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This theme issue on e-mental health presents 16 articles from leading researchers working on systems and theories related to supporting and improving mental health conditions and mental health care using information and communication technologies. In this editorial, we present the background of this theme issue, and highlight the content of this issue.
We are pleased to introduce this JMIR Theme Issue on E-Mental Health. “E-mental health” can be understood as a generic term to describe the use of information and communication technology (ICT) –in particular the many technologies related to the Internet –when these technologies are used to support and improve mental health conditions and mental health care, including care for people with substance use and comorbid disorders. E-mental health encompasses the use of digital technologies and new media for the delivery of screening, health promotion, prevention, early intervention, treatment, or relapse prevention as well as for improvement of health care delivery (eg, electronic patient files), professional education (e-learning), and online research in the field of mental health. In a broader sense, all Internet interventions are, in one way or another, targeting the “mind” and human behavior. For the purpose of this theme issue, we focus on mental health conditions, while interventions that facilitate behavior change for general health problems (such as obesity) or systems that provide general emotional or social support for nonmental health conditions (eg diabetes) lie somewhat outside of the core scope of “e-mental health” (and this theme issue), although developers working in these areas can clearly learn from principles and findings presented in this issue.
Looking through the “e-mental health” articles published in JMIR in the past 3 years, it becomes evident that depression remains a major public health issue and a primary target for Internet interventions [
The current theme issue brings together a group of papers presented at the First International E-Mental Health Summit in Amsterdam in 2009 organized by the Trimbos Institute in collaboration with the International Society for Research on Internet Interventions (ISRII) [
The summit was preceded by the fourth ISRII meeting, which was opened by Professor Pim Cuijpers (VU University Amsterdam, Netherlands). He highlighted the need for international collaboration – a need illustrated by the growing numbers of ISRII participants. He symbolically transferred the ISRII chair to Professor Helen Christensen, who will lead ISRII up to its fifth meeting in Sydney, Australia, in April 2011.
Many young researchers presented their latest results during the ISRII meeting. Some of them moved beyond traditional cognitive-behavioral effectiveness studies. Björn Paxling (Linköping University, Sweden, and VU University Amsterdam, Netherlands), for example, ventured to compare Web-based cognitive-behavioral therapy (CBT) with Internet-delivered psychoanalytic therapy for general anxiety disorder (GAD). He found that the two interventions had comparable impacts in terms of clinical improvement. The ISRII 2009 Best Paper Award was won by Sylvia Gerhards (Maastricht University, Netherlands), who reported on one of the first economic evaluations of unguided online CBT for depression in primary care [
At the summit itself, 195 presentations were given by academics, health professionals, and policymakers, including some of the world’s most respected experts on eHealth intervention evaluation and dissemination research (see www.ementalhealthsummit.org). Presentations highlighted the effectiveness of Web-based treatment, new treatment developments, novel research methodologies, and the need for international collaboration. The summit was opened by Dr. Annemiek van Bolhuis, a deputy of the Dutch Minister of Health, who spoke of the importance of e-mental health as a response to growing demand and rising costs in mental health care. Dr. Jan Walburg, chair of the board of the Trimbos Institute, stressed the importance of mental well-being in the life cycle and the potential role of information and communication technologies in fostering it.
At the close of the summit, Professor Isaac Marks (University College London, London, United Kingdom) and Professor Alfred Lange (University of Amsterdam, Netherlands) were honored by the ISRII board as founding fathers of e-mental health in research and practice. It was also in Amsterdam that Professor Lange introduced in 1999 the first Web-based treatment program for people with posttraumatic stress disorders, known as Interapy.
This theme issue illuminates the evolving fields of eHealth and e-mental health, including topics such as the need for international collaboration, ethical considerations, cost-effectiveness, treatment attrition, and self-management.
Professor Ricardo Muñoz at the E-Mental Health Summit
Professor Ricardo Muñoz won the best presentation award, and we open this theme issue with his paper [
In the study by Lange and Ruwaard [
Another important ethical imperative, dealing with privacy and security, is discussed by Bennett and colleagues [
Cost-effectiveness trials are long overdue. In this issue, Warmerdam and colleagues [
Online self-administered questionnaires for screening and for routine outcome assessment by patients themselves could also boost cost-effectiveness, but these questionnaires need to be validated when applying them in an online environment, as shown by Holländare and colleagues [
White and colleagues [
Of the contributors in this issue, two [
Parental skills were assessed in a pretest-posttest study by Van der Zanden and colleagues of a Web-based intervention aimed at parents with psychological problems [
The high levels of study and treatment attrition (dropout) are hot and debated issues in eHealth and e-mental health intervention research, as exemplified by four papers in this issue. Applying theoretical considerations and empirical data, the authors build further on what Eysenbach has labeled the “law of attrition” [
Study dropout from eHealth interventions may not be random, and, if not adequately addressed, dropout may lead to biased estimations. Blankers and colleagues [
Nicholas and colleagues [
Mohr and colleagues [
Meglič and colleagues [
The importance of self-management is addressed directly or indirectly in all papers in this issue. Nonetheless, empirical knowledge about patients’ preferences for and usage of Web-based interventions is still in its infancy. A study by Proudfoot and colleagues sheds light on the acceptability to patients of using mobile phones for the self-assessment and self-monitoring of clinical progress [
Klein and colleagues assessed the preferences of 1214 people aged 16 or older who used information websites on alcohol and other drugs [
Schrank and colleagues conducted semistructured interviews to investigate Internet use among 26 people with schizophrenia, which may be the first such study conducted with mental health patients [
The guest editors would like to thank all of the authors, who contributed their high-quality papers to this issue. We are also grateful to the reviewers for their helpful and pertinent comments on the submitted papers. Last but not least, we hope the readers will enjoy this theme issue of JMIR. It shows that Internet intervention research is clearly coming of age, though it still faces many challenges. And we hope to welcome you all to the fifth ISRII meeting in Sydney in 2011.
None Declared
Beck Depression Inventory
cognitive behavioral therapy
general anxiety disorder
International Society for Research on Internet Interventions
information and communication technology
Journal of Medical Internet Research
Montgomery-Åsberg Depression Rating Scale—Self-rated
University of Amsterdam