Changes in Stress, Anxiety, and Depression Levels of Subscribers to a Daily Supportive Text Message Program (Text4Hope) During the COVID-19 Pandemic: Cross-Sectional Survey Study

Abstract

Background In addition to the obvious physical medical impact of COVID-19, the disease poses evident threats to people’s mental health, psychological safety, and well-being. Provision of support for these challenges is complicated by the high number of people requiring support and the need to maintain physical distancing. Text4Hope, a daily supportive SMS text messaging program, was launched in Canada to mitigate the negative mental health impacts of the pandemic among Canadians. Objective This paper describes the changes in the stress, anxiety, and depression levels of subscribers to the Text4Hope program after 6 weeks of exposure to daily supportive SMS text messages. Methods We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of Text4Hope subscribers. Perceived stress, anxiety, and depression were measured with the 10-Item Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder–7 (GAD-7) scale, and the Patient Health Questionnaire–9 (PHQ-9) scale at baseline and sixth week time points. Moderate or high perceived stress, likely generalized anxiety disorder, and likely major depressive disorder were assessed using cutoff scores of ≥14 for the PSS-10, ≥10 for the GAD-7, and ≥10 for the PHQ-9, respectively. At 6 weeks into the program, 766 participants had completed the questionnaires at both time points. Results At the 6-week time point, there were statistically significant reductions in mean scores on the PSS-10 and GAD-7 scales but not on the PHQ-9 scale. Effect sizes were small overall. There were statistically significant reductions in the prevalence rates of moderate or high stress and likely generalized anxiety disorder but not likely major depressive disorder for the group that completed both the baseline and 6-week assessments. The largest reductions in mean scores and prevalence rates were for anxiety (18.7% and 13.5%, respectively). Conclusions Text4Hope is a convenient, cost-effective, and accessible means of implementing a population-level psychological intervention. This service demonstrated significant reductions in anxiety and stress levels during the COVID-19 pandemic and could be used as a population-level mental health intervention during natural disasters and other emergencies. International Registered Report Identifier (IRRID) RR2-10.2196/19292

COVID-19 Pandemic: Demographic Predictors of Self-Isolation or Self-Quarantine and Impact of Isolation and Quarantine on Perceived Stress, Anxiety, and Depression

“…Our research contributes to a larger program of research that is deliberately responding to the ongoing call for transformation of mental health care service to meet the needs of populations during the COVID-19 pandemic. Our study also aligns with our research program advocacy for mobilizing supportive text message technology (24)(25)(26)(27)(28)(29)(30)(31)(32) to reach populations disparately affected by mental health concerns.…”

Mental Health Outreach via Supportive Text Messages during the COVID-19 Pandemic: Improved Mental Health and Reduced Suicidal Ideation after Six Weeks in Subscribers of Text4Hope Compared to a Control Population

“…This study demonstrates the effectiveness of Text4Hope over six consecutive weeks on various psychological symptomatology, including stress, GAD, MDD, and suicidal ideation or thoughts of self-harm, but not for disturbed sleep symptoms. A related study which had no control group reported there were statistically significant reductions in the prevalence rates for clinically meaningful stress and anxiety as well as statistically significant reductions in mean scores on the PSS-10 and GAD-7 scales when comparing the baseline and sixth week assessments in subscribers of Text4Hope [ 19 ]. A second longer term study which also had no control group reported there were statistically significant reductions in the prevalence rates for clinically meaningful stress, anxiety and depression as well as statistically significant reductions in mean scores on the PSS-10, GAD-7, and PHQ-9 scales when comparing the baseline and third month assessments in subscribers of Text4Hope [ 20 ].…”

“…Recruitment strategies for this study were as described in the published study protocol [ 17 ] and in related publications [ 18 , 19 , 20 ]. In brief, Text4Hope was launched through an announcement by Alberta’s Chief Medical Officer of Health on behalf of AHS and the Government of Alberta on 23 March 2020.…”

“…In brief, Text4Hope was launched through an announcement by Alberta’s Chief Medical Officer of Health on behalf of AHS and the Government of Alberta on 23 March 2020. The announcement was broadcast widely across many electronic and print media networks in Alberta to inform Albertans about the program [ 19 ]. Additionally, Albertans were made aware of the program via websites dedicated to the service, electronic media, social media feeds, posters at addiction and mental health clinics, emergency departments and wards, and through word of mouth.…”

The Role of Social Determinants in Mental Health and Resilience After Disasters: Implications for Public Health Policy and Practice

“…Children, college students, and health workers are the most exposed groups who are especially vulnerable to PTSD, anxiety, depression, and other symptoms of distress (136). In Canada, Agyapong et al (138) launched a daily supportive SMS text messaging program "Text4Hope" to test the changes in the level of stress, anxiety, and depression of subscribers after 6 weeks of exposure to the daily supportive SMS text messages during the COVID-19 pandemic. The results indicated that at the 6-week and 3month time points, there was a statistically significant fall in mean score on the 10-item Perceived Stress Scale (PSS-10), the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder-7 (GAD-7) (138)(139)(140).…”