Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.
Health Sciences Area, Valencian International University, Valencia, Spain.
JMIR Form Res. 2024 Sep 30;8:e53767. doi: 10.2196/53767.
The COVID-19 pandemic has had an impact on mental health worldwide. Low- and middle-income countries were largely affected by it. Mexico was one of the most affected countries. Extended periods of lockdowns, isolation, and social distancing, among other factors, highlighted the need to introduce web-based psychological interventions to the Mexican population. In this context, Mental Health COVID-19 emerged as a self-guided web-based intervention (SGWI) aimed at adults to improve mental health during the COVID-19 pandemic.
This study aims to assess the efficacy of 2 modalities of a self-guided intervention (with and without chat support) in reducing depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation. In addition, it aimed to compare the moderating role of coping strategies, acceptance, and satisfaction in participants' symptom reduction. We hypothesize that the self-guided, chat-supported modality will show higher efficacy than the modality without chat support in achieving clinical change and better performance as a moderator of depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation, as well as an increase in participants' satisfaction and acceptability.
A randomized controlled trial was conducted. Data were collected from May 2020 to June 2022. We performed intrasubject measures at 4 evaluation periods: pretest, posttest, and follow-up measurements at 3 and 6 months. Differences between intervention groups were assessed through the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Changes due to intervention were analyzed using Wilcoxon W test. Moderated regression analysis was performed to test the hypothesized moderating role of coping strategies, usability, and opinion about treatment on clinical change.
A total of 36 participants completed the intervention; of these, 5 (14%) were part of the SGWI group, and 31 (86%) were on the SGWI plus chat support (SGWI+C) group, which included a chat service with therapists. The perceived high complexity of the system for the SGWI group had a moderating effect associated with a lack of efficacy of the intervention regarding depression, but not when controlled for sociodemographic variables. A perception of lower helpfulness of the intervention was associated with poorer outcomes. Coping strategies did not show moderating effects.
Enhancing the utility of web-based interventions for reducing clinical symptoms by incorporating a support chat to boost treatment adherence seemed to improve the perception of the intervention's usefulness. Web-based interventions face several challenges, such as eliminating complexities in platform use and increasing the users' perceived utility of the intervention, among other issues identified in the study.
ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/study/NCT04468893?tab=results.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/23117.
COVID-19 大流行对全球的心理健康产生了影响。中低收入国家受到了很大的影响。墨西哥是受影响最严重的国家之一。长时间的封锁、隔离和社会隔离等因素突显了向墨西哥民众推出基于网络的心理干预措施的必要性。在这种情况下，Mental Health COVID-19 作为一种针对成年人的自我引导的基于网络的干预措施（SGWI）出现，旨在改善 COVID-19 大流行期间的心理健康。
本研究旨在评估两种自我引导干预模式（有和没有聊天支持）在降低抑郁症状、广泛性焦虑、社区创伤后应激、广泛恐惧、焦虑、睡眠质量、生理和情感应对以及自杀意念方面的疗效。此外，还比较了应对策略、接受度和满意度在参与者症状减轻中的调节作用。我们假设，有聊天支持的自我引导模式将比没有聊天支持的模式在实现临床变化和更好地作为抑郁症状、广泛性焦虑、社区创伤后应激、广泛恐惧、焦虑、睡眠质量、生理和情感应对以及自杀意念的调节因素方面表现出更高的疗效，以及增加参与者的满意度和可接受性。
进行了一项随机对照试验。数据收集时间为 2020 年 5 月至 2022 年 6 月。我们在 4 个评估期进行了个体内测量：前测、后测和 3 个月和 6 个月的随访测量。通过 Mann-Whitney U 检验对连续变量和卡方检验对分类变量进行组间差异评估。使用 Wilcoxon W 检验分析干预引起的变化。进行了调节回归分析，以检验应对策略、可用性和对治疗的看法对临床变化的假设调节作用。
共有 36 名参与者完成了干预；其中，5 名（14%）为 SGWI 组的一部分，31 名（86%）为 SGWI 加聊天支持（SGWI+C）组，该组包括与治疗师的聊天服务。SGWI 组认为系统高度复杂具有调节作用，与干预的疗效缺乏相关，但不受社会人口统计学变量的控制。认为干预的帮助性较低与较差的结果相关。应对策略没有表现出调节作用。
通过加入支持聊天来提高治疗依从性，增强基于网络的干预措施减少临床症状的效用，似乎可以提高对干预措施有用性的认识。基于网络的干预措施面临着许多挑战，例如消除平台使用的复杂性，并增加用户对干预措施的感知效用，这是研究中发现的其他问题之一。
ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/study/NCT04468893?tab=results.
国际注册报告标识符（IRRID）：RR2-10.2196/23117.
