Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study

Abstract

Background During COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level. Objective This study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress). Methods A 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively. Results The intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P<.001; Wilks Λ=.71; partial η2=.29) showing small to moderate effect sizes on individual outcomes. The largest effect sizes were observed for life satisfaction and overall well-being (η2=.22 and η2=.2, respectively). Larger effect sizes were noted for those with problematic mental health scores at baseline. A total of 92% (82/89) of participants demonstrated reliable change in at least one mental health outcome. Differential response patterns using RCI revealed that more than one-half of the participants showed improvement in both mental well-being and psychological distress, over one-quarter in outcomes of well-being only, and almost one-fifth in distress only. Conclusions The results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness.

A Group-Facilitated, Internet-Based Intervention to Promote Mental Health and Well-Being in a Vulnerable Population of University Students: Randomized Controlled Trial of the Be Well Plan Program

“…The study clearly demonstrated the anticipated significant improvements in mental well-being and resilience, confirming preliminary positive effects identified in a previous uncontrolled intervention study [ 36 ]. We found medium effect sizes for mental well-being, which is above the average typically reported in the literature [ 29 , 79 ].…”

“…Given the tailored nature of the Be Well Plan that considers participants’ characteristics, needs, and preferences, there is the potential that the intervention also improves outcomes beyond mental health and well-being, such as self-efficacy, a sense of control, and cognitive flexibility. Although preliminary evidence for the Be Well Plan program’s impact has been established [ 36 ], there is a clear need now to establish its efficacy using a more robust methodological design.…”

Using the Intervention Mapping Approach to Develop a Mental Health Intervention: A Case Study on Improving the Reporting Standards for Developing Psychological Interventions

“…Two studies have, at time of writing this manuscript, been completed, with further studies underway. The first completed study was an uncontrolled intervention study aimed at determining the initial impact of the intervention, finding significant improvements in outcomes of wellbeing, resilience, and psychological distress, most notably for those with more problematic mental health scores at baseline (van Agteren et al, 2021a). Preliminary findings of a randomised controlled study are replicating the positive findings of the first study, with a manuscript currently being prepared.…”

“…These two steps are outside the scope of this article, as the aim here is to describe the development and design process. The actual evaluation of the programme on outcomes will be covered in subsequent publications, including a pre-post pilot study in university students and general community members (n = 89;van Agteren et al, 2021a) and a randomised controlled study in university students. A brief description of the evaluation approach is provided in the discussion of this manuscript.…”

“…While not all these influences are within the control of behavioural or psychological interventions, or feasible in light of the focus for our intervention, the team determined that two aspects were. Firstly, stimulating positive change related to our physical health will be beneficial to our mental health, as both are intrinsically linked, which is demonstrated by a considerable body of scientific evidence on the importance of health promotive factors such as physical activity, nutrition and sleep, all of which can be positively addressed using behavioural interventions (Valois et al, 2004;Penedo and Dahn, 2005;Chu and Richdale, 2009;Deslandes et al, 2009;Oddy et al, 2009;Rethorst et al, 2009;Nanri et al, 2010;Gradisar et al, 2011;Rienks et al, 2013;Bernert et al, 2014;Dalton and Logomarsino, 2014;Jacka et al, 2015). Inclusion of, at minimum, rudimentary techniques that could be used to stimulate positive health behaviours was deemed necessary for our intervention.…”