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

Abstract

In March 2020, Alberta Health Services launched Text4Hope, a free mental health text-message service. The service aimed to alleviate pandemic-associated stress, generalized anxiety disorder (GAD), major depressive disorder (MDD), and suicidal propensity. The effectiveness of Text4Hope was evaluated by comparing psychiatric parameters between two subscriber groups. Methods: A comparative cross-sectional study with two arms: Text4Hope subscribers who received daily texts for six weeks, the intervention group (IG); and new Text4Hope subscribers who were yet to receive messages, the control group (CG). Logistic regression models were used in the analysis. Results: Participants in the IG had lower prevalence rates for moderate/high stress (78.8% vs. 88.0%), likely GAD (31.4% vs. 46.5%), and likely MDD (36.8% vs. 52.1%), respectively, compared to respondents in the CG. After controlling for demographic variables, the IG remained less likely to self-report symptoms of moderate/high stress (OR = 0.56; 95% CI = 0.41–0.75), likely GAD (OR = 0.55; 95% CI = 0.44–0.68), and likely MDD (OR = 0.50; 95% CI = 0.47–0.73). The mean Composite Mental Health score, the sum of mean scores on the PSS, GAD-7, and PHQ-9 was 20.9% higher in the CG. Conclusions: Text4Hope is an effective population-level intervention that helps reduce stress, anxiety, depression, and suicidal thoughts during the COVID-19 pandemic. Similar texting services should be implemented during global crises.

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

“…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 3-month 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 – 140 ). Similar results could also be found in another study carried out by Agyapong et al ( 141 ).…”

“…Agyapong et al (139,140) This study describes the changes in the stress, anxiety, and depression levels of subscribers to the Text4Hope program after 3rd month of exposure to daily supportive SMS text messages.…”

Prevalence, Demographic, and Clinical Correlates of Likely PTSD in Subscribers of Text4Hope during the COVID-19 Pandemic

“…There is increasing attention being paid to this need in the media, and our data may serve to provide evidence-based support for such policy development and implementation. Cost-effective population-level interventions, such as supportive text messaging services, which are geographic-location independent, are free to the end user, do not require expensive data plans, and can reach thousands of people simultaneously [36][37][38][39][40][41][42][43][44][45][46], are useful for addressing PTSD and other psychological symptoms, such as anxiety and depression, during the COVID-19 pandemic.…”

Prevalence and Correlates of Likely Major Depressive Disorder among the Adult Population in Ghana during the COVID-19 Pandemic

“…This may be due to misunderstandings over whether or how family members and friends should protect themselves against the virus and the differences in opinions related to the conflicting information about the COVID-19 pandemic [ 71 ]. In another study, adequacy of living space, housing stability and housing satisfaction were significantly associated with a high prevalence of depression [ 72 ]. This reaffirms that housing is a key social determinant of mental health during the COVID-19 pandemic [ 73 ].…”

“…The government of Ghana could adopt for the population mental health interventions such as Text4Hope, launched in Alberta, Canada during the start of the COVID-19 pandemic, which effectively reduced depressive symptoms and suicidal ideation in subscribers [ 41 , 74 , 75 , 76 ]. Supportive text message programs are cost-effective, geographic location independent, are free to the end user and do not require expensive data plans, can reach thousands of people simultaneously and have been used to support residents of Alberta, Canada in managing stress, anxiety and depression [ 44 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ]. A similar program could serve as a useful tool in Ghana and other low- and middle-income as well as high-income countries during the COVID-19 pandemic and also during natural disasters and other public health emergencies.…”