Detweiler Guarino Isadora, Cowan Devin R, Fellows Abigail M, Buckey Jay C
Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.
JMIR Form Res. 2021 May 31;5(5):e26989. doi: 10.2196/26989.
Internet-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.
The 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.
Cumulative 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.
A 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.
Conflicts 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.
ClinicalTrials.gov NCT02726061; https://clinicaltrials.gov/ct2/show/NCT02726061.
基于互联网的项目有助于为有需要的人提供可及且廉价的行为健康护理；然而，对这些干预措施的评估大多局限于对照试验。缺乏关于自我推荐的、开放获取的在线干预措施的使用模式和有效性的数据。在新冠疫情期间，我们以免费且可自主引导的形式评估了一项旨在解决压力、抑郁和冲突管理问题的在线治疗项目——达特茅斯PATH项目。
主要目的是确定用户在新冠疫情期间的压力和抑郁水平，以及他们报告的问题和触发因素的性质。次要目的是评估PATH内容的可接受性和可用性，并确定这样一个项目作为独立的开放获取资源是否有用。最终目的是通过对比完成第一阶段课程后未再返回该项目的个体与返回完成更多课程的个体的使用模式和项目效果，了解与在线行为项目相关的高退出率。
对来自562名个体的累积匿名数据进行分析。使用定性分析技术分析压力触发因素、压力反应和报告的问题。使用符号检验和Wilcoxon符号秩检验评估可用性和可接受性问卷的得分。使用混合效应线性模型评估压力和抑郁随时间的变化。
2020年4月至10月共有2484名用户注册，其中大多数创建了账户但未启动模块。共有562名个体开始该项目并纳入数据分析。个体报告的最常见压力触发因素涉及与家人或配偶的冲突以及工作或工作量。情绪模块中处理的最常见问题是担忧、焦虑或压力以及注意力不集中或拖延。退出率很高，13%（21/156）的人完成了冲突模块，17%（50/289）的人完成了情绪模块的第一阶段课程，14%（16/117）的人完成了压力模块的第一阶段课程。情绪和压力模块的可用性和可接受性得分显著高于平均水平。在返回完成课程的人中，压力症状随时间有显著改善（P = 0.03），在所有时间点抑郁症状均有显著下降（P = 0.01）。第一阶段和第二阶段课程之间，抑郁严重程度平均下降了20%（标准差35.2%；P = 0.60）。
与他人的冲突、担忧和注意力不集中是人们使用该项目解决的一些最常见问题。完成模块的个体自我报告的压力和抑郁症状有所改善。用户还发现这些模块有效，并对该项目的可用性和可接受性给予高度评价。然而，退出率非常高，其他免费的在线干预措施也存在这种情况。
ClinicalTrials.gov NCT02726061；https://clinicaltrials.gov/ct2/show/NCT02726061
