JMIR Publications

ABSTRACT

Background:

The advent of digital tools has led to innovative mental care solutions, giving hope to persons living with anxiety disorders. However, the current plethora of digital tools available in the field of psychiatry and mental health to treat these disorders raises a wide range of experiential, clinical, ethical, and organizational questions.

Objective:

This study (IMAGINE) aimed to characterize the social representations of digital mental health (DMH) of three categories of healthcare system stakeholders from six different European countries: individuals living with anxiety disorders, caregivers of persons living with these disorders, and mental health professionals.

Methods:

A free association approach was used to explore representations of DMH for the three stakeholder categories in Belgium, France, Germany, the Netherlands, Northern Ireland, and Scotland. A lexicometric analysis was performed to qualify and quantify participants’ freely associated words by analysing their statistical distribution using the ALCESTE method with the IRaMuTeQ software package.

Results:

The free association task was completed by 94 participants. The representation system of DMH of persons living with anxiety disorders focused on the concept of social connection and autonomy. Instead, caregivers prioritized well-being and health, while mental health professionals concentrated on support. Participants aged 30-39 years old associated DMH with the concept of support and well-being, while younger and older individuals emphasized connection and information. Belgians focused on support and well-being; Germans, Northern Irish, and Dutch prioritized connection and information, while Scottish participants emphasised autonomy and empowerment. France was the only country where no representational concept was significantly more frequent than others. All participants, irrespective of their profile, had a low level of familiarity with DMH.Representations of DMH were shaped by age, stakeholder type, and nationality, reflecting socio-healthcare policies. Four main concepts emerged: (1) The need for support in psychiatry which leverages innovation while preserving a humanistic practice; (2) Interpersonal connections; (3) Autonomy and empowerment, understood through two dimensions: (i) Emancipatory technologies enabling a renegotiation of power dynamics among healthcare system stakeholders, and (ii) A contemporary imperative for individuals to embrace self-managenent of their health from an individualistic perspective; (4) Well-being and health, coupled with internalized pressure to engage in personal care, are pathways of self-awareness and self-mastery; they reinforce personal responsibility and maximize individual potential. Moreover, they reflect a shift towards individual repsonsability for one’s own well-being.

Conclusions:

The representations of DMH by the different healthcare system stakeholders appeared to be shaped by sociotechnical imaginaries which in turn were molded by socio-political contexts. Despite several State initiatives promoting DMH in the six European countries studied, there are implementation lags; this suggests an incremental evolution rather than a paradigm shift in terms of DMH integration in Europe. To limit these lags and ensure inclusivity, policies should prioritize societal practices over individual actions, emphasizing accessibility and equity. Finally, while technological advances hold promise for revolutionizing healthcare delivery, they also lead to concerns regarding power dynamics and social disparities