Tag: Mental health

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Assisting Screening of Adolescent Depression With Large Language Models as Symptom Detectors: Algorithm Development and Validation

<strong>Background:</strong> Depression prevalence is rising in adolescents and young adults (ages 10-24 years). Traditional screening methods for depression, such as the Patient Health Questionnaire (PHQ-9), are particularly challenging for adolescents. AI has potential to help with this, but the scarcity of annotated datasets highlights the need for off-the-shelf approaches. In this study, we investigate the feasibility of using state-of-the-art large language models (LLMs) to detect depressive symptoms in adolescent settings (ages 15-17 years). <strong>Objective:</strong> This study aimed to evaluate the feasibility of using in-context learning with LLMs to identify depressive symptoms in free-text clinical notes for adolescent populations, to evaluate the feasibility of off-the-shelf LLM configurations in detecting PHQ-9 symptom-related information under zero- and few-shot settings, and to demonstrate the potential clinical utility of LLM-driven evidence extraction through an interpretable AI-based depression screening tool. <strong>Methods:</strong> We examined free text of the electronic health records (EHRs) of adolescent patients with the diagnosis of depression or related mood disorders (age groups 15-17 years, 924 patients) from the Cincinnati Children’s Hospital Medical Center. We leveraged the combination of the Beck Depression Inventory (BDI) and the PHQ-9 to develop tailored categories suited for adolescent depression symptoms. We applied 3 state-of-the-art LLMs (Llama, smaller FLAN-T5, and Phi) to identify these symptom categories in zero- and few-shot configurations, allowing us to assess their performance without additional task-specific training. A word-search model was used as the baseline comparator. <strong>Results:</strong> We manually annotated clinical notes for 22 patients across 16 depression-related symptom categories. Our analysis shows that all LLMs substantially outperformed the word-matching baseline. Within the evaluated prompting configurations, FLAN-T5 achieved the highest precision (average <i>F</i><sub>1</sub>-score=0.65, precision=0.78) and strong performance in detecting rare symptoms such as sleep problems (<i>F</i><sub>1</sub>-score=0.92) and self-loathing (<i>F</i><sub>1</sub>-score=0.80). Phi offered a balanced performance (precision=0.44, recall=0.60), while Llama 3 achieved the highest recall (0.90) but tended to overgeneralize, making it less suitable for precise screening. Within this pilot study, the best-performing LLM exceeded the baseline <i>F</i><sub>1</sub>-score by 0.43. Finally, we demonstrate the clinical utility of FLAN-T5 annotations as features in a machine learning model, which distinguished depression cases from controls with high precision (0.78). <strong>Conclusions:</strong> We used a range of popular LLMs to identify indicators of adolescent (ages 15-17 years) depression symptoms in mental health notes. Within the evaluated configurations, FLAN-T5 demonstrated the most favorable balance between precision and recall. These results support the feasibility of using off-the-shelf LLMs for symptom detection in adolescent clinical notes, while future work using standardized prompting strategies and task formulations will help establish more definitive comparisons between model architectures. The computational efficiency of FLAN-T5 further supports its potential for deployment in resource-limited clinical settings. Our findings require further validation for broader populations and other mental health conditions.
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Psychiatric service dogs reduce loneliness and improve social functioning in adults with mental health conditions: a qualitative study from South Africa

IntroductionLoneliness and impaired social functioning are clinically significant features of mental illness. Psychiatric service dogs (PSDs) are individually trained to perform tasks that mitigate the functional impact of psychiatric disability and have been proposed as an intervention for loneliness and impaired social functioning for their handlers living with mental illness. However, the mechanisms through which they may reduce loneliness and improve social functioning are poorly understood and evidence from low-middle income contexts is almost entirely absent.MethodsThis qualitative study aimed to explore the experiences of PSD handlers in South Africa regarding the impact of their PSD on loneliness, social functioning, and psychosocial well-being across a diverse range of mental illnesses. PSD handlers were recruited through purposive sampling via three South African PSD training organisations. Data were collected through semi-structured individual interviews and analysed using reflexive thematic analysis following the six-phase framework described by Braun and Clarke.ResultsReflexive thematic analysis of participants’ accounts generated six themes describing the psychosocial impact of PSD partnership. Three themes capture the primary mechanisms through which PSD partnership improved social functioning and reduced loneliness: (1) alleviation of loneliness through non-judgmental companionship; (2) PSDs as social catalysts: from brief encounters to sustained relationships; and (3) gains in independence and expanded community participation. Two additional themes describe internal psychological mechanisms: (4) restoration of purpose, meaning, and structured routine; and (5) caregiving as a mechanism of self-regulation and re-engagement. A sixth theme addresses the social costs and challenges of PSD partnership: (6) access discrimination, public scrutiny, and the burden of visibility.DiscussionTogether, these themes describe a multi-layered set of psychosocial processes through which PSD partnership both expanded participants’ social worlds and imposed new burdens upon them. The findings suggest that PSDs may serve as a meaningful adjunctive intervention for loneliness and social isolation in adults with mental illness. Mental health professionals would benefit from greater awareness of PSDs and the psychosocial benefits and challenges associated with their use.
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Effect of soft Chinese martial arts on depressive symptoms among college students: a systematic review and meta-analysis

ObjectivesMental health problems are a growing concern among college students worldwide. While exercise is a proven mental health intervention, a quantitative synthesis on the effects of soft Chinese martial arts, as a unique mind-body practice, on depression in this specific population is lacking. This study aimed to fill this gap by systematically evaluating the effectiveness of soft Chinese martial arts interventions in alleviating depressive symptoms among college students.MethodsLiterature with publication dates up to July 31, 2025 was searched in seven databases, including PubMed/MEDLINE, Embase, Web of Science, Scopus, CENTRAL, PsycINFO, and CNKI. Studies were systematically screened according to the PRISMA guidelines, and the quality of the included literature was assessed using the Cochrane Risk of Bias tool. The size of the effect was expressed by means of SMD and 95% confidence interval, and subgroup analyses were performed to explore sources of heterogeneity.ResultsA total of 11 RCTs (11 independent datasets) involving 750 participants were included in the analysis. The meta-analysis revealed a significant overall effect of soft Chinese martial arts on reducing depressive symptoms in college students (SMD = –0.71, 95% CI: –1.23 to –0.18, p = 0.008). Subgroup analyses suggested potential moderating effects of intervention duration, frequency, and session length. For example, the effect size for the 9-14 week subgroup was SMD = –1.35 (95% CI: –2.10 to –0.60) and for the 20-60 minute single session duration subgroup was SMD = –0.69 (95% CI: –1.36 to –0.03). Heterogeneity was high (I2 = 82.6%, p < 0.001). Egger’s test was not statistically significant (p = 0.397), but publication bias cannot be ruled out due to the small number of studies.ConclusionSoft Chinese martial arts, particularly Tai Chi and Baduanjin, may be an effective non-pharmacological intervention for reducing depressive symptoms in college students, providing preliminary evidence for mental health programs. However, results should be interpreted with caution because of high heterogeneity, risk of bias, and possible publication bias. The certainty of evidence is very low according to the GRADE framework.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1129413, identifier CRD420251129413.
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[Comment] Preventing perinatal depression relapse

Mental health conditions are a leading cause of pregnancy-related deaths in the USA, affecting at least 20% of individuals in pregnancy and postpartum.1 Psychiatric relapse and emergencies in the perinatal period are disproportionately greater for women with a history of depression than for those without.2 Mindfulness-based cognitive therapy leverages cognitive behavioural therapy and meditative mindfulness practice to improve depression symptoms and prevent relapse among perinatal individuals with recurrent depression.

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The BELONG Study: Black Equality in OCD NeuroGenomics

By Boris Litvin, MA, Matthew Riello, Andrew Marshall, PhD, Emily Rodriguez, MS, MSc, Martha Falkenstein, PhD, and Alexander Rosenberg

BELONG Logo (1) (1)

One word appears more and more in the news surrounding mental health research (and the IOCDF Newsletter and blog): “genomics”. What does it mean, and why is it such a hot topic lately for both scientists and non-scientists? In the context of OCD research, genomics refers to the study of a person’s genome (all of a person’s genes) to gain insight into how OCD appears and develops.

Genomic studies of OCD over the past two decades have contributed significantly to our understanding of how OCD works. However, there remains more to be done and explored, for OCD as well as for other psychiatric conditions.

With support from a five-year grant by the National Institutes of Health (NIH), researchers at the Mount Sinai School of Medicine (New York, NY), Baylor College of Medicine (Houston, TX) and University of North Carolina at Chapel Hill (UNC) (Chapel Hill, NC) have launched the Black Equality in OCD NeuroGenomics (BELONG) study, a research project that looks specifically at the genomes of Black and African Americans with OCD and their families. BELONG aims to contribute to OCD research from multiple perspectives: first, enhancing our overall understanding of OCD genomics, second, achieving a deeper grasp of OCD risk by adding more participants, and, third, gaining more reliable insight into OCD risk by leveraging the power of human diversity.

For the first point, the lead investigator of the BELONG study, together with Dr. Sidney Hankerson, Mount Sinai’s Dorothy Grice, MD, explained: “We know that there are gene variants that significantly increase risk for OCD. When are those genes active developmentally? Can we understand more about where those gene products function in the brain? What part of the brain? What works in partnership with that part of the brain in terms of brain circuitry?”

For the second, Grice added, “Progress in OCD research has been limited by smaller sample sizes compared to other psychiatric conditions, for example, in 2018, there were samples from 130,000 individuals with major depression, about 60,000 individuals with schizophrenia and 20,000 individuals with bipolar disorder and fewer than 3,000 samples from individuals with OCD. These numbers have grown significantly since 2018, but OCD continues to be underrepresented in genetic research. Increasing the sample sizes has tremendous potential to advance our understanding of OCD genetics.”

Third, according to Grice, much of OCD research has mostly involved individuals with European ancestry: “Thinking about OCD and Black Americans, the prevalence is not any different. So it’s not because it doesn’t happen in other cohorts or populations — it’s because those individuals are not being included or not participating for a variety of reasons. So one motivation for our study is to try to get studies in OCD to reflect the real world and the population that’s out there.” Dr. Grice added, “This is a powerful tool to understand the genomics of OCD across all of human ancestry.”

 

Dorothy Grice, MD (Mt. Sinai School of Medicine)

Dorothy Grice, MD (Mt. Sinai School of Medicine)

James Crowley, PhD (University of North Carolina, Chapel Hill)

James Crowley, PhD (University of North Carolina, Chapel Hill)

Bridging Gaps

The number of people participating in OCD genomic studies has grown significantly over the past ten years, which was partly due to the emergence of the international Psychiatric Genomics Consortium (PGC) in 2007. However, the lack of diversity persisted, even for research published by PGC scientists. “This past year, the largest genomewide association study ever was published, with over 53,000 individuals with OCD (Strom et al., 2025),” said Baylor’s Eric Storch, PhD. “Despite all its strengths, virtually no one within the sample was of any sort of racial or ethnic diversity. When you start modeling effects of genetic composition on things like predicting treatment response, it doesn’t represent the beautiful diversity of our world.” Storch continued, “With such a lack, that really has a risk of creating a health disparity where many individuals that comprise our world would not be represented, or not benefit from those discoveries.”

“Humans came out of Africa,” noted UNC’s James Crowley, PhD. “If all of our genetic diversity goes back to Africa, and you focus just on individuals of European ancestry, you are only looking at a fraction of all the genetic diversity on the planet. There have been a lot of initiatives to include genetic data from individuals of African ancestry, and they have not been as successful as we would like. There are systemic barriers to access to assessment, treatment and biomedical research. We have an opportunity in this study to advance biomedical research in the African American community.”

Grice noted that, for Black Americans, “There’s a lot of hesitancy to participate in research studies, given the tragic history in that regard. In addition, we know that there’s a much higher rate of misdiagnosis in Black Americans. People may present with what may be OCD, but there are higher rates of being misdiagnosed as having anxiety or psychosis, even to the point of being inappropriately hospitalized compared to other groups.”

The BELONG team is hopeful that their efforts will contribute to the comparatively small amount of research on OCD in Black Americans. Baylor’s Ogechi “Cynthia” Onyeka, PhD, remarked, “With regards to understanding symptom presentation and expression, the literature on what OCD looks like in the Black community is very limited and restricted to a group of papers that were written 10-15 years ago. We are really excited to pick up where that limited literature has left off and not only understand what some of the symptom dimensions are that might be more prevalent, but also build upon that and get more information out to individuals who might think they have OCD to help support treatment awareness and engagement too.”

 

Eric Storch, PhD (Baylor College of Medicine)

Eric Storch, PhD (Baylor College of Medicine)

Ogechi "Cynthia" Onyeka, PhD (Baylor College of Medicine)

Ogechi “Cynthia” Onyeka, PhD (Baylor College of Medicine)

How BELONG Contributes to Science

How would genomics research contribute to knowledge of OCD, and further advances in treatment? Grice explained, “We’re focusing on rare genetic variation, and particularly de novo variation— which indicates a new, spontaneous genetic change that occurs randomly very early in embryonic development.”

To understand the role of de novo variation, BELONG invites not only Black Americans with OCD to participate, but also their family members, with a goal of at least 1,250 participants by the end of the study. The process for participating in BELONG is fairly simple, and anyone in the US can take part. Storch explained, “Go to our website (https://belongocd.com/), or email one of us. From there it’s a simple interview and mailing us a saliva sample via a kit that we provide. We also provide some compensation to participants for their time and effort.”

Naturally, concerns about the safety of DNA collection and storage can arise. “There’s a lot of oversight and attention to ensure our study is compliant with all the current ethical and confidentiality rules that are in place on every level,” Grice said. Crowley added, “First: there’s no for-profit institution involved in any of this research. Second: we remove all identifiers, like name, birthplace, and date of birth. All of that information is stripped from any of the genetic data. Third: the way that we work with the data is very controlled and regulated by each institution’s ethical review board.”

Importantly, this security extends to research conducted by future researchers who may access the data for years to come. The BELONG team adheres to strict federal and institutional standards to promote the safety of participants. Like many studies funded by the NIH, BELONG data will be available for future research. “With the consent of each participant, we share their anonymous information with NIH because NIH has a data repository available to other vetted and qualified researchers who can extend our work,” Grice specified. “The participants are doing so much for our study and if a researcher comes along in ten years with a great new idea that can benefit the field, they can apply to use this information. Every participant in BELONG is advancing knowledge of OCD today and in the future. And that’s fantastic.”

It all comes back to the participants. “We try to answer questions, make sure people feel comfortable about participating — that’s all a part of the informed consent process, to make sure that all the questions are answered about why we’re doing this study, what the study entails and how the participants are protected, before they actually get into the study. We want people to understand what it’s all about and make sure they have the knowledge that they need to make an informed decision about whether they want to join or not,” said Grice.

 

Beyond BELONG

While the BELONG study highlights and addresses major gaps in both genomics and OCD research, it is important to be mindful that all research has limitations, especially with the interpretation and extrapolation of data. Fellow scientists and clinicians like Sonya Faber, PhD, at the University of Ottawa warned that the results of genetic research could be misconstrued to “reinforce scientific racism and biological determinism, rather than addressing the structural and psychosocial contributors to mental health disparities.” Faber also noted that racially-based genetic studies could “risk excluding or misclassifying participants of mixed ancestry—who often face the same structural barriers but may be excluded for not fitting a clean racial “genetic” category”. Grice notes that African Americans are overwhelmingly of mixed ancestry and hence the BELONG study is in a unique position to address these risks. Similarly, Emory University School of Medicine’s Donovan Ellis, PhD, expressed, “[We want] to be mindful that we’re not reifying race science-based conclusions, or coming to the types of conclusions that unintentionally further marginalize communities, or be overly narrow”.

Both Faber and Ellis asserted that genetic risk factors for psychological disorders are not tied to race. Citing genetic research into schizophrenia, Faber explained, “Although there are now genes associated with the risk of developing schizophrenia, these do not directly correspond to higher risk by race, as race is a sociopolitical and not a genetic classification” (Faber et al., 2023). “This logic applies equally to OCD,” she stated.

Emory University clinical psychologist Joya Hampton-Anderson, PhD, suggested that this important study should ensure to carefully consider the cultural context and historical stigma associated with medical research and minority groups: “I think the alignment with the community is going to be really important with something like saliva samples being taken. There is a lot of historical mistrust in the Black community around medicine, broadly defined, but also research, and that is a very intimate data collection method.”

With these concerns in mind, Faber described how epigenetic factors may play a role in linking genetics with OCD. Epigenetics refers to how one’s behavior or environment can impact and interact with their own genome. “Since belonging to a certain race corresponds to an environmental risk of poor mental health (i.e., social disadvantage)…an association between race and [mental disorders] may be expected to be observed,” said Faber; these risks may include “chronic exposure to racism, discrimination-related stress, intergenerational trauma, and environmental adversity (housing, pollution, policing, poverty)”. Faber continued, “Epigenetics provides a far more accurate and justice-consistent framework for understanding why racially minoritized groups may show different biological profiles—without invoking race as a proxy for genetic difference”.

Faber concluded citing Bryant et al. (2022): “While ethnicity allows individuals the agency to self-define through shared culture and ancestry, race is an artificial category externally imposed to rank and divide human variation. Decades of genetic data confirm that race is not a proxy for genetics, but rather a proxy for the impacts of structural racism”.

 

Advancing OCD Research, One Saliva Sample at a Time

The BELONG researchers have acknowledged these concerns head-on. Regarding potentially reinforcing biological determinism, Grice explained, “We’re not thinking there will be different genes involved compared to other ancestries, but given all the ancestral population changes and genetics, there probably will be different genetic variants within a particular gene, which will help us to learn more about the biology of OCD, because not all genetic variation actually leads to a problem”. In fact, Grice notes that other ongoing psychiatric genetic studies in autism and schizophrenia that also focus on rare de novo variation do not show evidence for different biological profiles across different ancestries, so there is good reason to think these issues will be moot in BELONG.

Grice also clarified: “This study is focusing on genetics which plays a very important role in risk for OCD, and while there are also important non-genetic or environmental factors, those are not a focus of this particular study. We’re not saying it’s all genetic, but that is what we’re focusing on in BELONG”.

Recognizing the complex history of medical research involving minority communities, Onyeka reiterated that “We have a community advisory board that we’ve been working with, with different clinicians who are Black who work within this space in terms of providing treatment and therapy, and getting feedback from folks who are on the ground and actually engaging with these patients has also been helpful too”.

Despite genetics being the focus of the study, Onyeka mentioned that working directly with minority communities can provide insight into the environmental factors that shape OCD  “I think one thing that I’m really excited about is the phenotypic component of this study. In addition to getting a really good assessment of OCD with the participants, we’re also getting a lot of different perspectives about different socioecological factors that might be related to OCD. Things like ethnic identity membership and awareness of treatment of symptoms and other things that, with a large sample, we hope to obtain”.

Jordan Cattie, PhD, of Emory University School of Medicine expressed, “Researchers can build trust by using approachable, clear, and informative language about how a study can help, or is different from previous work. For example, this study team shared that (in both existing genetics and OCD treatment studies) there is significant underrepresentation of Black Americans, which makes representation a really important priority. This study team is unique in including a community advisory board that focuses on how to make research helpful for communities, as well as health equity researchers.”

Many researchers and clinicians remain hopeful about the prospects of this research and understand its importance in expanding the knowledge of OCD risk.

“Ultimately, BELONG represents a unique research study that goes beyond the laboratory. This research is really grounded in altruism,” said Onyeka. “It’s a one-time experience for the participant — to be able to meet for the assessment, get an understanding of what OCD looks like for them, have the validation of talking to somebody about their symptoms, which can be really validating and helpful and affirming, and then participate with regards to the genetic component. But the dividends of that participation go far beyond what we can even operationalize or quantify right now, which is something that’s really incredible and not something that you see a lot with research in the Black community. I think just what makes this study really unique is how far your participation can go.”

 

 

References

Bryant, B. E., Jordan, A., & Clark, U. S. (2022). Race as a Social Construct in Psychiatry Research and Practice. JAMA psychiatry, 79(2), 93–94. https://doi.org/10.1001/jamapsychiatry.2021.2877

Faber, S. C., Khanna Roy, A., Michaels, T. I., & Williams, M. T. (2023). The weaponization of medicine: Early psychosis in the Black community and the need for racially informed mental healthcare. Frontiers in psychiatry, 14, 1098292. https://doi.org/10.3389/fpsyt.2023.1098292 

Strom, N.I., Gerring, Z.F., Galimberti, M., Yu, D., Halvorsen, M.W., Abdellaoui, A., Rodriguez-Fontenla, C., Sealock, J.M., Bigdeli, T., Coleman, J.R., Mahjani, B., Thorp, J.G., Bey, K., Burton, C.L., Luykx, J.J., Zai, G., Alemany, S., Andre, C., Askland, K.D., Bäckman, J., … Mattheisen, M. (2025). Genome-wide analyses identify 30 loci associated with obsessive-compulsive disorder. Nature Genetics, 57(6), 1389–1401. https://doi.org/10.1038/s41588-025-02189-z 

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Symptom Trajectories and Attendance in Face-to-Face and Online Psychiatric Follow-Up for Major Depressive Disorder and Anxiety Symptoms: Prospective Observational Cohort Study

<strong>Background:</strong> Major depressive disorder is a leading cause of disability, and access to specialist psychiatric follow-up remains limited in many settings. Telepsychiatry may reduce logistical barriers to care, but data on video-based follow-up under routine outpatient conditions in Türkiye are scarce, and comparisons of delivery modalities are frequently limited by baseline imbalance between self-selected groups. <strong>Objective:</strong> The aim of the study is to describe symptom trajectories and attendance over 6 months of routine psychiatric follow-up delivered either face-to-face or online and to examine whether outcomes differed between modalities after adjustment for baseline severity. <strong>Methods:</strong> In this prospective, nonrandomized observational cohort study, 120 adults with <i>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition</i> (DSM-5) major depressive disorder were followed for 6 months at a university hospital psychiatry department in Ankara, Türkiye (September 2021 to May 2022). Participants entered face-to-face (n=60) or online (n=60) follow-up according to their own preference. Seven sessions were scheduled at approximately 4-week intervals; the Hamilton Depression Rating Scale (HAM-D; primary outcome), the Hamilton Anxiety Rating Scale, and DSM-5 Level 1 and Level 2 measures were administered at baseline and at sessions 1, 2, 4, and 6. Attendance was recorded at all sessions. Between-group comparisons used analysis of covariance adjusted for the corresponding baseline score and for prespecified covariates. Linear mixed models incorporating a group-by-time interaction were fitted to all available observations, and multiple imputation (<i>m</i>=20) was performed as a sensitivity analysis. <strong>Results:</strong> Depressive symptoms decreased substantially in both groups: mean HAM-D fell from 26.6 to 5.0 in the face-to-face group (81.2% reduction; Cohen <i>d</i>=4.86; <i>P</i>&lt;.001; n=43) and from 24.1 to 3.3 in the online group (86.3% reduction; Cohen <i>d</i>=6.06; <i>P</i>&lt;.001; n=49). Response rates were 41 of 43 (95.3%) and 48 of 49 (98%; <i>P</i>=.60), and remission rates were 32 of 43 (74.4%) and 43 of 49 (87.8%; <i>P</i>=.11). Unadjusted between-group differences at sessions 4 and 6 did not persist after adjustment for baseline severity (session 4: –0.47, 95% CI –1.71 to 0.77; <i>P</i>=.46; session 6: –0.79, 95% CI –2.22 to 0.65; <i>P</i>=.28), and the group-by-time interaction was not significant (<i>χ</i><sup>2</sup><sub>3</sub>=1.9; <i>P</i>=.59). Anxiety scores did not differ at any time point. Findings were unchanged under multiple imputation, and prescribing patterns were comparable. Attendance across all 7 scheduled sessions was higher in the online group overall (373/420, 88.8% vs 319/420, 76%; <i>P</i>&lt;.001), with differences at sessions 2 through 5. <strong>Conclusions:</strong> Both modalities were followed by large reductions in depressive symptoms, and between-group differences did not persist after adjustment for baseline severity. The study was not designed as an equivalence trial and cannot establish equivalence. The most consistent difference favoring online follow-up was attendance, although its reasons could not be determined. These findings characterize online psychiatric follow-up as a feasible means of maintaining continuity of routine care rather than as a more effective one.
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Characterizing Behavioral Engagement in Smartphone Cognitive Behavioral Therapy for Obsessive Compulsive Disorder: Secondary Analysis of a Randomized Controlled Trial

Background: Digital mental health interventions (DMHIs) are increasingly popular for their ability to disseminate evidence-based treatments in a scalable, accessible way. Engagement with digital treatments is critical for effectiveness but remains poorly defined and measured. Most studies rely on subjective self-reports or 1 or 2 objective metrics, overlooking the multidimensional nature of how users interact with DMHIs. Objective: This exploratory secondary analysis applied a road map for comprehensive behavioral engagement measurement, developed for a prior smartphone cognitive behavioral therapy program for body dysmorphic disorder, to a 12-week randomized controlled trial of smartphone cognitive behavioral therapy for obsessive compulsive disorder (OCD; N=60). Aims were to (1) comprehensively characterize behavioral engagement using 21 objective app analytics-based variables, (2) identify distinct behavioral engagement profiles via cluster analysis, (3) assess whether profiles were differentially associated with OCD symptom change, and (4) evaluate associations between profiles and pretreatment credibility, expectancy, posttreatment satisfaction, and perceived app quality. Methods: Behavioral engagement was measured via 21 objective variables derived from app analytics, spanning use volume, frequency, feature usage, session duration, and temporal patterns. Hierarchical agglomerative cluster analysis identified engagement profiles. Associations between cluster membership and OCD severity change (Yale-Brown Obsessive Compulsive Scale) were examined using hierarchical generalized linear mixed models. Objective measures were complemented with subjective self-reports: namely, cluster differences in treatment credibility, expectancy, satisfaction, and perceived app quality were examined using ANOVAs and Wilcoxon rank-sum tests. Results: Cluster analysis indicated a 3-cluster solution representing high (cluster 1: 21/60, 35%), moderate (cluster 2: 31/60, 52%), and low (cluster 3: 8/60, 13%) app users. All 3 clusters experienced significant reductions in OCD severity, with no significant differences in pre- to posttreatment Yale-Brown Obsessive Compulsive Scale change across clusters. Descriptively, cluster 1 had a higher rate of treatment responders than cluster 3. While clusters 1 and 2 had similar perceptions of treatment credibility and expectancy at baseline and satisfaction at posttreatment, cluster 3 perceived the intervention as significantly less credible, had lower expectations, and reported significantly lower satisfaction than cluster 2. All clusters rated app quality as similarly high. Conclusions: Comprehensive behavioral engagement measurement is feasible and informative across different DMHIs and clinical populations. The finding that all engagement profiles showed comparable symptom improvement challenges simple dose-response assumptions and may suggest that multiple paths of engagement can be therapeutically beneficial; nonsignificant differences in improvement across clusters may also reflect limited power to detect differences. Pretreatment credibility and expectancy are associated with engagement patterns, identifying a potential modifiable intervention target. Trial Registration: ClinicalTrials.gov NCT04136626; https://clinicaltrials.gov/study/NCT04136626
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Bridgedd, a Health Care Staff–Facing Community Resource Navigation Tool for an Urban Safety-Net Hospital: Cross-Sectional Formative Pilot Study

Background: Health care professionals in safety-net settings often rely on lengthy and inconsistently maintained community health resource lists when connecting patients with services. Bridgedd is a health care staff–facing web application designed to generate geographically and categorically filtered community resources in a unique format that makes information about each resource more accessible. Objective: This formative pilot study aimed to characterize the perceptions of behavioral health professionals toward Bridgedd’s usability, comparative value relative to existing community resource filtering and communication tools, and their intent to use it with patients if made available. Methods: We conducted a single-site, cross-sectional formative pilot of the web-based tool we developed, Bridgedd, within Grady Health System’s Integrated Behavioral Health Program between April 23 and May 14, 2026. All 21 program team members attending an all-staff meeting received a presentation about Bridgedd and were given the opportunity to try the tool and ask questions. Then, they independently evaluated it using a self-generated hypothetical patient scenario. Eleven completed an investigator-developed anonymous feedback survey assessing perceived ease of use, comparative value relative to existing tools, intent to use the tool with patients, and open-ended feedback. Quantitative responses were summarized using raw counts, and open-ended responses were summarized as descriptive observations. A post hoc descriptive analysis excluded 2 potentially direction-confused response patterns. The post hoc descriptive analysis did not materially change the overall interpretation. Results: Eleven behavioral health professionals (therapists, n=4; licensed professional counselors, n=3; social workers, n=2; mental health counselor, n=1; certified peer specialist–mental health, n=1) completed the survey. Of the 11 respondents, 9 rated the tool as very easy to use, none reported technical problems, 8 agreed or strongly agreed that Bridgedd was better than the tools they currently use to help patients navigate community health resources, and 8 reported an intent to use the tool with patients if it were made available. In the open-ended responses, 7 of the 11 respondents suggested that nothing was missing or offered no additional suggestions for improvement, while the remaining 4 open-ended responses centered on expanding mental or behavioral health resources, providing additional county coverage, including more resources within each category, and building a mechanism for updating resource information. Conclusions: In this small, single-setting formative pilot study using hypothetical patient scenarios, participating behavioral health professionals generally reported favorable perceptions of Bridgedd’s usability and potential utility. Further evaluation during routine clinical care is needed to assess actual use, workflow effects, patient experience, referral completion, and patient-level outcomes.
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