barriers to mental health care. Despite the growth of digital mental health interventions using relational agent technology, little is known about their use patterns, efficacy, and favorability among residentially vulnerable populations. OBJECTIVE: This study aimed to explore differences in app use, therapeutic alliance, mental health outcomes, and satisfaction across residential subgroups (metropolitan, nonmetropolitan, or rural), MUAs (yes or no), and MHPSAs (yes or no) among users of a smartphone-based, digital mental health intervention, Woebot LIFE (WB-LIFE). WB-LIFE was designed to help users better understand and manage their moods and features a relational agent, Woebot, that converses through text-based messages. METHODS: We used an exploratory study that examined data from 255 adults enrolled in an 8-week, single-arm trial of WB-LIFE. Analyses compared levels of app use and therapeutic alliance total scores as well as subscales (goal, task, and bond), mental health outcomes (depressive and anxiety symptoms, stress, resilience, and burnout), and program satisfaction across residential subgroups. RESULTS: Few study participants resided in nonmetropolitan (25/255, 10%) or rural (3/255, 1%) areas, precluding estimates across this variable. Despite a largely metropolitan sample, nearly 39% (99/255) resided in an MUA and 55% (141/255) in an MHPSA. There were no significant differences in app use or satisfaction by MUA or MHPSA status. There also were no differences in depressive symptoms, anxiety, stress, resilience, or burnout, with the exception of MUA participants having higher baseline depressive symptoms among those starting in the moderate range or higher (Patient Health Questionnaire-8 item scale≥10) than non-MUA participants (mean 16.50 vs 14.41, respectively; P=.01). Although working alliance scores did not differ by MHPSA status, those who resided in an MUA had higher goal (2-tailed t203.47=2.21; P=.03), and bond (t203.47=1.94; P=.05) scores at day 3 (t192.98=2.15; P=.03), and higher goal scores at week 8 (t186.19=2.28; P=.02) as compared with those not living in an MUA. CONCLUSIONS: Despite the study not recruiting many participants from rural or nonmetropolitan populations, sizable proportions resided in an MUA or an MHPSA. Analyses revealed few differences in app use, therapeutic alliance, mental health outcomes (including baseline levels), or satisfaction across MUA or MHPSA status over the 8-week study. Findings suggest that vulnerable residential populations may benefit from using digital agent-guided cognitive behavioral therapy. TRIAL REGISTRATION: ClinicalTrials.gov NCT05672745; https://clinicaltrials.gov/study/NCT05672745.

Tracking pollution from fur farms using forensic paleolimnology.

Eutrophication, which remains one of the greatest threats to water quality worldwide, is particularly acute in agricultural areas. Here we assessed long-term drivers of potential pollution inputs to lakes in southwest Nova Scotia (Canada), a region marked by fur farming (mainly mink) and other agricultural activities. We used a BACI (before-after-control-impact) study design with sediment cores collected from 14 lakes selected based on their proximity to mink farms. We combined economic data, mink faecal samples, and a series of geochemical markers in dated sediment cores, including sterols, δ15N, visible reflectance spectroscopy (VRS)-inferred chlorophyll-a, and heavy metals, to relate changes in sediment geochemistry to the growth of mink farms in the region. Sterol biomarkers (cholesterol and ß-sitosterol) measured in a range of samples (i.e. mink faeces and feed, aquaculture feed), were elevated where mink farms were located close to each study lake. Mink-related sterols (cholesterol, ß-sitoserol), δ15N measurements, VRS chlorophyll-a, and heavy metals As, Cu, Sr increased in the 1980s coeval with a ∼400% increase of mink farms in the region, especially near Nowlans Lake. Agricultural impacts were subtler in other lakes. Our study expands on prior applications of geochemical fingerprinting in forensic paleolimnology when direct monitoring data are incomplete. This multi-proxy approach has promising applications for environmental pollution assessments in other lake ecosystems experiencing water quality issues.

Striking centennial-scale changes in the population size of a threatened seabird.

Many animal populations are under stress and declining. For numerous marine bird species, only recent or sparse monitoring data are available, lacking the appropriate temporal perspective needed to consider natural, long-term population dynamics when developing conservation strategies. Here, we use a combination of established palaeoenvironmental approaches to examine the centennial-scale dynamics of the world's largest colony (representing approx. 50% of the global population) of the declining and vulnerable Leach's Storm-petrel (Hydrobates leucorhous). By reconstructing the last approximately 1700 years of the colony's population trends, we corroborate recent surveys indicating rapid declines since the 1980s. More surprisingly, however, was that the colony size was smaller and has changed strikingly in the past, even prior to the introduction of human stressors. Our results challenge notions that very large colonies are generally stable in the absence of anthropogenic pressures and speak to an increasingly pressing need to better understand inter-colony movement and recruitment when inferring range- and species-wide trends. While the recently documented decline in storm-petrels clearly warrants conservation concern, we show that colony size was consistently much lower in the past and changed markedly in the absence of major anthropogenic activity. In response, we emphasize the need for enlarged protected area networks to maintain natural population cycles, coupled with continued research to identify the driver(s) of the current global seabird decline.