Background: Asynchronous online forums provide flexible, accessible peer support for many people living with dementia and carers. Moderators are central to the functioning of these communities, yet little is known about their experiences. Objective: This study explored the experiences of individuals moderating an online dementia forum, including their motivations, perceived benefits, challenges, and suggestions for improvements. Methods: Moderators from a UK-based online dementia support forum were recruited using purposive sampling via forum administrators. Between January and March 2025, 5 moderators, all with dementia care experience, participated in remote semistructured interviews. Interview topics included pathways into moderation, perceptions of the moderator role, experiences of supporting forum members, challenges encountered, perceived personal benefits, and views on the future development of online support communities. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. Results: Four themes were produced: (1) “from support seeker to support provider”: moderators primarily identified as community members rather than authority figures, following a trajectory from receiving support as a carer to actively facilitating community support; (2) “understanding through shared experience”: lived experience of dementia was seen as essential for empathy, credibility, and sensitive responses, though sometimes prompted strong emotional reactions; (3) “giving back and gaining in return”: moderation offered purpose, structure, and social connection, particularly postretirement and following transition out of caring; (4) “balancing growth with community preservation”: forum expansion increased workload, spam management demands, and safeguarding responsibilities, and moderators were cautious about social media–style features and artificial intelligence–generated content undermining the effectiveness of support exchanges. Conclusions: Moderators play a crucial, value-driven role in sustaining dementia support forums, extending beyond administrative duties. The findings suggest that moderators occupy a distinctive position as both recipients and providers of peer support, drawing on experiential expertise to maintain trust and community cohesion. Forum growth and technological innovations present opportunities and challenges, highlighting the need to balance scalability with authenticity in online support communities.
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Technology-Enhanced Peer Support for Depression in Older Adults: Single-Arm Mixed Methods Feasibility Study
<strong>Background:</strong> Depression in late life is often compounded by social isolation and barriers to care. There is limited study of technology-enhanced peer support for depression among older adults. <strong>Objective:</strong> This study aimed to assess the feasibility and acceptability of a technology-enhanced peer support intervention to decrease depression among older adults. <strong>Methods:</strong> We used a mixed methods pilot study among adults aged 50 years and older with depression who received a peer support intervention called Peers+. The intervention consisted of 8 weekly video chats and unidirectional texts focused on increasing depression self-care and coping. Data obtained from screening, baseline, postintervention, and 3-month follow-up were used in the analysis to assess preliminary outcomes of the intervention. Mixed effects longitudinal models were used to assess change in depression, and qualitative data were collected and analyzed to identify key themes related to participant experiences. <strong>Results:</strong> A total of 34 older adults with a mean age of 67 (SD 9.57) years participated in the study, and 82.4% (28/34) of participants finished all 8 intervention meetings. Depressive symptoms declined over the course of the study of 35 weeks (<i>F</i><sub>1, 88.8</sub>=26.0; <i>β</i>=–.14, 95% CI –0.20 to 0.09; <i>P</i><.001). Emotional well-being (<i>β</i>=.48, 95% CI 0.26-0.70; <i>P</i><.001), social functioning (<i>β</i>=.71, 95% CI 0.33-1.09; <i>P</i><.001), self-efficacy (<i>β</i>=2.29, 95% CI 0.83-3.75; <i>P</i><.001), and coping (<i>β</i>=2.90, 95% CI 0.24-5.55; <i>P</i><.001) improved throughout the study period. Participants perceived supportive texts as reinforcing trust between peer coaches, using coping strategies, increasing social connection, and providing accountability for improving self-care. Peer coaches and older adults needed technology support for participation in the study. <strong>Conclusions:</strong> This study demonstrated the feasibility and acceptability of a peer support intervention enhanced by video chats and texts, delivered by older adult peer coaches to an ethnically diverse group of older adults with depression. Study findings indicate that ongoing and accessible technology support contributed to older adult participation and engagement.
Expedited Transition to Digital Delivery of Recovery Support Services Due to the COVID-19 Pandemic: Mixed Methods Needs Assessment
Background: Recovery support services (RSS) are an evidence-based approach to support recovery from substance use disorders, most often composed of peer-to-peer support, referrals to housing, job training, and other forms of prosocial engagement and activities. During the COVID-19 pandemic, RSS providers quickly converted in-person services to digital delivery to avoid disruption. It is unclear if this rapid conversion impacted the delivery of services or if this delivery model could enhance RSS reach and uptake more generally by extending the reach of RSS providers and offering an alternative delivery method and access point. Objective: The goal of this study was to identify how RSS providers in Texas adapted their services for digital delivery and to what extent, if at all, technology limitations (eg, lack of digital infrastructure) were present. Methods: We conducted an electronic survey of 85 RSS providers, assessing their current capacity and methods for the digital recovery support service (D-RSS), followed by semistructured online interviews with a subset of 20 respondents. Results: Most survey respondents (74/85, 87.1%) used D-RSS, though they used many dated technologies, devices, and platforms for service delivery. Many respondents indicated that they use Zoom (Zoom Video Communications) videoconferencing to communicate with participants; however, providers also indicated that they must use several different technology platforms to accomplish their service delivery goals. Four main themes emerged from the interviews: (1) the impact of the COVID-19 pandemic on RSS, (2) barriers and facilitators to technology-delivered D-RSS, (3) awareness and expectations regarding the use of D-RSS, and (4) training needs to deliver D-RSS. Conclusions: RSS organizations have access to technology for D-RSS; however, the technology is often outdated. Because the pandemic required a rapid and unexpected shift to D-RSS to maintain and potentially expand access during a public health emergency, providers desire guidance for training staff and participants on how to best use technology. A subset of providers endorsed the potential of a unified platform for D-RSS delivery, especially for data capture. Most barriers to D-RSS identified by our respondents may be addressable through the streamlined deployment of technology resources, rigorous training and onboarding programs in best practices for providers and participants, and tailored implementation strategies for varying local contexts.
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Peer Support in Online Women’s Health Communities: Mixed Methods Formative Analysis of Reddit Discourse
Background: Stigmatized women’s health issues, such as polycystic ovary syndrome (PCOS) and endometriosis, are often marginalized or dismissed in traditional clinical settings. This drives individuals to seek peer support in anonymous online communities such as Reddit. While these digital platforms host critical discussions, they are often designed as static information repositories, failing to account for the complex emotional, temporal, and cultural dynamics that shape users’ support needs. There is a disconnect between the lived experiences of users—particularly feelings of clinical dismissal and the need for culturally specific advice—and the design of the sociotechnical systems they rely on. Objective: This study aimed to deconstruct support practices in online women’s health forums to provide a formative basis for designing more responsive digital health systems. We analyzed the intersections of discussion topics, emotional expression, temporal shifts (specifically the impact of the COVID-19 pandemic), and culturally situated discourse to identify unmet user needs and effective peer-support patterns. Methods: We conducted a large-scale, mixed-methods analysis of 4995 posts and 460,317 comments from 5 major women’s health subreddits (r/WomensHealth, r/TwoXChromosomes, r/BirthControl, r/Endometriosis, and r/PCOS). Computational methods included Latent Dirichlet Allocation for topic modeling, Valence Aware Dictionary for Sentiment Reasoning for sentiment analysis, and the NRC Emotion Lexicon for granular emotion classification. We segmented the data into pre-, during-, and post–COVID-19 periods to analyze temporal shifts. This quantitative analysis was complemented by a 2-phase qualitative thematic analysis to identify and characterize engagement patterns within 147 validated culturally situated threads. Results: Our analysis revealed that the most prevalent and emotionally negative topic was “Pain & Doctor Visits,” which was uniquely characterized by high levels of fear and sadness linked to systemic clinical dismissal. The COVID-19 pandemic triggered a significant topical “turn inward,” with discussions shifting away from social or political issues and toward somatic concerns (eg, “PCOS” “Pain & Doctor Visits”). Paradoxically, this period saw a simultaneous rise in both negative emotions (eg, fear and sadness) and expressions of community trust. Critically, our qualitative analysis of culturally situated discourse uncovered a consistent three-stage “playbook” for effective support: (1) to establish psychological safety and validate cultural experiences; (2) to provide actionable, culturally tailored advice; and (3) to facilitate community-wide learning and empathy. Conclusions: Online health forums operate as essential, resilient sociotechnical infrastructures that actively compensate for failures and gaps in formal health care. The “Affirmation-Scaffolding-Bridging” model identified in our research provides a clear, formative framework for designing future digital health interventions. These findings can guide the development of new platforms that are emotionally aware, culturally responsive, and adaptive to user needs and external crises.
Current Landscape of Mental Health Conversational Agents From a Trauma-Informed Care Lens: Scoping Review
Background: Conversational agents (CAs) are increasingly used in mental health care to enhance access and engagement. However, their safe, ethical, and user-sensitive design remains a challenge. Despite growing attention to trauma-informed approaches in human-computer interaction, there is limited work on how the trauma-informed care (TIC) framework could be applied in the design of mental health CAs and no comprehensive synthesis to date. Objective: Guided by the Substance Abuse and Mental Health Services Administration’s TIC framework, this scoping review explored how TIC principles (safety; trustworthiness and transparency; collaboration and mutuality; empowerment, voice, and choice; peer support; and cultural, historical, and gender issues) are currently represented in the design and evaluation of mental health conversational agents (MHCAs) and identified gaps and opportunities to promote more trauma-informed design practices. Methods: Online databases, as well as a secondary survey of citation lists from an initial search, were used to identify English-language journal articles and conference proceedings from 2000 to 2024 that empirically evaluated an independent, web- or app-based, unassisted CA used for mental health and included concepts from TIC. Results: Our analysis included 38 publications (n=28, 73.7%, published in 2020 or later) covering 28 distinct MHCAs. Most studies used experimental methods (n=23, 60.6%) or user studies (n=11, 28.9%), with samples skewed toward female (men: mean 34.92%, SD 18.64%), young in age (mean 32.52, SD 14.6 y), and predominantly nonclinical (n=29, 76.3%). MHCAs were largely rule-based prototypes. No studies explicitly referenced the TIC framework as a guiding lens for MHCA design or evaluation. A total of 26 studies referenced terminology from TIC core principles but rarely defined them, while all 38 included language that could be linked to one or more principles. Overall, TIC-related concepts appeared most often within intervention design descriptions, qualitative assessments, or as items embedded in questionnaires evaluating broader constructs. Trustworthiness and transparency, safety, empowerment, voice and choice, and collaboration and mutuality were comparatively well addressed, while peer support and cultural, historical, and gender issues were largely absent. Design recommendations, where present, were relatively broad and emphasized secure, customizable, reliable, human-like, and context-sensitive MHCAs that offered multimodal interaction, goal setting and tracking, and transparency. Conclusions: Studies did not self-identify as using Substance Abuse and Mental Health Services Administration’s framework for TIC, making it more difficult to identify its elements. The fragmented terms, disciplines, and metrics used make it difficult to draw more systematic conclusions about the current research landscape related to TIC, but our analysis indicates TIC to be a descriptive and potentially unifying framework and provides a starting point for the explicit trauma-informed MHCA research and design.
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A phenomenological study on psychological resilience among medical vocational college freshmen
BackgroundMedical vocational college freshmen face severe challenges to their psychological resilience from various stressful events upon their enrollment. This qualitative study aimed to explore the authentic experiences and intrinsic characteristics of psychological resilience among medical vocational college freshmen.MethodsThe study employed a descriptive phenomenological design. A purposive sample of 24 medical vocational college freshmen was recruited as participants. Semi-structured interviews were conducted to collect data between January 2025 and February 2025. The interviews were transcribed verbatim and analyzed using the Colaizzi descriptive analysis method.ResultsData analysis identified nine subthemes falling into three macrothemes: (a) Challenges: The Erosion of Psychological Resilience, describing how freshmen’s psychological resilience is eroded when they face difficulties in adapting to college life; (b) Support: The Recovery of Psychological Resilience, focusing on how freshmen regain resilience through internal and external support; (c) Cognition: The Maintenance of Psychological Resilience, explaining the factors that promote the sustained development of freshmen’s psychological resilience.ConclusionFreshmen face pressures in academics, interpersonal relationships, and self-management. Family and peer support, together with personal growth, contribute to resilience recovery. Educators should employ cognitive restructuring, experiential learning, and other strategies to help maintain their psychological resilience.
Co-Design of a Depression Self-Management Tool for Adolescent and Young Adult Cancer Survivors: Rapid Qualitative Analysis of Interview Feedback on a Prototype
<strong>Background:</strong> Over 2.1 million adolescent and young adult cancer survivors (AYACS) live in the United States. Recent estimates suggest that up to one-third of AYACS experience major depressive disorder. Although several efficacious evidence-based interventions are available to manage symptoms of depression, these interventions are often inaccessible to AYACS who have many competing commitments. Digital mental health tools hold promise for this population; however, only a few have been tailored to meet the unique needs of AYACS, and findings to date have yielded mixed results. <strong>Objective:</strong> This study aims to obtain feedback from AYACS on a mid-fidelity prototype of a depression self-management tool being tailored for AYACS. <strong>Methods:</strong> Individuals with a history of cancer diagnosed at age 12 or older who were between the ages of 15 and 39 and had completed primary treatment were identified through a review of medical records from a comprehensive cancer center in the Southeastern United States. Potentially eligible participants were contacted by study staff to conduct additional screening and obtain informed consent via REDCap (Research Electronic Data Capture; Vanderbilt University). Upon enrollment, participants provided demographic and clinical information, as well as their availability for an interview. The principal investigator (KMI) conducted semistructured individual interviews with consented AYACS. Most of the interview was dedicated to showing participants the mid-fidelity prototype of the tool, explaining how the prototype might work, and requesting targeted feedback. Demographic and clinical characteristics, as well as some aspects of feedback on the prototype, were summarized using descriptive statistics. Interviews were audio- and video-recorded and transcribed. The transcriptions underwent rapid qualitative analysis guided by the Rigorous and Accelerated Data Reduction technique. <strong>Results:</strong> A total of 14 AYACS (n=9, 64%, female; n=9, 64%, white; ages 15-38) completed an individual interview. Participant preferences for mood tracking, content presentation, user input, and duration of use were captured qualitatively but analyzed quantitatively. For example, most participants (n=10, 71%) indicated that they preferred a mood-tracking option that included emojis and would be willing to track their mood at least once per day (n=11, 79%). Participant preferences captured qualitatively fell into 4 themes: (1) features to promote user engagement (eg, the use of gamification); (2) tailored content presentation (eg, authenticity in the portrayal of the cancer experience); (3) perceived usability (eg, simplifying user input); and (4) interface design (eg, implementing a coherent design theme and color scheme). <strong>Conclusions:</strong> Findings indicated that AYACS highly value personalization, flexibility, and peer support in digital interventions. Based on insights obtained during individual interviews, a working prototype was developed by reprogramming an existing digital tool. Qualitative and quantitative findings informed modifications to the existing digital tool. The working prototype will next undergo evaluation as part of a pilot full-factorial trial.
World Mental Health Day Statement
Ottawa – October 10, 2025
As someone who has worked in countries affected by conflict and humanitarian crises, I’ve learned that physical displacement is only part of the story. The mental and emotional toll defines the other half of that experience, and often for much longer.
This World Mental Health Day focuses on mental health in humanitarian emergencies. It asks us to consider not just the scale of the challenge, but the strength of the response possible when communities lead the way.
There is no single solution to the mental health impacts of humanitarian crises. But what I’ve witnessed, both internationally and here on Turtle Island, is that the most meaningful support often comes from within affected communities themselves.
Whether it’s refugees organizing healing circles in displacement camps, neighbours checking in on one another after a wildfire, or volunteers trained to provide peer support—these acts of care are not just helpful. They are essential. They save lives.
Right now, the world feels heavy. The growing phenomenon of eco-anxiety, combined with escalating crises of famine, war, and displacement, can make hope feel out of reach. We see the numbers—123 million people forcibly displaced worldwide—and it can be overwhelming.
But I’ve also seen what happens when we share that weight by leaning on one another. This is equally true for humanitarian aid workers, who are responding to unprecedented numbers of conflicts and urgencies at home and around the globe.
As the World Health Organization reminds us, “Humanitarian workers face extreme stress and are often directly affected by the crisis they respond to.”
As a member of this community, I know that sustaining an effective humanitarian response means meeting the needs of those providing comfort and care, whether through peer support, workplace health programs, or Mental Health First Aid. Here at home, programs like The Working Mind – First Responder are helping to create a culture of care for those we call on in crisis.
The way we heal—whether we’re first responders or community workers, volunteers or refugees—is through community. It’s in the everyday ways we show up for one another: listening without judgment, making space for grief and fear, and recognizing that asking for help is an act of courage.
On this World Mental Health Day, let’s all find the courage to lean on each other.
Lili-Anna Pereša C.Q.
President & CEO
Mental Health Commission of Canada
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