Coffield Edward, Kausar Khadeja
Department of Population Health, Hofstra University, Hempstead, NY, United States.
Business Intelligence and Value Based Management Analytics, Medical Affairs, Maimonides Medical Center, Brooklyn, NY, United States.
JMIR Form Res. 2025 Apr 14;9:e66301. doi: 10.2196/66301.
Approximately 20% of US adults identify as having a mental illness. Structural and other barriers prevent many people from receiving mental health services. Digital mental health apps that provide 24-hour, real-time access to human support may improve access to mental health services. However, information is needed regarding how and why people engage with licensed counselors through a digital, real-time, text-based mental health support app in nonexperimental settings.
This study aimed to evaluate how people engage with Counslr, a 24-hour, digital, mental health support app where users communicate in real time with human counselors through text messaging. Specifically, access patterns (eg, day of the week and time of session) and reasons for accessing the platform were examined. Furthermore, whether differences existed between session types (on-demand or scheduled) and membership types (education or noneducation) in regard to access patterns and why people accessed the platform were evaluated.
The study population (users) consisted of students whose schools, universities, or colleges partnered with Counslr and employees whose organizations also partnered with Counslr. Users participated in text-based mental health support sessions. In these sessions, users engaged with licensed counselors through digital, text-based messaging in real time. Users could initiate an on-demand session or schedule a session 24 hours a day. User engagement patterns were evaluated through session length, session day, session time, and self-reported reasons for initiating the session. The data were stratified by membership type (education [students] or noneducation [employees]) and session type (on-demand or scheduled) to evaluate whether differences existed in usage patterns and self-reported reasons for initiating sessions by membership and session types.
Most students (178/283, 62.9%) and employees (28/44, 63.6%) accessed Counslr through on-demand sessions. The average and median session times were 40 (SD 15.3) and 45 minutes. On-demand sessions (37.9 minutes) were shorter (P=.001) than scheduled sessions (43.5 minutes). Most users (262/327, 80.1%) accessed Counslr between 7 PM and 5 AM. The hours that users accessed Counslr did not statistically differ by membership type (P=.19) or session type (P=.10). Primary self-reported reasons for accessing Counslr were relationship reasons, depression, and anxiety; however, users initiated sessions for a variety of reasons. Statistically significant differences existed between membership and session types (P<.05) for some of the reasons why people initiated sessions.
The novel findings of this study illustrate that real-time, digital mental health support apps, which offer people the opportunity to engage with licensed counselors outside of standard office hours for a variety of mental health conditions, may help address structural barriers to accessing mental health support services. Additional research is needed to evaluate the effectiveness of human-based apps such as Counslr and whether such apps can also address disparities in access to mental health support services among different demographic groups.
约20%的美国成年人认为自己患有精神疾病。结构和其他障碍使许多人无法获得心理健康服务。提供24小时实时人工支持的数字心理健康应用程序可能会改善心理健康服务的可及性。然而，在非实验环境中，人们如何以及为何通过数字、实时、基于文本的心理健康支持应用程序与持牌咨询师互动，这方面仍需要信息。
本研究旨在评估人们如何与Counslr（一款24小时数字心理健康支持应用程序，用户通过短信与人工咨询师实时沟通）互动。具体而言，研究了访问模式（如星期几和会话时间）以及访问该平台的原因。此外，还评估了会话类型（按需或预约）和会员类型（教育或非教育）在访问模式方面是否存在差异，以及人们访问该平台的原因。
研究人群（用户）包括其学校、大学或学院与Counslr合作的学生，以及其组织也与Counslr合作的员工。用户参与基于文本的心理健康支持会话。在这些会话中，用户通过数字、基于文本的消息与持牌咨询师实时互动。用户可以随时发起按需会话或预约24小时内的会话。通过会话时长、会话日期、会话时间以及发起会话的自我报告原因来评估用户参与模式。数据按会员类型（教育[学生]或非教育[员工]）和会话类型（按需或预约）进行分层，以评估在使用模式以及按会员和会话类型发起会话的自我报告原因方面是否存在差异。
大多数学生（178/283，62.9%）和员工（28/44，63.6%）通过按需会话访问Counslr。平均会话时间和中位数会话时间分别为40（标准差15.3）分钟和45分钟。按需会话（37.9分钟）比预约会话（43.5分钟）短（P = 0.001）。大多数用户（262/327，80.1%）在晚上7点至凌晨5点之间访问Counslr。用户访问Counslr的时间在会员类型（P = 0.19）或会话类型（P = 0.10）方面无统计学差异。访问Counslr的主要自我报告原因是人际关系问题、抑郁和焦虑；然而，用户发起会话的原因多种多样。在人们发起会话的一些原因方面，会员和会话类型之间存在统计学显著差异（P < 0.05）。
本研究的新发现表明，实时数字心理健康支持应用程序为人们提供了在标准办公时间之外因各种心理健康状况与持牌咨询师互动的机会，可能有助于解决获得心理健康支持服务的结构障碍。需要进一步研究来评估像Counslr这样的基于人工的应用程序的有效性，以及此类应用程序是否也能解决不同人口群体在获得心理健康支持服务方面的差异。
