A Web-Based Mental Health Platform for Individuals Seeking Specialized Mental Health Care Services: Multicenter Pragmatic Randomized Controlled Trial.

Jennifer M Hensel,Laura Desveaux,Rebecca Yang,Simone N Vigod,Zachary Bouck,Ivy Wong,Megan Nguyen,Payal Agarwal,Ashley Cohen,Trevor Jamieson,Geetha Mukerji,Noah M Ivers,James Shaw,Lianne Jeffs,Nike Onabajo,R Sacha Bhatia

doi:10.2196/10838

Abstract

BackgroundWeb-based self-directed mental health applications are rapidly emerging to address health service gaps and unmet needs for information and support.ObjectiveThe aim of this study was to determine if a multicomponent, moderated Web-based mental health application could benefit individuals with mental health symptoms severe enough to warrant specialized mental health care.MethodsA multicenter, pragmatic randomized controlled trial was conducted across several outpatient mental health programs affiliated with 3 hospital programs in Ontario, Canada. Individuals referred to or receiving treatment, aged 16 years or older, with access to the internet and an email address, and having the ability to navigate a Web-based mental health application were eligible. A total of 812 participants were randomized 2:1 to receive immediate (immediate treatment group, ITG) or delayed (delayed treatment group, DTG) access for 3 months to the Big White Wall (BWW), a multicomponent Web-based mental health intervention based in the United Kingdom and New Zealand. The primary outcome was the total score on the Recovery Assessment Scale, revised (RAS-r) which measures mental health recovery. Secondary outcomes were total scores on the Patient Health Questionnaire-9 item (PHQ-9), the Generalized Anxiety Disorder Questionnaire-7 item (GAD-7), the EuroQOL 5-dimension quality of life questionnaire (EQ-5D-5L), and the Community Integration Questionnaire. An exploratory analysis examined the association between actual BWW use (categorized into quartiles) and outcomes among study completers.ResultsIntervention participants achieved small, statistically significant increases in adjusted RAS-r score (4.97 points, 95% CI 2.90 to 7.05), and decreases in PHQ-9 score (−1.83 points, 95% CI −2.85 to −0.82) and GAD-7 score (−1.55 points, 95% CI −2.42 to −0.70). Follow-up was achieved for 55% (446/812) at 3 months, 48% (260/542) of ITG participants and 69% (186/270) of DTG participants. Only 58% (312/542) of ITG participants logged on more than once. Some higher BWW user groups had significantly greater improvements in PHQ-9 and GAD-7 relative to the lowest use group.ConclusionsThe Web-based application may be beneficial; however, many participants did not engage in an ongoing way. This has implications for patient selection and engagement as well as delivery and funding structures for similar Web-based interventions.Trial RegistrationClinicalTrials.gov NCT02896894; https://clinicaltrials.gov/ct2/show/NCT02896894 (Archived by WebCite at http://www.webcitation.org/78LIpnuRO)

Highlights

Mental illness is prevalent, with estimates suggesting that upward of 1 billion people worldwide could be affected at a given point in time [1]
We investigated the effectiveness of 3 months of access to the Big White Wall (BWW) for mental health recovery, as well as symptoms of depression and anxiety, quality of life, and integration with one’s community, relative to a usual care control group who received delayed access to the intervention after the study period
The randomized groups were well-balanced in terms of sociodemographic, mental health variables, and previous 3-month health care utilization (Table 1)

Summary

Introduction

With estimates suggesting that upward of 1 billion people worldwide could be affected at a given point in time [1]. Mental and substance use disorders are emerging as a leading cause of disability, accounting for nearly 10% of global disability-adjusted life years [1]. Access to and use of appropriate and timely mental health services and specialists, continues to be a challenge because of limited resources and individual-level factors surrounding treatment seeking [2,3,4]. E-mental health applications can potentially help to address some of these gaps [5]. Engagement with self-directed, Web-based interventions has been cited as a challenge owing to a range of user and intervention design factors, with multicomponent interventions potentially enhancing engagement through more user choice, added interactivity, and customization [9,10]. Web-based self-directed mental health applications are rapidly emerging to address health service gaps and unmet needs for information and support

Methods

Results

Discussion

Conclusion