Department of Psychology, Harvard University.
Koko.
J Consult Clin Psychol. 2019 Apr;87(4):370-379. doi: 10.1037/ccp0000389.
Mental illness is a leading cause of disease burden; however, many barriers prevent people from seeking mental health services. Technological innovations may improve our ability to reach underserved populations by overcoming many existing barriers. We evaluated a brief, automated risk assessment and intervention platform designed to increase the use of crisis resources provided to those online and in crisis.
Participants, users of the digital mental health app Koko, were randomly assigned to treatment or control conditions upon accessing the app and were included in the study after their posts were identified by machine learning classifiers as signaling a current mental health crisis. Participants in the treatment condition received a brief Barrier Reduction Intervention (BRI) designed to increase the use of crisis service referrals provided on the app. Participants were followed up several hours later to assess the use of crisis services.
Only about one quarter of participants in a crisis (21.8%) reported being "very likely" to use clinical referrals provided to them, with the most commonly endorsed barriers being they "just want to chat" or their "thoughts are too intense." Among participants providing follow-up data (41.3%), receipt of the BRI was associated with a 23% increase in the use of crisis services.
These findings suggest that a brief, automated BRI can be efficacious on digital platforms, even among individuals experiencing acute psychological distress. The potential to increase help seeking and service utilization with such procedures holds promise for those in need of psychiatric services.
clinicaltrials.gov identifier: NCT03633825. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
精神疾病是导致疾病负担的主要原因之一；然而，许多障碍阻止人们寻求心理健康服务。技术创新可以通过克服许多现有的障碍来提高我们为服务不足的人群提供服务的能力。我们评估了一个简短的自动化风险评估和干预平台，旨在增加向在线和处于危机中的人提供的危机资源的使用。
参与者是数字心理健康应用程序 Koko 的用户，他们在访问应用程序时被随机分配到治疗或对照组，并在通过机器学习分类器确定他们的帖子表示当前心理健康危机后被纳入研究。治疗组的参与者接受了一个简短的减少障碍干预（BRI），旨在增加对应用程序上提供的危机服务推荐的使用。几个小时后，对参与者进行了随访，以评估危机服务的使用情况。
只有大约四分之一的处于危机中的参与者（21.8%）表示“非常有可能”使用提供给他们的临床推荐，最常被认可的障碍是他们“只是想聊天”或他们的“想法太强烈”。在提供后续数据的参与者中（41.3%），接受 BRI 与危机服务使用增加 23%相关。
这些发现表明，即使在经历急性心理困扰的个体中，简短的自动化 BRI 在数字平台上也可能有效。这种程序增加寻求帮助和服务利用的潜力为那些需要精神病服务的人带来了希望。
clinicaltrials.gov 标识符：NCT03633825。（PsycINFO 数据库记录（c）2019 APA，保留所有权利）。
