Feasibility of Psychiatric Consultation by Metaverse for Youths with Mental Health Conditions

Feasibility of Psychiatric Consultation by Metaverse for Youths with Mental Health Conditions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility of Psychiatric Consultation by Metaverse for Youths with Mental Health Conditions Mio Ishii, Junichi Fujita, Nao Toyohara, Keiko Ide, Tomoko Moroga, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5685619/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The unmet needs of young people for mental health services (MHSs) remain a significant issue. Despite the high demand, many young people are unable to access timely and high-quality MHS. The Metaverse, a virtual space where people interact and communicate through avatars, is expected to introduce new possibilities for MHS. This study aims to investigate the feasibility of using the Metaverse for mental health consultations with young people experiencing mental health conditions. Methods This qualitative observational study was conducted at a single institution via semistructured interviews. Participants aged 16–24 years who were aware of mental health conditions were assigned to experience a metaverse consultation with a psychiatrist through avatars. Afterward, participants were interviewed to assess the feasibility, usability, and influencing factors of metaverse-based consultation. Results Twenty-six participants were assigned, and all completed the study without any adverse psychological events. Some reported minor physical effects, such as headaches and VR-related sickness. The findings from the postinterview suggest that metaverse consultations may be particularly beneficial for individuals experiencing interpersonal anxiety, those with high sensory sensitivity due to autism spectrum disorder, those who struggle outside due to psychiatric conditions such as depression or agoraphobia, those with strong psychological resistance to receiving psychiatric care, and those who feel uncomfortable disclosing their own physical appearance in real-life settings (e.g., gender incongruence). Conclusions Metaverse psychiatric consultation is feasible for young people with mental health conditions, particularly for individuals with specific needs. Technical and accessibility issues must be addressed to enhance its effectiveness. Metaverse avatar communication youth mental health Figures Figure 1 Background Youth mental health is a critical global issue that remains complex and challenging. Reports indicate that one in five young people experiences anxiety, and one in four faces depression due to factors such as poverty and shifts in lifestyle patterns [1, 2]. This prevalence doubled before and after the COVID-19 pandemic [3]. With more than 25% of mental disorders beginning before the age of twenty-five years [4] and the significant socioeconomic impact of these conditions[5], the need for effective mental healthcare for young people is clear. Despite this, many young people struggle to access timely and high-quality mental health services (MHSs). Several factors contribute to this gap between the demand and supply of MHS for young people, including physical barriers such as the shortage and geographic distribution of child and adolescent psychiatrists, as well as psychological barriers such as stigma and low mental health literacy [6]. Although various initiatives, such as school-based psychoeducation, peer training, and outreach programs, have been launched to address these barriers and improve access to mental health services, a breakthrough solution remains elusive[7–9], underscoring the need for further research. As an innovative solution, information and communication technology (ICT) plays a pivotal role in the lives of young people, providing a critical platform for socialization and information gathering. Its widespread accessibility and integration into daily life position ICT as a promising tool for youth-friendly MHS, offering opportunities for prevention, early intervention, and accessible support tailored to the unique needs of this demographic [10]. One particularly innovative approach is Metaverse—a virtual space where users, represented by avatars, can navigate, engage in various experiences, and interact with others. The Metaverse platform is not simply a virtual or augmented reality (VR/AR) platform; it enables immersive social activities that go beyond physical limitations. Key components include interactions via avatars in VR/AR spaces, economic activities through nonfungible tokens (NFTs), and decentralized, user-driven communities via decentralized autonomous organizations (DAOs). For youth, the Metaverse presents the potential to create accessible, engaging, and flexible platforms. In Japan, for example, emerging initiatives in some cities use virtual reality-based support services for individuals with social withdrawal (Hikikomori)[11], exploring ways to reduce stigma and facilitate access to support. The Metaverse could extend these efforts internationally by offering an alternative environment where young people with mental health issues can seek help discreetly and interactively. However, studies on the feasibility and effectiveness of metaverse-based MHS remain limited. This study aims to assess the feasibility of metaverse psychiatric consultations tailored for young people with mental health conditions. The findings will guide the development and implementation of future youth MHS, addressing key barriers to access and engagement. Methods Study Design This was an observational study involving semistructured interviews. After experiencing a metaverse consultation with a psychiatrist, the participants were individually interviewed. This qualitative design was used to assess participants’ opinions on the usability and feasibility of the metaverse consultation. Participants and Setting The target group for this study consisted of young people aged 16 to 25 years who self-identified as experiencing mental health conditions. The participants were recruited from Yokohama University Hospital, nearby clinics, local universities, high schools, support groups, and social media. The study was conducted in a meeting room on the Yokohama University campus. 1..1. Inclusion criteria 1. Individuals aged 16-25 at the time of consent. 2. Individuals who are aware of their mental health conditions. 3. Individuals able to provide written consent in Japanese. 1..2. Exclusion criteria Individuals currently receiving treatment at a psychiatric medical institution who do not have permission from their primary physician to participate in this study. Procedures 1..1. Baseline assessment As a baseline assessment, the participants completed a self-administered questionnaire consisting of four parts: (1) mental and physical conditions, (2) living conditions over the past three months, (3) internet usage, and (4) perceptions of mental health and psychiatry. 1..2. Metaverse environment setup and technical support After the baseline assessment, the participants entered the metaverse environment under the guidance of technical staff, wearing VR goggles and using a controller. Since the participants were unfamiliar with Metaverse operations, the technical staff provided detailed instructions for fitting the goggles, launching the application, and logging in. For this study, experimental worlds and avatars were set up on commercially available Metaverse applications, VRChat® and Workrooms®. VRChat® is a social virtual reality platform that allows users to create, share, and explore user-generated virtual worlds through customizable avatars, fostering social interaction and creative expression in immersive settings. In contrast, Workrooms® is a virtual collaboration tool designed for professional and educational use, enabling users to hold virtual meetings in shared spaces with avatars and facilitating interactive discussions, presentations, and collaborative tasks. These applications provided structured and flexible virtual spaces suitable for the purposes of this study. The virtual environments included three distinct spaces: an outer space environment, a hospital examination room, and a meeting room with selectable views of a beach or mountains. The avatars included both human and nonhuman fictional characters, providing participants with diverse ways of interacting and expressing themselves. Figure 1 illustrates one of the settings and avatars used in the study. 1..3. Metaverse Psychiatric Consultation The metaverse consultations were conducted one-on-one in private virtual rooms with a psychiatrist, who also wore VR goggles and appeared as avatars from remote locations. The psychiatrists included both male and female professionals with an average of 19 years of clinical experience. Each consultation lasted 30-40 minutes and followed a semistructured framework resembling a standard initial psychiatric consultation. The key components of the consultations were as follows: 1. Introduction and establishing rapport (5–10 minutes): • The psychiatrist greeted the participant using their avatar and introduced themselves, explaining the goals and structure of the session. • A brief discussion was conducted to help the participants feel comfortable in the virtual environment. 2. Review of medical and life history (10–15 minutes): • The psychiatrist inquired about the participant’s medical history, including any previous mental health diagnoses or treatments. • Life history was reviewed to understand the participants’ background, relationships, daily routines, and environmental stressors. 3. Symptom Observation and Assessment (10–15 minutes): • The participants were guided to share their current mental health concerns, such as anxiety, mood fluctuations, or sleep disturbances. • The psychiatrist observed verbal and nonverbal cues through avatar interactions to evaluate the participants’ emotional state and engagement. 4. Providing guidance and recommendations (5–10 minutes): • Tailored advice was provided to address the participants’ specific concerns. • Recommendations included coping strategies, lifestyle adjustments, and referrals to additional mental health resources when needed. 5. Closing and feedback (5 minutes): • The session concludes with a summary of the discussion and an opportunity for the participant to ask questions or provide feedback on the experience. The consultations were designed to balance structure and flexibility, providing participants with a supportive environment to explore their mental health concerns in a novel, virtual setting. During the session, the participants navigated the three distinct spaces within Metaverse alongside the psychiatrist and interacted via various types of avatars. Technical staff were available to assist as needed, ensuring a seamless and accessible experience. 1..4. Postconsultation interviews and feedback After the metaverse consultation, the participants were individually interviewed to gather insights into their experiences and acceptance of the metaverse consultation. The interviews also aimed to identify challenges associated with using the Metaverse for mental health support. Specifically, the interview topics included the following: • The usability of metaverse devices. • Physical or psychological discomfort and adverse effects experienced. • Acceptance of metaverse consultations compared with face-to-face consultations. • Opinions on the types of individuals and situations where metaverse consultations might be useful. • Key requirements and concerns regarding metaverse consultations. Following the interviews, the psychiatrists who conducted the metaverse consultations, along with the research team—including psychiatric social workers and a nurse—discussed the usability, expectations, and concerns related to metaverse consultations. Specifically, they provided feedback on the following: • The functionality and user experience of the Metaverse platform. • The technical environment. • Differences between metaverse consultations and face-to-face consultations. • The compatibility of the metaverse with the characteristics and conditions of participants. • Any other observations or insights noted during the study. Data analysis The interview data were analysed via thematic analysis following established qualitative research methodologies. First, all the interviews were transcribed verbatim to ensure accuracy. The transcripts were then reviewed multiple times to facilitate familiarity with the data and identify potential patterns. Initial coding was conducted by systematically highlighting recurring phrases, concepts, and key statements. These codes were grouped into broader categories that represented emerging themes. To enhance rigor, the themes were independently reviewed and refined by multiple researchers to ensure consistency and reduce bias. The analysis focused on three primary domains: 1. Usability of the Metaverse Platform: Exploring participants’ experiences with the technical aspects, including VR device operation, comfort, and adaptability. 2. Acceptance of Metaverse Consultations: Assessing participants’ preferences, perceptions, and satisfaction with metaverse consultations compared with face-to-face interactions. 3. Conditions or Characteristics Beneficial for Metaverse Consultations: Identifying specific participant profiles or conditions, such as social anxiety or sensory sensitivities, where metaverse consultations may offer unique advantages. Results Baseline characteristics A total of 26 young people were assigned from a pool of 33 volunteers. One individual was excluded for not meeting the inclusion criteria, five lost contacts before providing informed consent, and one could not participate because of his condition on the day. Table 1 summarizes the baseline characteristics, while Table 2 presents the results of the baseline assessments of the participants. The mental and physical conditions of the participants varied, with many expressing difficulties in social interactions, feelings of isolation, and discomfort in seeking support from others. Most participants reported frequent internet use, although their levels of social engagement and self-care practices differed. All the participants owned internet-enabled devices, and most used the internet daily. However, some participants acknowledged neglecting essential tasks due to internet use, whereas others reported difficulties in limiting their internet usage. The participants’ initial impressions of the Metaverse also varied. While only a minority had extensive knowledge or prior experience with the Metaverse, many expressed curiosity. Their views on associating with individuals who had a history of psychiatric treatment ranged widely, with some expressing comfort and acceptance, whereas others showed apprehension or stigma toward mental health issues. Table 1 Baseline characteristics Characteristic Description Age Mean 19.9 years (range 16–25 years) Gender Male: 15, Female: 7, Non binary: 3, No response: 1 Recruitment Sources Yokohama City University Health Management Center, medical students and junior residents, outpatient of University Hospital and neighborhood clinics, participants from other survey of our research team, Neighborhood Private High School, Facebook History of Psychiatric Treatment Yes: 22, No: 4 Table 2 Baseline assessment Aspect of Assessment Summary of Findings 1. Physical and psychological condition Perceived Health Issues Most participants (80%) indicated concerns about their physical or mental health, with common issues including insomnia, social anxiety, general anxiety, depression, learning disabilities, difficulty speaking with others, and lack of motivation. Comfort Being in Social Situations Nearly two-thirds (68%) reported discomfort being in front of others, and 64% felt uncomfortable talking with strangers, indicating significant social anxiety. Help-Seeking Behavior Approximately 65% reported that they seek advice when facing problems, primarily consulting family, friends, teachers, or medical staff. Sense of Social Connection Mixed responses: 50% reported sometimes feeling a lack of social connections, while others felt relatively neutral or disagreed with feelings of isolation. Feelings of Exclusion and Isolation Most participants (77%) felt neither excluded nor isolated, suggesting a generally stable sense of belonging, despite some individual cases of feeling isolated or left out. 2. Living condition of past 3 months Frequency of Going Out Most participants went out frequently, with 73% going out at least once a week, while 27% went out less frequently. Conversations with Family Members The majority (88%) reported daily conversations with family, indicating strong familial interaction. Conversations with Non-Family Members Over half (77%) had conversations with nonfamily members at least weekly, suggesting moderate social interaction outside the family. Ability to Maintain a Regular Routine Only 27% of participants maintained a regular routine daily or several times per week, with the remainder struggling to do so consistently. Sufficient Sleep Approximately half (50%) reported receiving sufficient sleep almost daily or several times per week, while others reported inconsistent sleep. Frequency of Bathing or Showering Nearly all participants (92%) bathed or showered daily, indicating consistent personal hygiene practices. Concentration on Work or Studies Only 27% could concentrate on work or studies consistently (daily or multiple times per week), with others facing challenges in concentration. Engagement in Non-Work/Study Activities Most participants (61%) engaged in hobbies, sports, or social activities at least once a week, while others were less active. 3. Internet Usage Access to internet-Enabled Devices All participants (100%) owned internet-enabled devices, such as computers, smartphones, or gaming consoles. Freq uency of internet Use Nearly all participants reported daily internet use, indicating high internet engagement. Neglect of Responsibilities Due to internet Use A majority (73%) sometimes or always neglected responsibilities due to internet use, with only one participant reporting no impact. Making New Connections Online Around half (46%) reported occasionally or frequently making new connections online, while 27% never made new connections through the internet. Difficulty Reducing internet Use Nearly half (46%) indicated difficulty reducing internet use, with the remainder having little to no issues in managing their usage. Familiarity with the Metaverse Knowledge about the Metaverse varied, with 46% reporting some familiarity, while the rest indicated limited or no knowledge. Experience with the Metaverse Only a small portion (23%) had direct experience with the Metaverse, indicating it was relatively new to most participants. 4. Attitudes Toward Mental Health and Psychiatry Friendship with Individuals who Have Seen a Psychiatrist Most participants (88%) expressed openness, agreeing that they could become close friends with someone who has sought psychiatric care. Trust in Individuals with a History of Psychiatric Hospitalization A majority (73%) believed that individuals with past psychiatric hospitalization are just as trustworthy as others. Perception of Psychiatric Treatment as a Personal Failing Most participants (85%) disagreed with the notion that seeking psychiatric help is a sign of personal failure. Reluctance to Hire Individuals with Psychiatric History Over half (65%) felt that many people would be reluctant to hire someone with a history of psychiatric treatment, reflecting a perceived societal stigma. Willingness to Date Someone with a History of Psychiatric Treatment Around half (54%) were neutral or positive about dating someone with a psychiatric history, while 27% expressed reluctance. Interviews 1..1. Usability of the Metaverse Device The participants’ responses regarding the usability of the Metaverse device fell into three categories: Positive Opinions (12 responses, 46%) Some participants noted that they “quickly got used to the controls” and found the device “easy to use due to regular use of gaming devices.” Optimism for future accessibility was evident in comments such as “I would like to use it when it becomes easier and more affordable.” Neutral Opinions (6 responses, 23%) Several participants were neutral about the device, stating that while they adapted to its operations, they would require assistance for more complex tasks. One participant commented, “I feel comfortable for short sessions, but longer sessions might be tough with these devices . ” Negative Opinions (8 responses, 31%) Some participants raised concerns about the device’s physical fit and comfort. Nine participants experienced issues such as the goggles feeling “too tight,” “too loose and slipping,” or challenging to fit over glasses. Five participants reported mild physical discomfort, including VR sickness or head heaviness, although no psychological discomfort was noted. A participant remarked, “It might be difficult to connect and operate remotely without staff assistance,” highlighting barriers to independent use. 1..2. Acceptance of the Metaverse Consultation Responses regarding the acceptance of metaverse consultations revealed a range of perspectives: Positive opinions (10 responses, 38%) The participants who preferred metaverse consultations over face-to-face sessions cited benefits such as reduced psychological pressure and convenience. The comments included “It’s a big help not having to leave home when I’m feeling too unwell to go out” and “Meeting a new doctor is less nerve-wracking through an avatar.” Another participant noted, “I don’t have to endure the intimidating atmosphere of psychiatric institutions or the doctor’s imposing presence.” Neutral Opinions (10 responses, 38%) Neutral responses indicated that participants found the content and quality of metaverse consultations comparable to those of face-to-face consultations. Many noted that their preference would depend on their condition at the time. For example, one participant remarked, “I prefer face-to-face if I can go out, but there are times I’d rather use the Metaverse.” Others suggested that “The Metaverse would be preferable if issues such as cost, ease of access, and privacy were addressed.” Negative Opinions (6 responses, 24%) The participants who preferred face-to-face consultations emphasized the reassurance of observing expressions and body language. One participant shared, “If I can’t see their face, I worry whether they’re truly understanding or accurately interpreting what I want to convey.” Another participant added, “For personal and serious discussions, I want to see the person face-to-face.” The participants also shared insights into specific scenarios where metaverse consultations might be beneficial. One participant stated, “It’s ideal for people like me who are self-conscious about being seen. I can focus more on the consultation and express what I truly want to say.” Another remarked, “It’s helpful for those who find it challenging to visit psychiatric clinics.” 1..3. Keywords and Concerns for Metaverse Consultations The participants highlighted several key requirements and concerns regarding metaverse consultations: Security and privacy concerns The importance of a secure and private consultation environment was frequently mentioned. The participants requested assurances that psychiatrists understood them accurately. One participant commented, “I don’t want to show my face, but if the avatar’s facial expressions and body movements are synchronized with reality, it feels more reassuring than a phone call.” Concerns about information security for private consultations were also raised. Preferences for Avatars and Room Settings The participants frequently emphasized the importance of customizable settings, using terms such as “relaxing,” “free from distractions,” and “self-selectable.” Twelve participants expressed a preference for avatars that felt authentic to them, with one stating, “choosing my avatar is a way of expressing myself, and it makes me feel more comfortable in the consultation.” Preferences for human avatars (6 participants) and nonhuman characters (6 participants) were evenly split. 1..4. Psychiatric team’s perspective The psychiatric team provided valuable insights into the potential benefits and challenges of metaverse consultations: Positive Opinion Team members noted that individuals with sensory hypersensitivity, such as those associated with ASD traits, appeared to focus more effectively in the immersive VR environment. They also reported that individuals with significant social anxiety or tension seemed to relax more quickly, enabling broader and deeper conversations. Concerns and suggestions The team expressed concerns about the limitations of metaverse consultations for participants with pronounced symptoms, as these limitations may hinder accurate diagnoses. Suggestions included simplifying metaverse operations for easier access and expanding the range of avatars and room settings to allow for more personalized consultations. They also recommended developing diagnostic support tools to enhance the consultation experience. Discussion In this study, we investigated the feasibility of metaverse psychiatric consultations for young people with mental health conditions. This is the first observational trial to evaluate the feasibility of metaverse consultations in psychiatry. A total of 26 young people participated and completed the study. Despite the mild physical discomfort reported by some participants, such as VR sickness and head heaviness, no significant adverse psychological events occurred, ensuring the study’s successful completion. Postexperience interviews provided valuable insights into both the advantages and challenges of metaverse consultations, offering a roadmap for the future development and implementation of these services. High affinity for metaverse psychiatric consultations This study identified specific groups with a strong affinity for metaverse-based psychiatric consultations. Five distinct groups are highlighted: 1..1. Individuals with Interpersonal Anxiety The participants who struggled with accessing medical facilities or engaging in face-to-face conversations due to anxiety expressed that avatar-based communication significantly reduced their psychological burden. The ability to interact from a safe and familiar environment helped participants focus better on the consultation. 1..2. Individuals with sensory sensitivities (e.g., ASD) The immersive experience provided by VR goggles allowed some participants with sensory sensitivities to block overwhelming external stimuli, enabling better concentration during consultations. One participant remarked, “After experiencing the metaverse consultation, I felt I truly understood what a consultation was meant to be for the first time.” However, this benefit must be interpreted cautiously. Previous studies have noted VR-related discomfort among individuals with ASD, including VR sickness, sensitivity to brightness, and challenges adapting to immersive environments [12]. This highlights the need for further investigations to tailor VR interventions appropriately for sensory-sensitive populations. 1..3. Individuals Struggling to Leave Their Homes Due to Psychiatric Conditions Conditions such as depression, agoraphobia, or Hikikomori make in-person consultations inaccessible for some individuals. The Metaverse offers a safe and private platform, allowing participants to connect with mental health professionals without leaving their homes. Avatars also serve as a psychological bridge, facilitating more comfortable communication. 1..4. Individuals Facing Stigma or Resistance to Psychiatric Care Stigma around mental health often discourages help-seeking behaviors. The participants noted that avatar-based consultations reduced the fear of judgment and made accessing services more approachable. For many, this initial step provided a reassuring and nonthreatening introduction to mental health care, potentially easing its transition into traditional services. 1..5. Individuals Uncomfortable with Disclosing Their Physical Appearance The participants with gender incongruence, negative body image, or other appearance-related discomforts expressed that avatars provided a sense of safety and self-expression. They felt more comfortable engaging in consultations through avatars than in real-life settings. Challenges in Implementing Metaverse Consultations While the Metaverse presents significant opportunities for MHSs, several challenges must be addressed to enable its effective implementation: 1..1. Accessibility Issues The current process of accessing and using Metaverse platforms remains complex. Technical staff were required to assist participants with the VR goggle setup, navigation, and operation. Improving accessibility and ease of use, including simplifying VR operations, will be essential for making these services universally available. Reliable internet access and more affordable VR equipment are also necessary for broader adoption. 1..2. Physical Discomfort Physical challenges such as VR sickness, head heaviness, and discomfort while wearing goggles were common barriers to engagement. Although the immersive experience was seen as a significant advantage, this discomfort must be mitigated to maximize the benefits of metaverse consultations. 1..3. Potential for “Light Metaverse” Options Metaverse platforms can often be classified based on the devices, technologies, and functionalities they utilize. In this study, we distinguish between Light Metaverse and Heavy Metaverse as two broad categories. The Light Metaverse refers to experiences that do not require advanced equipment, such as VR goggles; instead, they are accessible via smartphones or PC browsers, offering a more simplified and accessible form of interaction. In contrast, the Heavy Metaverse involves immersive experiences that utilize advanced technologies such as VR goggles and related equipment, providing a fully immersive and engaging digital environment. Expanding beyond VR-based platforms to include Light Metaverse options could significantly increase accessibility for a broader population, particularly for individuals who may lack access to VR technology or experience physical discomfort or other limitations while using it. Light Metaverse options hold the potential to enhance inclusivity and convenience, reduce technological and financial barriers, and still facilitate meaningful virtual interactions. To better understand the efficacy and inclusivity of these options, comparative studies evaluating VR-based (Heavy Metaverse) and non-VR-based (Light Metaverse) approaches are essential. Such studies can provide valuable insights into the most effective and user-friendly strategies for delivering mental health services through the Metaverse, tailored to the diverse needs of different populations. 1..4. Ethical considerations The ethical challenges of metaverse consultations remain unresolved. In this study, eligibility confirmation and consent were obtained in person, but future implementations will require robust mechanisms for ensuring informed consent, safeguarding privacy, and maintaining secure interactions entirely within virtual platforms. These measures are critical for building trust and maintaining the integrity of therapeutic environments. Encouraging Autonomy in Mental Health Services A key insight from this study is the importance of autonomy in MHSs for young people. The concept of “choice” emerged consistently in participant responses, highlighting their desire for flexibility and personalization. The choice of avatars enabled participants to express their identities, creating a more comfortable and engaging consultation experience. The participants emphasized the value of having both metaverse-based and in-person options available. This aligns with prior research indicating that traditional, paternalistic models often discourage help-seeking behaviors among young people by limiting autonomy [13, 14]. In contrast, youth-friendly services that prioritize choice and personalization have been shown to foster greater engagement and trust [15]. The Metaverse has significant potential to support these preferences. By integrating flexibility, personalization, and nonjudgmental environments, metaverse-based services can bridge the gap between accessibility and engagement, creating a supportive platform where young people feel empowered to seek help. Strengths This study has several strengths: 1..1. Innovative Contribution This is the first observational trial to explore the feasibility of metaverse consultations in psychiatry, offering a pioneering investigation into a novel approach for mental health support. 1..2. Potential to expand access: The identification of specific groups with a high affinity for metaverse consultations provides a roadmap for addressing barriers to traditional mental health support, particularly for underserved populations. Limitations Despite its strengths, this study has several limitations: 1..1. Small and Limited Samples: The sample size was small, and participants were recruited from areas near the university, limiting generalizability. Future studies should include a broader range of participants, particularly those who may benefit most from the Metaverse, such as individuals with severe physical or mental limitations. 1..2. Narrow Scope of Metaverse Functionality: The study focused solely on avatar-based communication via VR, without exploring broader metaverse features. Prior studies suggest that one of the key elements of the metaverse, decentralized autonomous organizations (DAOs), has the potential to foster inclusive and collaborative environments for mental health support by enabling user-governed networks, promoting shared decision-making, and facilitating collective healing [16]. Future research should incorporate these elements to fully evaluate the potential of the metaverse. 1..3. Excluded Populations: Certain groups, such as individuals with speech difficulties or nonnative speakers, were not included in this study. Future research should consider these populations to enhance the inclusivity of metaverse-based MHS. Conclusion This qualitative observational study suggests that metaverse-based psychiatric consultations are feasible for young people with mental health conditions. While challenges persist, further research is necessary to evaluate the utility of this service across a broader target population and a wider range of applications, thereby supporting the development of a truly impactful and effective mental health intervention. Abbreviations ASD: Autism Spectrum Disorder; DAO: Decentralized Autonomous Organization; ICT: Information and Communication Technology; MHS: Mental Health Service; NFT: Non-Fungible Token; PC: Personal Computer; VR: Virtual Reality; AR: Augmented Reality Declarations Ethics approval and consent to participate This study was approved by Institutional Review Board (IRB) of Yokohama City University, Japan (Approval No.: F230400055). Written informed consent was obtained from all participants. For participants younger than 18 years of age, written informed consent was obtained from their legal guardians. The trial was conducted in compliance with the Declaration of Helsinki and the Ethical Guidelines for Life Science and Medical Research Involving Human Subjects. Since this study was conducted as an observational study, clinical trial registration was not applicable. This manuscript also includes images of staff members demonstrating the Metaverse consultation sessions. All individuals appearing in the images provided written informed consent for the publication of their images and copies of the signed consent forms have been submitted with the manuscript. Availability of data and materials The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request. Competing interests MI, NT, KI, TM, MT, TA and TM have no competing interests. JF serves as the Executive Director of the Seisa Yokohama Education Counselling Center. Funding This work was supported by Japan Science and Technology Agency Grant No. JPMJPF2203. The funders had no role in the study design, data collection, analysis, interpretation, or decision to submit the manuscript for publication. Authors' contributions The study was designed by MI, JF, NT, KI and TM. Participants were recruited by MI, JF, KI, TA,TM, and MT. MI and JF administered the assessments, interventions and interviews with support from TM and MI. NT, TM and MT scored all assessments, managed the data and transcribed qualitative interviews. Transcripts were analyzed by MI, JF and NT. MI wrote the first draft of the paper with JF. All authors reviewed manuscripts, contributed to further drafts and approved the final paper. Acknowledgements We would like to thank Jun Tamura for the statistical advice given during the writing of the paper. Additionally, we would like to thank Minori Ito for assisting with recruitment and trial implementation and Arimatsu and Miyakawa from Tomoiku Co., Ltd., for providing technical support with the Metaverse platform. References Lu W. 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Immersive VR Assessment and Intervention Research of Individuals with Neurodevelopmental Disorders Is Dominated by ASD and ADHD: a Scoping Review. Review Journal of Autism and Developmental Disorders. 2023. Gibson K. What Young People Want from Mental Health Services. London: Routledge; 2021. Hetrick SE, Bailey AP, Smith KE, Malla A, Mathias S, Singh SP, et al. Integrated (one-stop shop) youth health care: best available evidence and future directions. Medical Journal of Australia. 2017;207:S5–18. Radez J, Reardon T, Creswell C, Lawrence PJ, Evdoka-Burton G, Waite P. Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European Child and Adolescent Psychiatry. 2021;30:183–211. Navas-Medrano S, Soler-Dominguez JL, Pons P. Mixed Reality for a collective and adaptive mental health metaverse. Front Psychiatry. 2023;14. Additional Declarations No competing interests reported. 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Reports indicate that one in five young people experiences anxiety, and one in four faces depression due to factors such as poverty and shifts in lifestyle patterns [1, 2]. This prevalence doubled before and after the COVID-19 pandemic [3]. With more than 25% of mental disorders beginning before the age of twenty-five years [4] and the significant socioeconomic impact of these conditions[5], the need for effective mental healthcare for young people is clear. Despite this, many young people struggle to access timely and high-quality mental health services (MHSs). Several factors contribute to this gap between the demand and supply of MHS for young people, including physical barriers such as the shortage and geographic distribution of child and adolescent psychiatrists, as well as psychological barriers such as stigma and low mental health literacy [6]. Although various initiatives, such as school-based psychoeducation, peer training, and outreach programs, have been launched to address these barriers and improve access to mental health services, a breakthrough solution remains elusive[7\u0026ndash;9], underscoring the need for further research.\u003c/p\u003e\n\u003cp\u003eAs an innovative solution, information and communication technology (ICT) plays a pivotal role in the lives of young people, providing a critical platform for socialization and information gathering. Its widespread accessibility and integration into daily life position ICT as a promising tool for youth-friendly MHS, offering opportunities for prevention, early intervention, and accessible support tailored to the unique needs of this demographic [10]. One particularly innovative approach is Metaverse\u0026mdash;a virtual space where users, represented by avatars, can navigate, engage in various experiences, and interact with others. The Metaverse platform is not simply a virtual or augmented reality (VR/AR) platform; it enables immersive social activities that go beyond physical limitations. Key components include interactions via avatars in VR/AR spaces, economic activities through nonfungible tokens (NFTs), and decentralized, user-driven communities via decentralized autonomous organizations (DAOs).\u003c/p\u003e\n\u003cp\u003eFor youth, the Metaverse presents the potential to create accessible, engaging, and flexible platforms. In Japan, for example, emerging initiatives in some cities use virtual reality-based support services for individuals with social withdrawal (Hikikomori)[11], exploring ways to reduce stigma and facilitate access to support. The Metaverse could extend these efforts internationally by offering an alternative environment where young people with mental health issues can seek help discreetly and interactively.\u003c/p\u003e\n\u003cp\u003eHowever, studies on the feasibility and effectiveness of metaverse-based MHS remain limited. This study aims to assess the feasibility of metaverse psychiatric consultations tailored for young people with mental health conditions. The findings will guide the development and implementation of future youth MHS, addressing key barriers to access and engagement.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy Design\u003c/h2\u003e\n\u003cp\u003eThis was an observational study involving semistructured interviews. After experiencing a metaverse consultation with a psychiatrist, the participants were individually interviewed. This qualitative design was used to assess participants\u0026rsquo; opinions on the usability and feasibility of the metaverse consultation.\u003c/p\u003e\n\u003ch2\u003eParticipants and Setting\u003c/h2\u003e\n\u003cp\u003eThe target group for this study consisted of young people aged 16 to 25 years who self-identified as experiencing mental health conditions. The participants were recruited from Yokohama University Hospital, nearby clinics, local universities, high schools, support groups, and social media. The study was conducted in a meeting room on the Yokohama University campus.\u003c/p\u003e\n\u003ch3\u003e1..1. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Inclusion criteria\u003c/h3\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Individuals aged 16-25 at the time of consent.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Individuals who are aware of their mental health conditions.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 3. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Individuals able to provide written consent in Japanese.\u003c/p\u003e\n\u003ch3\u003e1..2. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Exclusion criteria\u003c/h3\u003e\n\u003cp\u003eIndividuals currently receiving treatment at a psychiatric medical institution who do not have permission from their primary physician to participate in this study.\u003c/p\u003e\n\u003ch2\u003eProcedures\u003c/h2\u003e\n\u003ch3\u003e1..1. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Baseline assessment\u003c/h3\u003e\n\u003cp\u003eAs a baseline assessment, the participants completed a self-administered questionnaire consisting of four parts: (1) mental and physical conditions, (2) living conditions over the past three months, (3) internet usage, and (4) perceptions of mental health and psychiatry.\u003c/p\u003e\n\u003ch3\u003e1..2. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Metaverse environment setup and technical support\u003c/h3\u003e\n\u003cp\u003eAfter the baseline assessment, the participants entered the metaverse environment under the guidance of technical staff, wearing VR goggles and using a controller. Since the participants were unfamiliar with Metaverse operations, the technical staff provided detailed instructions for fitting the goggles, launching the application, and logging in.\u003c/p\u003e\n\u003cp\u003eFor this study, experimental worlds and avatars were set up on commercially available Metaverse applications, VRChat\u0026reg; and Workrooms\u0026reg;. VRChat\u0026reg; is a social virtual reality platform that allows users to create, share, and explore user-generated virtual worlds through customizable avatars, fostering social interaction and creative expression in immersive settings. In contrast, Workrooms\u0026reg; is a virtual collaboration tool designed for professional and educational use, enabling users to hold virtual meetings in shared spaces with avatars and facilitating interactive discussions, presentations, and collaborative tasks. These applications provided structured and flexible virtual spaces suitable for the purposes of this study.\u003c/p\u003e\n\u003cp\u003eThe virtual environments included three distinct spaces: an outer space environment, a hospital examination room, and a meeting room with selectable views of a beach or mountains. The avatars included both human and nonhuman fictional characters, providing participants with diverse ways of interacting and expressing themselves. \u003cstrong\u003eFigure 1\u003c/strong\u003e illustrates one of the settings and avatars used in the study.\u003c/p\u003e\n\u003ch3\u003e1..3.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Metaverse Psychiatric Consultation\u003c/h3\u003e\n\u003cp\u003eThe metaverse consultations were conducted one-on-one in private virtual rooms with a psychiatrist, who also wore VR goggles and appeared as avatars from remote locations. The psychiatrists included both male and female professionals with an average of 19 years of clinical experience.\u003c/p\u003e\n\u003cp\u003eEach consultation lasted 30-40 minutes and followed a semistructured framework resembling a standard initial psychiatric consultation. The key components of the consultations were as follows:\u003c/p\u003e\n\u003ch4\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Introduction and establishing rapport (5\u0026ndash;10 minutes):\u003c/h4\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The psychiatrist greeted the participant using their avatar and introduced themselves, explaining the goals and structure of the session.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;A brief discussion was conducted to help the participants feel comfortable in the virtual environment.\u003c/p\u003e\n\u003ch4\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Review of medical and life history (10\u0026ndash;15 minutes):\u003c/h4\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The psychiatrist inquired about the participant\u0026rsquo;s medical history, including any previous mental health diagnoses or treatments.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Life history was reviewed to understand the participants\u0026rsquo; background, relationships, daily routines, and environmental stressors.\u003c/p\u003e\n\u003ch4\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;3.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Symptom Observation and Assessment (10\u0026ndash;15 minutes):\u003c/h4\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The participants were guided to share their current mental health concerns, such as anxiety, mood fluctuations, or sleep disturbances.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The psychiatrist observed verbal and nonverbal cues through avatar interactions to evaluate the participants\u0026rsquo; emotional state and engagement.\u003c/p\u003e\n\u003ch4\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;4.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Providing guidance and recommendations (5\u0026ndash;10 minutes):\u003c/h4\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Tailored advice was provided to address the participants\u0026rsquo; specific concerns.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Recommendations included coping strategies, lifestyle adjustments, and referrals to additional mental health resources when needed.\u003c/p\u003e\n\u003ch4\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;5.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Closing and feedback (5 minutes):\u003c/h4\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The session concludes with a summary of the discussion and an opportunity for the participant to ask questions or provide feedback on the experience.\u003c/p\u003e\n\u003cp\u003eThe consultations were designed to balance structure and flexibility, providing participants with a supportive environment to explore their mental health concerns in a novel, virtual setting. During the session, the participants navigated the three distinct spaces within Metaverse alongside the psychiatrist and interacted via various types of avatars. Technical staff were available to assist as needed, ensuring a seamless and accessible experience.\u003c/p\u003e\n\u003ch3\u003e1..4.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Postconsultation interviews and feedback\u003c/h3\u003e\n\u003cp\u003eAfter the metaverse consultation, the participants were individually interviewed to gather insights into their experiences and acceptance of the metaverse consultation. The interviews also aimed to identify challenges associated with using the Metaverse for mental health support. Specifically, the interview topics included the following:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The usability of metaverse devices.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Physical or psychological discomfort and adverse effects experienced.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Acceptance of metaverse consultations compared with face-to-face consultations.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Opinions on the types of individuals and situations where metaverse consultations might be useful.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Key requirements and concerns regarding metaverse consultations.\u003c/p\u003e\n\u003cp\u003eFollowing the interviews, the psychiatrists who conducted the metaverse consultations, along with the research team\u0026mdash;including psychiatric social workers and a nurse\u0026mdash;discussed the usability, expectations, and concerns related to metaverse consultations. Specifically, they provided feedback on the following:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The functionality and user experience of the Metaverse platform.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The technical environment.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Differences between metaverse consultations and face-to-face consultations.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The compatibility of the metaverse with the characteristics and conditions of participants.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Any other observations or insights noted during the study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData analysis\u003c/h2\u003e\n\u003cp\u003eThe interview data were analysed via thematic analysis following established qualitative research methodologies. First, all the interviews were transcribed verbatim to ensure accuracy. The transcripts were then reviewed multiple times to facilitate familiarity with the data and identify potential patterns.\u003c/p\u003e\n\u003cp\u003eInitial coding was conducted by systematically highlighting recurring phrases, concepts, and key statements. These codes were grouped into broader categories that represented emerging themes. To enhance rigor, the themes were independently reviewed and refined by multiple researchers to ensure consistency and reduce bias.\u003c/p\u003e\n\u003cp\u003eThe analysis focused on three primary domains:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Usability of the Metaverse Platform: Exploring participants\u0026rsquo; experiences with the technical aspects, including VR device operation, comfort, and adaptability.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Acceptance of Metaverse Consultations: Assessing participants\u0026rsquo; preferences, perceptions, and satisfaction with metaverse consultations compared with face-to-face interactions.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; 3. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Conditions or Characteristics Beneficial for Metaverse Consultations: Identifying specific participant profiles or conditions, such as social anxiety or sensory sensitivities, where metaverse consultations may offer unique advantages.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBaseline characteristics\u003c/p\u003e\n\u003cp\u003eA total of 26 young people were assigned from a pool of 33 volunteers. One individual was excluded for not meeting the inclusion criteria, five lost contacts before providing informed consent, and one could not participate because of his condition on the day.\u003cstrong\u003e\u0026nbsp;Table 1\u0026nbsp;\u003c/strong\u003esummarizes the baseline characteristics, while\u003cstrong\u003e\u0026nbsp;Table 2\u0026nbsp;\u003c/strong\u003epresents the results of the baseline assessments of the participants. The mental and physical conditions of the participants varied, with many expressing difficulties in social interactions, feelings of isolation, and discomfort in seeking support from others. Most participants reported frequent internet use, although their levels of social engagement and self-care practices differed. All the participants owned internet-enabled devices, and most used the internet daily. However, some participants acknowledged neglecting essential tasks due to internet use, whereas others reported difficulties in limiting their internet usage. The participants\u0026rsquo; initial impressions of the Metaverse also varied. While only a minority had extensive knowledge or prior experience with the Metaverse, many expressed curiosity. Their views on associating with individuals who had a history of psychiatric treatment ranged widely, with some expressing comfort and acceptance, whereas others showed apprehension or stigma toward mental health issues.\u003c/p\u003e\n\u003cp\u003eTable 1 Baseline characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003eCharacteristic\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 371px;\"\u003eDescription\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003eAge\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 371px;\"\u003eMean 19.9 years (range 16\u0026ndash;25 years)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003eGender\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 371px;\"\u003eMale: 15, Female: 7,\u0026nbsp;\u003cins cite=\"mailto:Editor\" datetime=\"2024-12-20T11:50\"\u003eNon\u003c/ins\u003ebinary: 3, No response: 1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003eRecruitment Sources\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 371px;\"\u003eYokohama City University Health Management Center, medical students and junior residents, outpatient of University Hospital and neighborhood clinics, participants from other survey of our research team, Neighborhood Private High School, Facebook\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003eHistory of Psychiatric Treatment\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 371px;\"\u003eYes: 22, No: 4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 2 Baseline assessment\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eAspect of Assessment\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003e\u003cstrong\u003eSummary of Findings\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 589px;\"\u003e\u003cstrong\u003e1. \u0026nbsp; \u0026nbsp;Physical and psychological condition\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003ePerceived Health Issues\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eMost participants (80%) indicated concerns about their physical or mental health, with common issues including insomnia, social anxiety, general anxiety, depression, learning disabilities, difficulty speaking with others, and lack of motivation.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eComfort Being in Social Situations\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eNearly two-thirds (68%) reported discomfort being in front of others, and 64% felt uncomfortable talking with strangers, indicating significant social anxiety.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eHelp-Seeking Behavior\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eApproximately 65% reported that they seek advice when facing problems, primarily consulting family, friends, teachers, or medical staff.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eSense of Social Connection\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eMixed responses: 50% reported sometimes feeling a lack of social connections, while others felt relatively neutral or disagreed with feelings of isolation.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eFeelings of Exclusion and Isolation\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eMost participants (77%) felt neither excluded nor isolated, suggesting a generally stable sense of belonging, despite some individual cases of feeling isolated or left out.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 589px;\"\u003e2. \u003cstrong\u003eLiving condition of past 3 months\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eFrequency of Going Out \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eMost participants went out frequently, with 73% going out at least once a week, while 27% went out less frequently.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eConversations with Family Members \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eThe majority (88%) reported daily conversations with family, indicating strong familial interaction.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eConversations with Non-Family Members\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eOver half (77%) had conversations with nonfamily members at least weekly, suggesting moderate social interaction outside the family.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eAbility to Maintain a Regular Routine \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eOnly 27% of participants maintained a regular routine daily or several times per week, with the remainder struggling to do so consistently.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eSufficient Sleep \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eApproximately half (50%) reported receiving sufficient sleep almost daily or several times per week, while others reported inconsistent sleep.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eFrequency of Bathing or Showering \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eNearly all participants (92%) bathed or showered daily, indicating consistent personal hygiene practices.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eConcentration on Work or Studies \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eOnly 27% could concentrate on work or studies consistently (daily or multiple times per week), with others facing challenges in concentration.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eEngagement in Non-Work/Study Activities \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eMost participants (61%) engaged in hobbies, sports, or social activities at least once a week, while others were less active.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 589px;\"\u003e\u003cstrong\u003e3. \u0026nbsp; \u0026nbsp;Internet Usage\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eAccess to internet-Enabled Devices \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eAll participants (100%) owned internet-enabled devices, such as computers, smartphones, or gaming consoles.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eFreq uency of internet Use \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eNearly all participants reported daily internet use, indicating high internet engagement.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eNeglect of Responsibilities Due to internet Use \u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eA majority (73%) sometimes or always neglected responsibilities due to internet use, with only one participant reporting no impact.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eMaking New Connections Online\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eAround half (46%) reported occasionally or frequently making new connections online, while 27% never made new connections through the internet.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eDifficulty Reducing internet Use \u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eNearly half (46%) indicated difficulty reducing internet use, with the remainder having little to no issues in managing their usage.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eFamiliarity with the Metaverse \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eKnowledge about the Metaverse varied, with 46% reporting some familiarity, while the rest indicated limited or no knowledge.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eExperience with the Metaverse \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eOnly a small portion (23%) had direct experience with the Metaverse, indicating it was relatively new to most participants.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 589px;\"\u003e4. \u003cstrong\u003eAttitudes Toward Mental Health and Psychiatry\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eFriendship with Individuals who Have Seen a Psychiatrist\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eMost participants (88%) expressed openness, agreeing that they could become close friends with someone who has sought psychiatric care.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eTrust in Individuals with a History of Psychiatric Hospitalization\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eA majority (73%) believed that individuals with past psychiatric hospitalization are just as trustworthy as others.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003ePerception of Psychiatric Treatment as a Personal Failing\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eMost participants (85%) disagreed with the notion that seeking psychiatric help is a sign of personal failure.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eReluctance to Hire Individuals with Psychiatric History\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eOver half (65%) felt that many people would be reluctant to hire someone with a history of psychiatric treatment, reflecting a perceived societal stigma.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\u003cstrong\u003eWillingness to Date Someone with a History of Psychiatric Treatment\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 400px;\"\u003eAround half (54%) were neutral or positive about dating someone with a psychiatric history, while 27% expressed reluctance.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eInterviews\u003c/p\u003e\n\u003cp\u003e1..1. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Usability of the Metaverse Device\u003c/p\u003e\n\u003cp\u003eThe participants\u0026rsquo; responses regarding the usability of the Metaverse device fell into three categories:\u003c/p\u003e\n\u003cp\u003ePositive Opinions (12 responses, 46%)\u003c/p\u003e\n\u003cp\u003eSome participants noted that they \u003cem\u003e\u0026ldquo;quickly got used to the controls\u0026rdquo;\u0026nbsp;\u003c/em\u003eand found the device \u003cem\u003e\u0026ldquo;easy to use due to regular use of gaming devices.\u0026rdquo;\u0026nbsp;\u003c/em\u003eOptimism for future accessibility was evident in comments such as\u003cem\u003e\u0026nbsp;\u0026ldquo;I would like to use it when it becomes easier and more affordable.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNeutral Opinions (6 responses, 23%)\u003c/p\u003e\n\u003cp\u003eSeveral participants were neutral about the device, stating that while they adapted to its operations, they would require assistance for more complex tasks. One participant commented, \u003cem\u003e\u0026ldquo;I feel comfortable for short sessions, but longer sessions might be tough with these devices\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNegative Opinions (8 responses, 31%)\u003c/p\u003e\n\u003cp\u003eSome participants raised concerns about the device\u0026rsquo;s physical fit and comfort. Nine participants experienced issues such as the goggles feeling \u003cem\u003e\u0026ldquo;too tight,\u0026rdquo; \u0026ldquo;too loose and slipping,\u0026rdquo;\u003c/em\u003e or challenging to fit over glasses. Five participants reported mild physical discomfort, including VR sickness or head heaviness, although no psychological discomfort was noted. A participant remarked, \u003cem\u003e\u0026ldquo;It might be difficult to connect and operate remotely without staff assistance,\u0026rdquo;\u0026nbsp;\u003c/em\u003ehighlighting barriers to independent use.\u003c/p\u003e\n\u003cp\u003e1..2. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Acceptance of the Metaverse Consultation\u003c/p\u003e\n\u003cp\u003eResponses regarding the acceptance of metaverse consultations revealed a range of perspectives:\u003c/p\u003e\n\u003cp\u003ePositive opinions (10 responses, 38%)\u003c/p\u003e\n\u003cp\u003eThe participants who preferred metaverse consultations over face-to-face sessions cited benefits such as reduced psychological pressure and convenience. The comments included \u003cem\u003e\u0026ldquo;It\u0026rsquo;s a big help not having to leave home when I\u0026rsquo;m feeling too unwell to go out\u0026rdquo;\u0026nbsp;\u003c/em\u003eand \u003cem\u003e\u0026ldquo;Meeting a new doctor is less nerve-wracking through an avatar.\u0026rdquo;\u003c/em\u003e Another participant noted, \u003cem\u003e\u0026ldquo;I don\u0026rsquo;t have to endure the intimidating atmosphere of psychiatric institutions or the doctor\u0026rsquo;s imposing presence.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNeutral Opinions (10 responses, 38%)\u003c/p\u003e\n\u003cp\u003eNeutral responses indicated that participants found the content and quality of metaverse consultations comparable to those of face-to-face consultations. Many noted that their preference would depend on their condition at the time. For example, one participant remarked, \u003cem\u003e\u0026ldquo;I prefer face-to-face if I can go out, but there are times I\u0026rsquo;d rather use the Metaverse.\u0026rdquo;\u0026nbsp;\u003c/em\u003eOthers suggested that \u003cem\u003e\u0026ldquo;The Metaverse would be preferable if issues such as cost, ease of access, and privacy were addressed.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNegative Opinions (6 responses, 24%)\u003c/p\u003e\n\u003cp\u003eThe participants who preferred face-to-face consultations emphasized the reassurance of observing expressions and body language. One participant shared, \u003cem\u003e\u0026ldquo;If I can\u0026rsquo;t see their face, I worry whether they\u0026rsquo;re truly understanding or accurately interpreting what I want to convey.\u0026rdquo;\u0026nbsp;\u003c/em\u003eAnother participant added, \u003cem\u003e\u0026ldquo;For personal and serious discussions, I want to see the person face-to-face.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe participants also shared insights into specific scenarios where metaverse consultations might be beneficial. One participant stated, \u003cem\u003e\u0026ldquo;It\u0026rsquo;s ideal for people like me who are self-conscious about being seen. I can focus more on the consultation and express what I truly want to say.\u0026rdquo;\u003c/em\u003e Another remarked, \u003cem\u003e\u0026ldquo;It\u0026rsquo;s helpful for those who find it challenging to visit psychiatric clinics.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e1..3. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Keywords and Concerns for Metaverse Consultations\u003c/p\u003e\n\u003cp\u003eThe participants highlighted several key requirements and concerns regarding metaverse consultations:\u003c/p\u003e\n\u003cp\u003eSecurity and privacy concerns\u003c/p\u003e\n\u003cp\u003eThe importance of a secure and private consultation environment was frequently mentioned. The participants requested assurances that psychiatrists understood them accurately. One participant commented, \u003cem\u003e\u0026ldquo;I don\u0026rsquo;t want to show my face, but if the avatar\u0026rsquo;s facial expressions and body movements are synchronized with reality, it feels more reassuring than a phone call.\u0026rdquo;\u003c/em\u003e Concerns about information security for private consultations were also raised.\u003c/p\u003e\n\u003cp\u003ePreferences for Avatars and Room Settings\u003c/p\u003e\n\u003cp\u003eThe participants frequently emphasized the importance of customizable settings, using terms such as \u003cem\u003e\u0026ldquo;relaxing,\u0026rdquo; \u0026ldquo;free from distractions,\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;self-selectable.\u0026rdquo;\u003c/em\u003e Twelve participants expressed a preference for avatars that felt authentic to them, with one stating, \u003cem\u003e\u0026ldquo;choosing my avatar is a way of expressing myself, and it makes me feel more comfortable in the consultation.\u0026rdquo;\u0026nbsp;\u003c/em\u003ePreferences for human avatars (6 participants) and nonhuman characters (6 participants) were evenly split.\u003c/p\u003e\n\u003cp\u003e1..4. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Psychiatric team\u0026rsquo;s perspective\u003c/p\u003e\n\u003cp\u003eThe psychiatric team provided valuable insights into the potential benefits and challenges of metaverse consultations:\u003c/p\u003e\n\u003cp\u003ePositive Opinion\u003c/p\u003e\n\u003cp\u003eTeam members noted that individuals with sensory hypersensitivity, such as those associated with ASD traits, appeared to focus more effectively in the immersive VR environment. They also reported that individuals with significant social anxiety or tension seemed to relax more quickly, enabling broader and deeper conversations.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConcerns and suggestions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe team expressed concerns about the limitations of metaverse consultations for participants with pronounced symptoms, as these limitations may hinder accurate diagnoses. Suggestions included simplifying metaverse operations for easier access and expanding the range of avatars and room settings to allow for more personalized consultations. They also recommended developing diagnostic support tools to enhance the consultation experience.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we investigated the feasibility of metaverse psychiatric consultations for young people with mental health conditions. This is the first observational trial to evaluate the feasibility of metaverse consultations in psychiatry. A total of 26 young people participated and completed the study. Despite the mild physical discomfort reported by some participants, such as VR sickness and head heaviness, no significant adverse psychological events occurred, ensuring the study\u0026rsquo;s successful completion. Postexperience interviews provided valuable insights into both the advantages and challenges of metaverse consultations, offering a roadmap for the future development and implementation of these services.\u003c/p\u003e\n\u003ch2\u003eHigh affinity for metaverse psychiatric consultations\u003c/h2\u003e\n\u003cp\u003eThis study identified specific groups with a strong affinity for metaverse-based psychiatric consultations. Five distinct groups are highlighted:\u003c/p\u003e\n\u003ch3\u003e1..1. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Individuals with Interpersonal Anxiety\u003c/h3\u003e\n\u003cp\u003eThe participants who struggled with accessing medical facilities or engaging in face-to-face conversations due to anxiety expressed that avatar-based communication significantly reduced their psychological burden. The ability to interact from a safe and familiar environment helped participants focus better on the consultation.\u003c/p\u003e\n\u003ch3\u003e1..2. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Individuals with sensory sensitivities (e.g., ASD)\u003c/h3\u003e\n\u003cp\u003eThe immersive experience provided by VR goggles allowed some participants with sensory sensitivities to block overwhelming external stimuli, enabling better concentration during consultations. One participant remarked, \u003cem\u003e\u0026ldquo;After experiencing the metaverse consultation, I felt I truly understood what a consultation was meant to be for the first time.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHowever, this benefit must be interpreted cautiously. Previous studies have noted VR-related discomfort among individuals with ASD, including VR sickness, sensitivity to brightness, and challenges adapting to immersive environments\u0026nbsp;[12]. This highlights the need for further investigations to tailor VR interventions appropriately for sensory-sensitive populations.\u003c/p\u003e\n\u003ch3\u003e1..3. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Individuals Struggling to Leave Their Homes Due to Psychiatric Conditions\u003c/h3\u003e\n\u003cp\u003eConditions such as depression, agoraphobia, or Hikikomori make in-person consultations inaccessible for some individuals. The Metaverse offers a safe and private platform, allowing participants to connect with mental health professionals without leaving their homes. Avatars also serve as a psychological bridge, facilitating more comfortable communication.\u003c/p\u003e\n\u003ch3\u003e1..4. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Individuals Facing Stigma or Resistance to Psychiatric Care\u003c/h3\u003e\n\u003cp\u003eStigma around mental health often discourages help-seeking behaviors. The participants noted that avatar-based consultations reduced the fear of judgment and made accessing services more approachable. For many, this initial step provided a reassuring and nonthreatening introduction to mental health care, potentially easing its transition into traditional services.\u003c/p\u003e\n\u003ch3\u003e1..5. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Individuals Uncomfortable with Disclosing Their Physical Appearance\u003c/h3\u003e\n\u003cp\u003eThe participants with gender incongruence, negative body image, or other appearance-related discomforts expressed that avatars provided a sense of safety and self-expression. They felt more comfortable engaging in consultations through avatars than in real-life settings.\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Challenges in Implementing Metaverse Consultations\u003c/h2\u003e\n\u003cp\u003eWhile the Metaverse presents significant opportunities for MHSs, several challenges must be addressed to enable its effective implementation:\u003c/p\u003e\n\u003ch3\u003e1..1. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Accessibility Issues\u003c/h3\u003e\n\u003cp\u003eThe current process of accessing and using Metaverse platforms remains complex. Technical staff were required to assist participants with the VR goggle setup, navigation, and operation. Improving accessibility and ease of use, including simplifying VR operations, will be essential for making these services universally available. Reliable internet access and more affordable VR equipment are also necessary for broader adoption.\u003c/p\u003e\n\u003ch3\u003e1..2. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Physical Discomfort\u003c/h3\u003e\n\u003cp\u003ePhysical challenges such as VR sickness, head heaviness, and discomfort while wearing goggles were common barriers to engagement. Although the immersive experience was seen as a significant advantage, this discomfort must be mitigated to maximize the benefits of metaverse consultations.\u003c/p\u003e\n\u003ch3\u003e1..3. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Potential for \u0026ldquo;Light Metaverse\u0026rdquo; Options\u003c/h3\u003e\n\u003cp\u003eMetaverse platforms can often be classified based on the devices, technologies, and functionalities they utilize. In this study, we distinguish between Light Metaverse and Heavy Metaverse as two broad categories. The Light Metaverse refers to experiences that do not require advanced equipment, such as VR goggles; instead, they are accessible via smartphones or PC browsers, offering a more simplified and accessible form of interaction. In contrast, the Heavy Metaverse involves immersive experiences that utilize advanced technologies such as VR goggles and related equipment, providing a fully immersive and engaging digital environment.\u003c/p\u003e\n\u003cp\u003eExpanding beyond VR-based platforms to include Light Metaverse options could significantly increase accessibility for a broader population, particularly for individuals who may lack access to VR technology or experience physical discomfort or other limitations while using it. Light Metaverse options hold the potential to enhance inclusivity and convenience, reduce technological and financial barriers, and still facilitate meaningful virtual interactions.\u003c/p\u003e\n\u003cp\u003eTo better understand the efficacy and inclusivity of these options, comparative studies evaluating VR-based (Heavy Metaverse) and non-VR-based (Light Metaverse) approaches are essential. Such studies can provide valuable insights into the most effective and user-friendly strategies for delivering mental health services through the Metaverse, tailored to the diverse needs of different populations.\u003c/p\u003e\n\u003ch3\u003e1..4. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Ethical considerations\u003c/h3\u003e\n\u003cp\u003eThe ethical challenges of metaverse consultations remain unresolved. In this study, eligibility confirmation and consent were obtained in person, but future implementations will require robust mechanisms for ensuring informed consent, safeguarding privacy, and maintaining secure interactions entirely within virtual platforms. These measures are critical for building trust and maintaining the integrity of therapeutic environments.\u003c/p\u003e\n\u003ch2\u003eEncouraging Autonomy in Mental Health Services\u003c/h2\u003e\n\u003cp\u003eA key insight from this study is the importance of autonomy in MHSs for young people. The concept of \u003cem\u003e\u0026ldquo;choice\u0026rdquo;\u003c/em\u003e emerged consistently in participant responses, highlighting their desire for flexibility and personalization. The choice of avatars enabled participants to express their identities, creating a more comfortable and engaging consultation experience.\u003c/p\u003e\n\u003cp\u003eThe participants emphasized the value of having both metaverse-based and in-person options available. This aligns with prior research indicating that traditional, paternalistic models often discourage help-seeking behaviors among young people by limiting autonomy [13, 14]. In contrast, youth-friendly services that prioritize choice and personalization have been shown to foster greater engagement and trust [15].\u003c/p\u003e\n\u003cp\u003eThe Metaverse has significant potential to support these preferences. By integrating flexibility, personalization, and nonjudgmental environments, metaverse-based services can bridge the gap between accessibility and engagement, creating a supportive platform where young people feel empowered to seek help.\u003c/p\u003e\n\u003ch2\u003eStrengths\u003c/h2\u003e\n\u003cp\u003eThis study has several strengths:\u003c/p\u003e\n\u003ch3\u003e1..1. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Innovative Contribution\u003c/h3\u003e\n\u003cp\u003eThis is the first observational trial to explore the feasibility of metaverse consultations in psychiatry, offering a pioneering investigation into a novel approach for mental health support.\u003c/p\u003e\n\u003ch3\u003e1..2. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Potential to expand access:\u003c/h3\u003e\n\u003cp\u003eThe identification of specific groups with a high affinity for metaverse consultations provides a roadmap for addressing barriers to traditional mental health support, particularly for underserved populations.\u003c/p\u003e\n\u003ch2\u003eLimitations\u003c/h2\u003e\n\u003cp\u003eDespite its strengths, this study has several limitations:\u003c/p\u003e\n\u003ch3\u003e1..1. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Small and Limited Samples:\u003c/h3\u003e\n\u003cp\u003eThe sample size was small, and participants were recruited from areas near the university, limiting generalizability. Future studies should include a broader range of participants, particularly those who may benefit most from the Metaverse, such as individuals with severe physical or mental limitations.\u003c/p\u003e\n\u003ch3\u003e1..2. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Narrow Scope of Metaverse Functionality:\u003c/h3\u003e\n\u003cp\u003eThe study focused solely on avatar-based communication via VR, without exploring broader metaverse features. Prior studies suggest that one of the key elements of the metaverse, decentralized autonomous organizations (DAOs), has the potential to foster inclusive and collaborative environments for mental health support by enabling user-governed networks, promoting shared decision-making, and facilitating collective healing\u0026nbsp;[16]. Future research should incorporate these elements to fully evaluate the potential of the metaverse.\u003c/p\u003e\n\u003ch3\u003e1..3. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Excluded Populations:\u003c/h3\u003e\n\u003cp\u003eCertain groups, such as individuals with speech difficulties or nonnative speakers, were not included in this study. Future research should consider these populations to enhance the inclusivity of metaverse-based MHS.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis qualitative observational study suggests that metaverse-based psychiatric consultations are feasible for young people with mental health conditions. While challenges persist, further research is necessary to evaluate the utility of this service across a broader target population and a wider range of applications, thereby supporting the development of a truly impactful and effective mental health intervention.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eASD: Autism Spectrum Disorder; DAO: Decentralized Autonomous Organization; ICT: Information and Communication Technology; MHS: Mental Health Service; NFT: Non-Fungible Token; PC: Personal Computer; VR: Virtual Reality; AR: Augmented Reality\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was approved by Institutional Review Board (IRB) of Yokohama City University, Japan (Approval No.: F230400055). Written informed consent was obtained from all participants. For participants younger than 18 years of age, written informed consent was obtained from their legal guardians.\u003c/p\u003e\n\u003cp\u003eThe trial was conducted in compliance with the Declaration of Helsinki and the Ethical Guidelines for Life Science and Medical Research Involving Human Subjects.\u003c/p\u003e\n\u003cp\u003eSince this study was conducted as an observational study, clinical trial registration was not applicable.\u003c/p\u003e\n\u003cp\u003eThis manuscript also includes images of staff members demonstrating the Metaverse consultation sessions. All individuals appearing in the images provided written informed consent for the publication of their images and copies of the signed consent forms have been submitted with the manuscript.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eMI, NT, KI, TM, MT, TA and TM have no competing interests.\u003c/p\u003e\n\u003cp\u003eJF serves as the Executive Director of the Seisa Yokohama Education Counselling Center.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis work was supported by Japan Science and Technology Agency Grant No. JPMJPF2203. The funders had no role in the study design, data collection, analysis, interpretation, or decision to submit the manuscript for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eThe study was designed by MI, JF, NT, KI and TM. Participants were recruited by MI, JF, KI, TA,TM, and MT. MI and JF administered the assessments, interventions and interviews with support from TM and MI. NT, TM and MT scored all assessments, managed the data and transcribed qualitative interviews. Transcripts were analyzed by MI, JF and NT. MI wrote the first draft of the paper with JF. All authors reviewed manuscripts, contributed to further drafts and approved the final paper.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe would like to thank Jun Tamura for the statistical advice given during the writing of the paper. Additionally, we would like to thank Minori Ito for assisting with recruitment and trial implementation and Arimatsu and Miyakawa from Tomoiku Co., Ltd., for providing technical support with the Metaverse platform.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLu W. Adolescent Depression: National Trends, Risk Factors, and Healthcare Disparities. Am J Health Behav. 2019;43:181\u0026ndash;94.\u003c/li\u003e\n\u003cli\u003eKowalchuk A, Gonzalez SJ, Zoorob RJ. Anxiety Disorders in Children and Adolescents. Am Fam Physician. 2022;106:657\u0026ndash;64.\u003c/li\u003e\n\u003cli\u003eRacine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19. JAMA Pediatr. 2021;175:1142.\u003c/li\u003e\n\u003cli\u003eKessler RC, Angermeyer M, Anthony JC, De Graaf R, Demyttenaere K, Gasquet I, et al. Ministry of Health, Jerusalem, Israel; 14; 22 Institute for Social Research. 2007.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Mental health of adolescents. 2024. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health. Accessed 18 Nov 2024.\u003c/li\u003e\n\u003cli\u003eMcgorry PD, Mei C, Chanen A, Hodges C, Alvarez-Jimenez M, Killackey E. Designing and scaling up integrated youth mental health care. 2022.\u003c/li\u003e\n\u003cli\u003eAguirre Velasco A, Cruz ISS, Billings J, Jimenez M, Rowe S. What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry. 2020;20.\u003c/li\u003e\n\u003cli\u003eMa KKY, Anderson JK, Burn AM. Review: School-based interventions to improve mental health literacy and reduce mental health stigma \u0026ndash; a systematic review. Child and Adolescent Mental Health. 2023;28:230\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eSeedaket S, Turnbull N, Phajan T, Wanchai A. Improving mental health literacy in adolescents: systematic review of supporting intervention studies. Tropical Medicine and International Health. 2020;25:1055\u0026ndash;64.\u003c/li\u003e\n\u003cli\u003eHollis C. Youth mental health: risks and opportunities in the digital world. World Psychiatry. 2022;21:81\u0026ndash;2.\u003c/li\u003e\n\u003cli\u003eKyushu University. The World\u0026rsquo;s First Hikikomori Research Lab @ Kyushu University. https://www.hikikomori-lab.com/en. Accessed 18 Nov 2024.\u003c/li\u003e\n\u003cli\u003eSatu P, Minna L, Satu S. Immersive VR Assessment and Intervention Research of Individuals with Neurodevelopmental Disorders Is Dominated by ASD and ADHD: a Scoping Review. Review Journal of Autism and Developmental Disorders. 2023.\u003c/li\u003e\n\u003cli\u003eGibson K. What Young People Want from Mental Health Services. London: Routledge; 2021.\u003c/li\u003e\n\u003cli\u003eHetrick SE, Bailey AP, Smith KE, Malla A, Mathias S, Singh SP, et al. Integrated (one-stop shop) youth health care: best available evidence and future directions. Medical Journal of Australia. 2017;207:S5\u0026ndash;18.\u003c/li\u003e\n\u003cli\u003eRadez J, Reardon T, Creswell C, Lawrence PJ, Evdoka-Burton G, Waite P. Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European Child and Adolescent Psychiatry. 2021;30:183\u0026ndash;211.\u003c/li\u003e\n\u003cli\u003eNavas-Medrano S, Soler-Dominguez JL, Pons P. Mixed Reality for a collective and adaptive mental health metaverse. Front Psychiatry. 2023;14. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Metaverse, avatar communication, youth mental health","lastPublishedDoi":"10.21203/rs.3.rs-5685619/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5685619/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe unmet needs of young people for mental health services (MHSs) remain a significant issue. Despite the high demand, many young people are unable to access timely and high-quality MHS. The Metaverse, a virtual space where people interact and communicate through avatars, is expected to introduce new possibilities for MHS. This study aims to investigate the feasibility of using the Metaverse for mental health consultations with young people experiencing mental health conditions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis qualitative observational study was conducted at a single institution via semistructured interviews. Participants aged 16\u0026ndash;24 years who were aware of mental health conditions were assigned to experience a metaverse consultation with a psychiatrist through avatars. Afterward, participants were interviewed to assess the feasibility, usability, and influencing factors of metaverse-based consultation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTwenty-six participants were assigned, and all completed the study without any adverse psychological events. Some reported minor physical effects, such as headaches and VR-related sickness. The findings from the postinterview suggest that metaverse consultations may be particularly beneficial for individuals experiencing interpersonal anxiety, those with high sensory sensitivity due to autism spectrum disorder, those who struggle outside due to psychiatric conditions such as depression or agoraphobia, those with strong psychological resistance to receiving psychiatric care, and those who feel uncomfortable disclosing their own physical appearance in real-life settings (e.g., gender incongruence).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eMetaverse psychiatric consultation is feasible for young people with mental health conditions, particularly for individuals with specific needs. Technical and accessibility issues must be addressed to enhance its effectiveness.\u003c/p\u003e","manuscriptTitle":"Feasibility of Psychiatric Consultation by Metaverse for Youths with Mental Health Conditions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-02 11:27:10","doi":"10.21203/rs.3.rs-5685619/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b96e931e-c09e-4e95-80ae-c89f1f1d2468","owner":[],"postedDate":"January 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-13T08:40:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-02 11:27:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5685619","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5685619","identity":"rs-5685619","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}