Abstract

BackgroundTraditional in-person psychotherapies are incapable of addressing global mental health needs. Use of computer-based interventions is one promising solution for closing the gap between the amount of global mental health treatment needed and received.ObjectiveAlthough many meta-analyses have provided evidence supporting the efficacy of self-guided, computer-based interventions, most report low rates of treatment engagement (eg, high attrition and low adherence). The aim of this study is to investigate the efficacy of an adjunctive treatment component that uses task shifting, wherein mental health care is provided by nonspecialist peer counselors to enhance engagement in an internet-based, self-directed, evidence-based mindfulness intervention among Chinese university students.MethodsFrom 3 universities across China, 54 students who reported at least mild stress, anxiety, or depression were randomly assigned to a 4-week internet-based mindfulness intervention (MIND) or to the intervention plus peer counselor support (MIND+), respectively. Be Mindful delivers all the elements of mindfulness-based cognitive therapy in an internet-based, 4-week course. Participants completed daily monitoring of mindfulness practice and mood, as well as baseline and posttreatment self-reported levels of depression, anxiety, stress, and trait mindfulness. We screened 56 volunteer peer counselor candidates who had no former training in the delivery of mental health services. Of these, 10 were invited to participate in a day-long training, and 4 were selected. Peer counselors were instructed to provide 6 brief (15-20 minute) sessions each week, to help encouraging participants to complete the internet-based intervention. Peer counselors received weekly web-based group supervision.ResultsFor both conditions, participation in the internet-based intervention was associated with significant improvements in mindfulness and mental health outcomes. The pre-post effect sizes (Cohen d) for mindfulness, depression, anxiety, and stress were 0.55, 0.95, 0.89, and 1.13, respectively. Participants assigned to the MIND+ (vs MIND) condition demonstrated significantly less attrition and more adherence, as indicated by a greater likelihood of completing posttreatment assessments (16/27, 59% vs 7/27, 26%; χ21=6.1; P=.01) and a higher percentage of course completion (72.6/100, 72.6% vs 50.7/100, 50.7%; t52=2.10; P=.04), respectively. No significant between-group differences in daily frequency and duration of mindfulness practice were observed. Multilevel logistic growth models showed that MIND+ participants reported significantly greater pre-post improvements in daily stress ratings (interaction estimate 0.39, SE 0.18; t317=2.29; P=.02) and depression (interaction estimate 0.38, SE 0.16; t330=2.37; P=.02) than those in the MIND condition.ConclusionsThis study provides new insights into effective ways of leveraging technology and task shifting to implement large-scale mental health initiatives that are financially feasible, easily transportable, and quickly scalable in low-resource settings. The findings suggest that volunteer peer counselors receiving low-cost, low-intensity training and supervision may significantly improve participants’ indices of treatment engagement and mental health outcomes in an internet-based mindfulness intervention among Chinese university students.

Highlights

  • BackgroundApproximately 1 in 5 adults in the United States experiences mental illness annually [1], with young adults reporting the highest prevalence

  • Peer counselors received weekly web-based group supervision. For both conditions, participation in the internet-based intervention was associated with significant improvements in mindfulness and mental health outcomes

  • There is a large gap between treatment needed and treatment received for mental disorders, and the mental health treatment gap is larger in low- and middle-income countries (LMICs) than in higher-income countries [5]

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Summary

Introduction

BackgroundApproximately 1 in 5 adults in the United States experiences mental illness annually [1], with young adults (aged 18-25 years) reporting the highest prevalence. In China, more than 1 in 4 university students reported being depressed; 4 out of 10 people worldwide suffer from a psychiatric illness at some point in their lives, nearly half of the world’s population lives in a country with less than 1 psychiatrist per 100,000 people [6,7]. The reasons for these treatment gaps are multifaceted and include factors such as stigma, perceived helpfulness of treatments, and convenience. Use of computer-based interventions is one promising solution for closing the gap between the amount of global mental health treatment needed and received

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