Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
Reproductive Care Program, Healthy Population & Provincial Initiatives, IWK, Halifax, NS, Canada.
JMIR Form Res. 2024 Sep 9;8:e59003. doi: 10.2196/59003.
The prevalence of major depressive disorder (MDD) poses significant global health challenges, with available treatments often insufficient in achieving remission for many patients. Digital health technologies, such as SMS text messaging-based cognitive behavioral therapy, offer accessible alternatives but may not reach all individuals. Email communication presents a secure avenue for health communication, yet its effectiveness compared to SMS text messaging in providing mental health support for patients with MDD remains uncertain.
This study aims to compare the efficacy of email versus SMS text messaging as delivery platforms for supporting patients with MDD, addressing a critical gap in understanding optimal digital interventions for mental health care.
A randomized noninferiority pilot trial was conducted, comparing outcomes for patients receiving 6-week daily supportive messages via email with those receiving messages via SMS text message. This duration corresponds to a minimum of 180 days of message delivery. The supportive messages maintained consistent length and structure across both delivery methods. Participants (N=66) were recruited from the Access 24/7 clinic in Edmonton, Alberta, among those who were diagnosed with MDD. The outcomes were measured at baseline and 6 months after enrollment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Well-Being Index (WHO-5).
Most of the participants were females (n=43, 65%), aged between 26 and 40 years (n=34, 55%), had high school education (n=35, 58%), employed (n=33, 50%), and single (n=24, 36%). Again, most participants had had no history of any major physical illness (n=56, 85%) and (n=61, 92%) responded "No" to having a history of admission for treatment of mood disorders. There was no statistically significant difference in the mean changes in PHQ-9, GAD-7, and WHO-5 scores between the email and SMS text messaging groups (mean difference, 95% CI: -1.90, 95% CI -6.53 to 2.74; 5.78, 95% CI -1.94 to 13.50; and 11.85, 95% CI -3.81 to 27.51), respectively. Both supportive modalities showed potential in reducing depressive symptoms and improving quality of life.
The study's findings suggest that both email and SMS text messaging interventions have equivalent effectiveness in reducing depression symptoms among individuals with MDD. As digital technology continues to evolve, harnessing the power of multiple digital platforms for mental health interventions can significantly contribute to bridging the existing treatment gaps and improving the overall well-being of individuals with depressive conditions. Further research is needed with a larger sample size to confirm and expand upon these findings.
ClinicalTrials.gov NCT04638231; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/.
重度抑郁症（MDD）的患病率给全球健康带来了重大挑战，许多患者接受现有治疗后仍无法缓解病情。数字健康技术，如基于短信的认知行为疗法，提供了更便捷的替代方案，但可能无法覆盖所有人群。电子邮件是一种安全的医患沟通渠道，但在为 MDD 患者提供心理健康支持方面，其与短信相比的效果尚不确定。
本研究旨在比较电子邮件与短信作为支持 MDD 患者的平台的疗效，以填补理解数字干预措施在精神卫生保健中最佳应用的空白。
本研究采用了一项随机非劣效性试点试验，比较了 6 周内每天通过电子邮件或短信为患者提供支持性信息的两种干预措施的结果。这一持续时间相当于至少 180 天的信息传递。支持性信息在两种传递方式中保持一致的长度和结构。参与者（N=66）从阿尔伯塔省埃德蒙顿的 24/7 接入诊所招募，他们被诊断为 MDD。使用患者健康问卷-9（PHQ-9）、广泛性焦虑症-7（GAD-7）和世界卫生组织幸福指数（WHO-5）在入组后 6 个月进行基线和随访评估。
大多数参与者为女性（n=43，65%），年龄在 26 至 40 岁之间（n=34，55%），具有高中教育水平（n=35，58%），有工作（n=33，50%），单身（n=24，36%）。此外，大多数参与者没有重大躯体疾病史（n=56，85%），（n=61，92%）表示没有因情绪障碍入院治疗的病史。电子邮件组和短信组的 PHQ-9、GAD-7 和 WHO-5 评分的平均变化均无统计学差异（平均差值，95%CI：-1.90，95%CI-6.53 至 2.74；5.78，95%CI-1.94 至 13.50；11.85，95%CI-3.81 至 27.51）。两种支持方式都显示出减轻抑郁症状和改善生活质量的潜力。
本研究结果表明，电子邮件和短信干预在减轻 MDD 患者的抑郁症状方面具有同等疗效。随着数字技术的不断发展，利用多种数字平台进行心理健康干预可以显著有助于缩小现有治疗差距，提高有抑郁症状人群的整体幸福感。需要进一步开展更大规模的研究来证实和扩展这些发现。
ClinicalTrials.gov NCT04638231；https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/。
