Open Access

Internet- and mobile technologies are increasingly used to deliver mental health care. E-Mental Health is promising for the prevention and treatment of mental disorders, in particular due to its wide population access, a low threshold, the active role of the client, lower costs compared to traditional care, and the possibility to integrate interventions in real-world settings. However, while E-Mental Health was shown to be an effective treatment tool, fewer studies investigated the prevention of mental health problems with E-Mental Health approaches. In a series of three studies, this dissertation examines internet- and mobile-based approaches for the early monitoring and supporting of mental health. First, a pilot study investigates the use of smartphone data as collected by daily self-reports and sensor information for the self-monitoring of bipolar disorder symptoms. It was found that some, but not all smartphone measurements predicted clinical symptoms of mania and depression, indicating that smartphones could be used as an earlywarning system for patients with bipolar disorder. Second, a randomized controlled trial evaluates the effectiveness of an internet-based intervention among persons with depression and sickness absence. The intervention was found to be effective in reducing depressive symptoms compared to a control group, suggesting that the internet can provide effective support for people with sickness absence due to depression. Third, a study protocol proposes to combine self-monitoring with a mobile intervention to support mental health in daily life. Supportive self-monitoring will be evaluated in a fully mobile randomized controlled trial among a sample of smartphone users with psychological distress. If supportive self-monitoring on the basis of a smartphone application is effective, it could be widely distributed to monitor and support mental health on a population level. Finally, the contribution of the presented studies to current research topics in E-Mental Health is discussed.

Despite the great progress that has been made in the prophylaxis of oral diseases over the past decades, dental caries and periodontal diseases remain major challenges in the field of dentistry. Biofilm formation on dental hard tissues is strongly associated with the etiology of these oral diseases. Therefore, the process of bioadhesion and biofilm formation on tooth surfaces is of particular interest for dental research. The first stage of bioadhesion on dental surfaces is the formation of the pellicle layer. This mainly acellular film, composed largely of adsorbed proteins, glycoproteins, and lipids, is distinguished from the microbial biofilm (plaque). As the interface between teeth and the oral environment, the pellicle plays a key role in the maintenance of oral health and is of great physiological and pathophysiological importance. On the one hand, the pellicle shows protective properties for the underlying dental hard tissues. On the other hand, it also serves as the basis for dental plaque and therefore, for the development of oral diseases such as caries and periodontitis. Hydrophobic interactions, which are governed by lipophilic substances, are of high relevance for bacterial adherence. Therefore, pellicle lipids, which are a significant constituent of this biological structure, are an interesting target for dental research, as they could modulate oral surfaces, influence microbial interactions, and potentially impede bacterial adherence. Compared to the extensive work on the pellicle´s ultrastructure and protein/amino acid composition, little attention has been given to its lipid profile. Knowledge of the lipid composition of the pellicle may provide insight into several oral pathological states, including caries, dental erosion, and periodontal disease processes and could contribute to novel approaches in preventive dentistry. The principle aim of this thesis was the comprehensive characterization of the fatty acid (FA) profile of the in situ formed pellicle layer. This includes the influence of pellicle maturation on the FA profile as well as intra- and interindividual differences. Furthermore, investigations on the effect of rinses with edible oils on the pellicle´s FA composition were a focus of this work. For these purposes, an analytical method based on a combination of innovative specimen generation and convenient sample preparation with sensitive mass spectrometric analysis was successfully developed and comprehensively validated within this thesis. Pellicle samples were formed in situ on bovine enamel slabs mounted on individual upper jaw splints. After a comprehensive sample preparation, gas chromatography coupled with electron impact ionization mass spectrometry (GC-EI/MS) was used in order to characterize qualitatively and quantitatively a wide range of FA (C12-C24). The individual FA profiles of pellicle and saliva samples collected from ten research participants were investigated. The relative FA profiles of the pellicle samples gained from the different subjects were very similar, whereas the amount of FAs showed significant interindividual variability. Compared to the pellicle´s characteristic FA profile, higher proportions of unsaturated FAs were detected in the saliva samples, highlighting that FAs available in saliva are not adsorbed equivalently to the pellicle layer. This, in turn, shows that pellicle formation is a highly selective process that does not correlate directly with salivary composition. Additionally, pellicle samples collected after 3, 30, 60, 120, and 240 min of intraoral exposure were analyzed. It could be shown that pellicle maturation has only a minor impact on the FA composition. However, the FA content increased substantially with increasing oral exposure time. Modifying the pellicle´s lipid composition by using edible oils as a mouthwash could alter the physicochemical characteristics of the pellicle and strengthen its protective properties by delaying bacterial adhesion. Therefore, the impact of rinses with safflower oil on the pellicle´s FA composition was determined. The application of rinses with safflower oil resulted in an accumulation of its specific FAs in the pellicle, thus representing a possibility for modifying the pellicle´s lipid profile. The present work is the first to apply a validated method that combines in situ pellicle formation, sample preparation, and the comprehensive determination of FAs via a sensitive analytical method. The results provide valuable information regarding the pellicle´s FA composition which closes an existing knowledge gap in pellicle research. A broader knowledge of the lipid composition of the pellicle contributes to the understanding of oral bioadhesion processes and may help facilitate novel approaches in preventive dentistry.