Design and acceptability of a psychosocial text messaging intervention for victims of gender-based violence

Involving Crowdworkers with Lived Experience in Content-Development for Push-Based Digital Mental Health Tools: Lessons Learned from Crowdsourcing Mental Health Messages

Digital tools can support individuals managing mental health concerns, but delivering sufficiently engaging content is challenging. This paper seeks to clarify how individuals with mental health concerns can contribute content to improve push-based mental health messaging tools. We recruited crowdworkers with mental health symptoms to evaluate and revise expert-composed content for an automated messaging tool, and to generate new topics and messages. A second wave of crowdworkers evaluated expert and crowdsourced content. Crowdworkers generated topics for messages that had not been prioritized by experts, including self-care, positive thinking, inspiration, relaxation, and reassurance. Peer evaluators rated messages written by experts and peers similarly. Our findings also suggest the importance of personalization, particularly when content adaptation occurs over time as users interact with example messages. These findings demonstrate the potential of crowdsourcing for generating diverse and engaging content for push-based tools, and suggest the need to support users in meaningful content customization.

Message-based psychotherapy for older adults: A cohort comparison study

OBJECTIVE

Digital Mental Health Interventions (DMHI) can diminish inequities in mental health care provision. As DMHIs increase in popularity, however, older adults may be unintentionally excluded due to barriers such as lack of awareness, internet access, digital tools, technological socialization and education, physiological accessibility, and communication technology infrastructure. The aim of this study was to examine longitudinal treatment engagement patterns and 15-week clinical outcomes of depressed and anxious older adults compared to a matched cohort of younger adults seeking treatment from a large asynchronous telemedicine provider.

METHODS

The 2,470 older adults (55+ years) and a matched cohort of younger adults (26-35 years) diagnosed with depression or anxiety were treated by licensed therapists via messaging 5 days a week. Patterns of treatment engagement on the platform were compared across groups by examining total number of days in treatment, days actively messaging on the platform, and average words and messages per week sent by patients over the entire period they remained in treatment. Symptoms were assessed every 3 weeks using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), and changes were compared across age groups over 15 weeks.

RESULTS

Older patients attended more days in treatment than younger patients, but there were no differences in number of days actively messaging on the platform, number of messages per week, or word count per week. The two age groups did not differ in their final anxiety or depressive symptoms when controlling for total number of weeks attended. Patients in the younger age group experienced a quicker rate of reduction than older adults in their anxiety, but not depressive symptoms.

CONCLUSIONS

Among individuals willing to initiate care through a DMHI, older adults had overall similar engagement as younger adults and they showed similar improvement in symptoms of depression and anxiety. Given the advantages of message-based care for aiding a mental health workforce in serving larger numbers of individuals in need and the expected growth of the aging population, these findings could help healthcare systems in evaluating a variety of treatment options and delivery media for meeting the healthcare needs of the future.

Protocol for a sequential, multiple assignment, randomised trial to test the effectiveness of message-based psychotherapy for depression compared with telepsychotherapy

INTRODUCTION

Digital mental health tools have become popular alternatives to traditional psychotherapy. One emerging form of digital mental health is message-based care, the use of text messages or asynchronous voice or video messaging to provide psychotherapy. There has been no research into whether this is an effective method of psychotherapy as a stand-alone treatment or in combination with traditional psychotherapy.

METHODS AND ANALYSIS

This is a sequential, multiple assignment randomised trial to compare message-based care, videoconference-psychotherapy and a combination of the two treatments in 1000 depressed adults. Participants will be recruited through Talkspace, a digital mental health company, and randomised to receive 6 weeks of either message-based care only or videoconference-psychotherapy only. At 6 weeks, participants will be evaluated for their response to treatment. Those with a 50% or more response to treatment will continue with their assigned condition. Those who do not respond will be randomised to either monthly videoconference-psychotherapy or weekly videoconference-psychotherapy plus message-based care. Primary outcomes will be depression and social functioning. We will also explore moderators of treatment outcome.

ETHICS AND DISSEMINATION

The study received ethics approval from the University of Washington Institutional Review Board. Results of this study will be presented in peer-reviewed journals and at professional conferences.

TRIAL REGISTRATION NUMBER

NCT04513080; Pre-results.

Effectiveness of a Psychosocial Therapy with SMS in Immigrant Women with Different Degrees of Depression

Immigrant women who are forced to adapt to a new cultural context often live in low income situations, have informal jobs, and experience social inclusion difficulties; these women frequently have mental health and social relationship problems. We conducted an experimental investigation with a group of vulnerable immigrant women who were receiving support from public social services. Our goal was to analyze the effectiveness of a bio-psychosocial therapy system with text messages to personal mobile phones. We grouped women by different degrees of depression. We studied psychosocial characteristics from personalized interviews and developed message banks to advise healthy habits and accompany moods. We programmed a remote delivery system, and for 26 days, each woman (n = 44) received four of our messages. We analyzed changes in mood and depression at the beginning and at the end of therapy and observed positive changes. The analysis of the initial and final (Personal Health Questionnaire) PHQ−9 quartile intervals shows that text messages significantly improve the mood and depression symptoms of immigrant women when the initial PHQ−9 value is greater than 5 (moderate depression).

Exploratory Study of Psychosocial Therapies with Text Messages to Mobile Phones in Groups of Vulnerable Immigrant Women

Various experimental studies on psychosocial therapy have been carried out through text messages with groups of people suffering from depression, anxiety, alcoholism, addictions, etc., but without distinguishing between men and women or highly vulnerable groups such as immigrants. We present an exploratory study of a mobile communication system which intends to improve the mental, physical and social health of a group of vulnerable immigrant women in Spain (n = 71), distinguishing between an intervention group and a non-equivalent control group. We sent automatic text messages (SMS) to the mobile phones of an intervention group formed by immigrant women who used the social services (n = 44). During a 26-day intervention period, the women received 4 daily automatic text messages on their phones, at a predetermined time. We measured mood and depression symptoms at the beginning and end of the intervention, and analysed the qualitative data to determine the acceptance level of a remote message program. The mood and depression symptoms were measured with the personal health questionnaire-9 (PHQ-9) and were significantly better in the intervention group; they evolved from an initial 9.4 (DS = 6.4, range 1-25) to a 5.0 score at the end of the message period (DS = 4.8); with a significant difference (t (44) = 2.01, p = 7.80). Most women stated that the messages had improved their mood (86.3%), which made them feel more connected to their social environment (65.9%) and that they would like to continue receiving more messages (86.6%).