Abstract
BackgroundInternet-based programs can help provide accessible and inexpensive behavioral health care to those in need; however, the evaluation of these interventions has been mostly limited to controlled trials. Data regarding patterns of use and effectiveness of self-referred, open-access online interventions are lacking. We evaluated an online-based treatment designed to address stress, depression, and conflict management, the Dartmouth PATH Program, in a freely available and self-guided format during the COVID-19 pandemic.ObjectiveThe primary aim is to determine users’ levels of stress and depression, and the nature of problems and triggers they reported during the COVID-19 pandemic. A secondary objective is to assess the acceptability and usability of the PATH content and determine whether such a program would be useful as a stand-alone open-access resource. The final objective is understanding the high dropout rates associated with online behavioral programs by contrasting the use pattern and program efficacy of individuals who completed session one and did not return to the program with those who came back to complete more sessions.MethodsCumulative anonymous data from 562 individuals were analyzed. Stress triggers, stress responses, and reported problems were analyzed using qualitative analysis techniques. Scores on usability and acceptability questionnaires were evaluated using the sign test and Wilcoxon signed rank test. Mixed-effects linear modeling was used to evaluate changes in stress and depression over time.ResultsA total of 2484 users registered from April through October 2020, most of whom created an account without initiating a module. A total of 562 individuals started the program and were considered in the data analysis. The most common stress triggers individuals reported involved either conflicts with family or spouses and work or workload. The most common problems addressed in the mood module were worry, anxiousness, or stress and difficulty concentrating or procrastination. The attrition rate was high with 13% (21/156) completing the conflict module, 17% (50/289) completing session one of the mood module, and 14% (16/117) completing session one of the stress module. Usability and acceptability scores for the mood and stress modules were significantly better than average. In those who returned to complete sessions, symptoms of stress showed a significant improvement over time (P=.03), and there was a significant decrease in depressive symptoms over all time points (P=.01). Depression severity decreased on average by 20% (SD 35.2%; P=.60) between sessions one and two.ConclusionsConflicts with others, worry, and difficulty concentrating were some of the most common problems people used the programs to address. Individuals who completed the modules indicated improvements in self-reported stress and depression symptoms. Users also found the modules to be effective and rated the program highly for usability and acceptability. Nevertheless, the attrition rate was very high, as has been found with other freely available online-based interventions.Trial RegistrationClinicalTrials.gov NCT02726061; https://clinicaltrials.gov/ct2/show/NCT02726061
Highlights
Community epidemiological surveys estimate that as many as 30% of adults in the United States are affected by a mental disorder, yet less than half see a physician, and only a quarter are treated properly [1,2]
Usability and acceptability scores for the mood and stress modules were significantly better than average. In those who returned to complete sessions, symptoms of stress showed a significant improvement over time (P=.03), and there was a significant decrease in depressive symptoms over all time points (P=.01)
The secondary analysis focused on the usability and acceptability differences perceived by those who completed session one and did not return to the program with those who came back to complete more sessions to evaluate potential causes for treatment dropout rates
Summary
Community epidemiological surveys estimate that as many as 30% of adults in the United States are affected by a mental disorder, yet less than half see a physician, and only a quarter are treated properly [1,2]. A number of barriers limit access to cognitive behavioral therapy (CBT) It is often not widely available, in part due to a lack of adequately trained CBT professionals [3], high cost, potential stigma, inconvenient hours, demands of attending in-person treatments, and concerns over privacy [4]. Internet-delivered CBT (ICBT) has existed for 20 years, and a number of controlled trials and meta-analytic reviews have demonstrated the effectiveness of this approach [5,6,7,8,9,10]. The evaluation of web-based programs has been mostly limited to controlled trials, rather than open-access interventions [17], restricting the interpretations of the efficacy and feasibility of these programs in an unstructured format. Internet-based programs can help provide accessible and inexpensive behavioral health care to those in need; the evaluation of these interventions has been mostly limited to controlled trials.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
