Suicidal Ideation and Risk Reduction Associated with Participation in a Therapist-Supported Digital Mental Health Intervention

Abstract Background Suicide is a significant public health concern with increasing prevalence. Novel interventions that reduce stigma and increase accessibility, such as therapist-supported digital mental health interventions, are urgently needed. Methods This preregistered retrospective cohort, single-arm, and intent-to-treat study with 778 patients examined suicidal ideation (SI) trajectories using multilevel models during and up to 6-months after an 12-week therapist-supported digital mental health intervention (Meru Health Program [MHP]) as assessed by the ninth item of the Patient Health Questionnaire-9 (PHQ-9). Estimates of associated suicide attempts and deaths by suicide were calculated using published data linking PHQ-9-assessed SI to records of suicide attempts and deaths by suicide. Results MHP participants reporting SI “not at all” significantly increased between baseline and end-of-treatment (78.02–91.00%). Effect sizes of SI changes between baseline and end-of-treatment, 3-month, and 6-month follow-ups were 0.33 (95%CI=0.27-0.38), 0.32 (95%CI=0.27-0.38), and 0.32 (95%CI=0.27-0.438), respectively. Results also indicated an estimated 30.49% reduction (95%CI=25.15%-35.13%) in suicide attempts and death by suicide across treatment. Conclusion This real-world study provides preliminary evidence that participants of the MHP show significant reductions in SI and estimated suicide attempts and deaths by suicide across treatment that are maintained 6-months following treatment. The next steps are to conduct a randomized control trial to confirm these results.

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Suicidal Ideation and Risk Reduction Associated with Participation in an Evidence-Based mHealth Intervention

10.31234/osf.io/9xvcp ◽

2021 ◽

Author(s):

Benjamin W Nelson ◽

Silvan Hornstein ◽

Vilma Viiala ◽

Erin Gillung ◽

Nicholas Peiper ◽

...

Keyword(s):

Suicidal Ideation ◽

Multilevel Models ◽

Suicide Attempts ◽

Health Concern ◽

Published Data ◽

Evidence Based ◽

Mhealth Intervention ◽

End Of Treatment ◽

Patient Health ◽

Significant Public Health

Introduction: Suicide is a significant public health concern with increasing prevalence. Novel interventions that reduce stigma and increase accessibility, such as mobile health (mHealth) interventions, are urgently needed. Methods: This retrospective cohort intent-to-treat study examined suicidal ideation (SI) trajectories using multilevel models during and up to 6-months after an evidence-based 12-week mHealth intervention (Meru Health Program [MHP]) as assessed by the ninth item of the Patient Health Questionnaire-9 (PHQ-9). Estimates of associated suicide attempts and deaths by suicide were calculated using published data linking PHQ-9-assessed SI to records of suicide attempts and deaths by suicide. Results: MHP participants reporting SI “not at all” significantly increased between baseline and end-of-treatment (78.02% to 91.00%). Effect sizes of SI changes between baseline and end-of-treatment, 3-month, and 6-month follow-ups were 0.33 (95%CI=0.27-0.38), 0.32 (95%CI=0.27-0.38), and 0.32 (95%CI=0.27-0.438), respectively. Results also indicated an estimated 30.49% reduction (95%CI=25.15%-35.13%) in suicide attempts and death by suicide across treatment.Conclusion: This real-world study indicates that participants of the MHP show significant reductions in SI and estimated suicide attempts and deaths by suicide across treatment that are maintained 6-months following treatment.

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Evaluation of ReachOut.com, an Unstructured Digital Youth Mental Health Intervention: Prospective Cohort Study

JMIR Mental Health ◽

10.2196/21280 ◽

2020 ◽

Vol 7 (10) ◽

pp. e21280

Author(s):

Bianca Lorraine Kahl ◽

Hilary May Miller ◽

Kathryn Cairns ◽

Hayley Giniunas ◽

Mariesa Nicholas

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Young People ◽

Health Services ◽

Retention Rate ◽

Well Being ◽

Evidence Base ◽

Preliminary Evidence ◽

Health Intervention ◽

Mental Health Intervention

Background Young people experience a disproportionate burden associated with mental illness that Australia’s mental health care system is ill-equipped to handle. Despite improvements in the provision of mental health services, the rates of service utilization among young people remain suboptimal, and there are still considerable barriers to seeking help. Digital mental health services can overcome a number of barriers and connect young people requiring support; however, the evidence base of digital interventions is limited. Objective The aim of this study is to examine the effectiveness of a brief, self-directed, unstructured digital intervention, ReachOut.com (hereafter ReachOut), in reducing depression, anxiety, stress, and risk of suicide. Methods A cohort of 1982 ReachOut users participated in a 12-week longitudinal study, with a retention rate of 81.18% (1609/1982) across the duration of the study. Participants completed web-based surveys, with outcome measures of mental health status and suicide risk assessed at 3 time points across the study period. Results The results demonstrated that over the 12-week study period, young people using ReachOut experienced modest yet significant reductions in symptoms of depression, anxiety, and stress. Significant, albeit modest, reductions in the proportion of participants at high risk of suicide were also observed. Conclusions The findings of this research provide preliminary evidence of the promise of an unstructured digital mental health intervention, ReachOut, in alleviating symptoms of mental ill-health and promoting well-being in young people. These findings are particularly important given that digital services are not only acceptable and accessible but also have the potential to cater to the diverse mental health needs of young people at scale, in a way that other services cannot.

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The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group

JMIR Mental Health ◽

10.2196/26617 ◽

2021 ◽

Vol 8 (2) ◽

pp. e26617

Author(s):

Eliane M Boucher ◽

Emily C McNaughton ◽

Nicole Harake ◽

Julia L Stafford ◽

Acacia C Parks

Keyword(s):

Mental Health ◽

Focus Group ◽

Mental Health Problems ◽

Health Problems ◽

Health Intervention ◽

Health Concern ◽

Mental Health Intervention ◽

Social Distancing ◽

Self Perceptions ◽

The Impact

Background Loneliness is a growing area of concern, attracting attention as a public health concern due to its association with a variety of psychological and physical health problems. However, interventions targeting loneliness are less common than interventions for other mental health problems, such as depression and anxiety, and existing interventions focus primarily on building social skills and increasing opportunities for social interaction despite research suggesting these techniques are not the most effective. Furthermore, although there is an increasing need for scalable and convenient interventions, digital interventions for loneliness are even less common. Objective Using a qualitative approach, we explore how adults (18-64 years of age) who express wanting to be more connected to others experience loneliness and react to a digital mental health intervention targeting loneliness. Methods A total of 11 participants were recruited from a pilot randomized controlled trial exploring the impact of a digital mental health intervention, Happify Health, on loneliness among adults aged 18-64 years who indicated wanting to feel more connected to others when signing up for the platform. Participants were invited to participate in a 3-day asynchronous focus group about their experiences with loneliness, with Happify Health, and with social distancing during the COVID-19 pandemic. All 11 participants completed the focus group in May 2020. Results Participants’ responses were coded using thematic analysis, which led to identifying five themes, each with separate subthemes, that could be applied across the 3-day focus group: loneliness, relationships, social distancing, skill acquisition, and coping. Overall, we observed variability across participants in terms of the source of their loneliness, their perceptions of their social connections, and their motivation to reduce feelings of loneliness; however, participants commonly referred to negative self-perceptions as a cause or consequence of loneliness. Participants also varied in the extent to which they felt social distancing increased or decreased feelings of loneliness. In regard to the intervention, participants showed evidence of adopting skills they used to address their loneliness, particularly mindfulness and gratitude, and then using these skills to shift toward more active coping strategies following the intervention, including during the COVID-19 pandemic. Conclusions The heterogeneity in participants’ experiences with loneliness described during this focus group emphasizes the subjective and complex nature of loneliness. This highlights the importance of developing loneliness interventions that use a variety of strategies, including both direct and indirect strategies for reducing loneliness. However, based on our data, a key component to loneliness interventions is incorporating strategies for addressing underlying negative self-perceptions that stem from, but also contribute to, loneliness. This data also provides preliminary evidence that digital platforms may be an effective tool for disseminating loneliness interventions while providing the added benefit of offering a productive distraction when feeling lonely.

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The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group (Preprint)

10.2196/preprints.26617 ◽

2020 ◽

Author(s):

Eliane M Boucher ◽

Emily C McNaughton ◽

Nicole Harake ◽

Julia L Stafford ◽

Acacia C Parks

Keyword(s):

Mental Health ◽

Focus Group ◽

Mental Health Problems ◽

Health Problems ◽

Health Intervention ◽

Health Concern ◽

Mental Health Intervention ◽

Social Distancing ◽

Self Perceptions ◽

The Impact

BACKGROUND Loneliness is a growing area of concern, attracting attention as a public health concern due to its association with a variety of psychological and physical health problems. However, interventions targeting loneliness are less common than interventions for other mental health problems, such as depression and anxiety, and existing interventions focus primarily on building social skills and increasing opportunities for social interaction despite research suggesting these techniques are not the most effective. Furthermore, although there is an increasing need for scalable and convenient interventions, digital interventions for loneliness are even less common. OBJECTIVE Using a qualitative approach, we explore how adults (18-64 years of age) who express wanting to be more connected to others experience loneliness and react to a digital mental health intervention targeting loneliness. METHODS A total of 11 participants were recruited from a pilot randomized controlled trial exploring the impact of a digital mental health intervention, Happify Health, on loneliness among adults aged 18-64 years who indicated wanting to feel more connected to others when signing up for the platform. Participants were invited to participate in a 3-day asynchronous focus group about their experiences with loneliness, with Happify Health, and with social distancing during the COVID-19 pandemic. All 11 participants completed the focus group in May 2020. RESULTS Participants’ responses were coded using thematic analysis, which led to identifying five themes, each with separate subthemes, that could be applied across the 3-day focus group: loneliness, relationships, social distancing, skill acquisition, and coping. Overall, we observed variability across participants in terms of the source of their loneliness, their perceptions of their social connections, and their motivation to reduce feelings of loneliness; however, participants commonly referred to negative self-perceptions as a cause or consequence of loneliness. Participants also varied in the extent to which they felt social distancing increased or decreased feelings of loneliness. In regard to the intervention, participants showed evidence of adopting skills they used to address their loneliness, particularly mindfulness and gratitude, and then using these skills to shift toward more active coping strategies following the intervention, including during the COVID-19 pandemic. CONCLUSIONS The heterogeneity in participants’ experiences with loneliness described during this focus group emphasizes the subjective and complex nature of loneliness. This highlights the importance of developing loneliness interventions that use a variety of strategies, including both direct and indirect strategies for reducing loneliness. However, based on our data, a key component to loneliness interventions is incorporating strategies for addressing underlying negative self-perceptions that stem from, but also contribute to, loneliness. This data also provides preliminary evidence that digital platforms may be an effective tool for disseminating loneliness interventions while providing the added benefit of offering a productive distraction when feeling lonely.

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Evaluation of ReachOut.com, an Unstructured Digital Youth Mental Health Intervention: Prospective Cohort Study (Preprint)

10.2196/preprints.21280 ◽

2020 ◽

Author(s):

Bianca Lorraine Kahl ◽

Hilary May Miller ◽

Kathryn Cairns ◽

Hayley Giniunas ◽

Mariesa Nicholas

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Young People ◽

Health Services ◽

Retention Rate ◽

Well Being ◽

Evidence Base ◽

Preliminary Evidence ◽

Health Intervention ◽

Mental Health Intervention

BACKGROUND Young people experience a disproportionate burden associated with mental illness that Australia’s mental health care system is ill-equipped to handle. Despite improvements in the provision of mental health services, the rates of service utilization among young people remain suboptimal, and there are still considerable barriers to seeking help. Digital mental health services can overcome a number of barriers and connect young people requiring support; however, the evidence base of digital interventions is limited. OBJECTIVE The aim of this study is to examine the effectiveness of a brief, self-directed, unstructured digital intervention, ReachOut.com (hereafter ReachOut), in reducing depression, anxiety, stress, and risk of suicide. METHODS A cohort of 1982 ReachOut users participated in a 12-week longitudinal study, with a retention rate of 81.18% (1609/1982) across the duration of the study. Participants completed web-based surveys, with outcome measures of mental health status and suicide risk assessed at 3 time points across the study period. RESULTS The results demonstrated that over the 12-week study period, young people using ReachOut experienced modest yet significant reductions in symptoms of depression, anxiety, and stress. Significant, albeit modest, reductions in the proportion of participants at high risk of suicide were also observed. CONCLUSIONS The findings of this research provide preliminary evidence of the promise of an unstructured digital mental health intervention, ReachOut, in alleviating symptoms of mental ill-health and promoting well-being in young people. These findings are particularly important given that digital services are not only acceptable and accessible but also have the potential to cater to the diverse mental health needs of young people at scale, in a way that other services cannot.

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