Assessing Predictive Factors of Attitudes Toward Peer-Supported Mental Health Interventions in the Metaverse: Mixed Methods Study
Authors: Ramos Francisco Nicolas , Bernstein Rachel A , Ezawa Iony D 
Published: August 2024

Background
The metaverse is a promising avenue for accessible, effective digital mental health treatments. However, general attitudes toward peer-supported metaverse mental health interventions (MMHIs) remain largely unexplored.

Objective
This study examined the relation of sociodemographic, mental health, and technology factors in predicting attitudes toward MMHIs.

Methods
We used a mixed methods design with a self-report online survey (N=545 participants) to assess participant attitudes toward MMHIs and sociodemographic, mental health, and technology factors. Ordinal logistic regression was used to examine predictors of general interest in peer-supported MMHIs and binary logistic regression to examine predictors of preference for MMHIs versus face-to-face interventions. Inductive content analysis was performed on 483 open-ended responses regarding intervention preference.

Results
Older age (odds ratio [OR] 1.03, 95% CI 1.02-1.05; P<.001), higher ethnic identity centrality (OR 1.44, 95% CI 1.25-1.66; P<.001), more positive mental help–seeking attitudes (OR 1.22, 95% CI 1.06-1.42; P=.007), more online video game use (OR 1.26, 95% CI 1.09-1.44; P=.001), and greater virtual reality experience (OR 1.55, 95% CI 1.28-1.90; P<.001) were associated with greater odds of reporting more interest in MMHIs. Internet access was associated with greater odds of reporting less interest in MMHIs (OR 0.50, 95% CI 0.30-0.84; P=.01). Hispanic ethnicity (OR 1.81, 95% CI 1.13-2.90; P=.01), older age (OR 1.04, 95% CI 1.02-1.05; P<.001), higher ethnic identity centrality (OR 1.28, 95% CI 1.09-1.51; P=.003), smartphone access (OR 10.46, 95% CI 2.87-50.71; P<.001), higher self-reported video game use (OR 1.25, 95% CI 1.05-1.48; P=.01), and more positive computer attitudes (OR 1.05, 95% CI 1.01-1.10; P=.02) predicted greater odds of preference for MMHIs (versus face-to-face interventions), whereas the male gender (OR 0.43, 95% CI 0.28-0.68; P<.001), internet access (OR 0.12, 95% CI 0.02-0.40; P=.002), more positive mental help–seeking attitudes (OR 0.76, 95% CI 0.62-0.92; P=.005), and moderately severe (OR 0.20, 95% CI 0.07-0.51; P=.001) and severe (OR 0.26, 95% CI 0.08-0.79; P=.02) levels of depression symptoms predicted lower odds of preference for MMHIs. Qualitative analysis revealed 14 themes describing reasons for intervention preference. Anonymity (133/483, 27.5%), social aversion (38/483, 7.9%), ease of use and accessibility (35/483, 7.2%), anxiety (28/483, 5.8%), and comfort (26/483, 5.4%) tended to be endorsed by those preferring MMHIs. Ecological validity of social interactions (99/483, 20.5%), ecological validity of interventions (75/483, 15.5%), aversion/distrust toward technology (42/483, 8.7%), impersonal quality (31/483, 6.4%), and immersion/engagement (11/483, 2.3%) tended to be endorsed by those who preferred face-to-face interventions. Mental health attitudes (28/483, 5.8%), privacy (19/483, 3.9%), and miscellaneous reasons (46/483, 9.5%) were endorsed equally between preferences. Novelty (21/483, 4.3%) was most cited by those who expressed no preference.

Conclusions
This study identified several factors associated with attitudes toward peer-supported MMHIs, which may be leveraged to inform mental health outreach to interested populations.