Closing the Psychological Treatment Gap During the COVID-19 Pandemic With a Supportive Text Messaging Program: Protocol for Implementation and Evaluation

Abstract

Background Coronavirus disease (COVID-19) has spread globally with far-reaching, significant, and unprecedented impacts on health and everyday life. Threats to mental health, psychological safety, and well-being are now emerging, increasing the impact of this virus on world health. Providing support for these challenges is difficult because of the high number of people requiring support in the context of a need to maintain physical distancing. This protocol describes the use of SMS text messaging (Text4Hope) as a convenient, cost-effective, and accessible population-level mental health intervention. This program is evidence-based, with prior research supporting good outcomes and high user satisfaction. Objective The project goal is to implement a program of daily supportive SMS text messaging (Text4Hope) to reduce distress related to the COVID-19 crisis, initially among Canadians. The prevalence of stress, anxiety, and depressive symptoms; the demographic correlates of the same; and the outcomes of the Text4Hope intervention in mitigating distress will be evaluated. Methods Self-administered anonymous online questionnaires will be used to assess stress (Perceived Stress Scale), anxiety (Generalized Anxiety Disorder-7 scale [GAD-7]), and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]). Data will be collected at baseline (onset of SMS text messaging), the program midpoint (6 weeks), and the program endpoint (12 weeks). Results Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, stress, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. Given the large size of the data set, machine learning and data mining methods will also be used. Conclusions This COVID-19 project will provide key information regarding prevalence rates of stress, anxiety, and depressive symptoms during the pandemic; demographic correlates of distress; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for practitioners and useful for informing policy and decision making regarding psychological interventions during the pandemic. International Registered Report Identifier (IRRID) DERR1-10.2196/19292

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

“…To this end, similar initiatives might be considered, especially in the context of technology-based, remotely accessible, and population-level interventions, within different clinical contexts, for vulnerable populations. This study along with two related published outcome studies [ 16 , 17 ] on the Text4Hope program may serve to provide evidence-based support for such policy implementation in high-, middle-, and low-income countries. The research team therefore plans to explore national scale-up and implementation of the Text4Hope program in multiple languages to benefit all Canadians.…”

“…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.…”

“…Messages were designed in the framework of cognitive behavioral therapy (CBT). Text4Hope aimed to improve psychological resilience, alleviate mental health burdens, and enable development of coping mechanisms to prevent and overcome the potential distress and anxiety that may arise in the COVID-19 pandemic [ 17 ]. Participants receive a different non-personalized pre-programmed message from a web application each day for three months.…”

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

“…This cross-sectional comparative study sought to assess the effectiveness of community implementation of a supportive SMS text message intervention program focused on reducing symptoms of stress, anxiety, and depression during the COVID-19 pandemic. The study protocol [ 28 ] was approved by the Research and Ethics Board of the University of Alberta (Pro00086163).…”

Text4Hope: Receiving Daily Supportive Text Messages for 3 Months During the COVID-19 Pandemic Reduces Stress, Anxiety, and Depression

“…5 Based on this, the study hypothesis was that the Text4Hope intervention would result in ≥25% reduction in mean scores and prevalence rates in all 3 factors: the Perceived Stress Scale-10 (PSS-10), General Anxiety Disorder Scale 7 (GAD-7), and Patient Health Questionnaire (PHQ-9) scales at 3rd month versus baseline. This study is part of a larger project, 9 with additional results forthcoming. A literature search on major scientific data bases, including; MEDLINE, Scopus, Embase, Web of Science, Google Scholar, Chemical Abstracts, and PsychINFO, suggests that, this is the first study to report 3rd-month outcomes for a supportive text message program which seeks to address stress, anxiety, and depression at the population level during a pandemic.…”