A Dialectical Behavior Therapy (DBT)-Informed mHealth Intervention to Enhance Coping Skills and Mental Health among Men Who Have Sex with Men Living with HIV in China: A Mixed-Methods Feasibility Pilot Study.

Men who have sex with men (MSM) bear a disproportionate burden of HIV and mental health problems in China, hindering HIV-related care engagement and medication adherence. We developed a culturally-tailored dialectical behavior therapy (DBT)-informed mHealth intervention composed of individual skills training through a mobile app, online skills group, and on-demand skills coaching. The primary objective of this feasibility study was to assess the intervention acceptability, feasibility, and app usability. The secondary aim is to explore preliminary intervention effects. Participants were recruited in collaboration with Shanghai China Sex Worker & Men Who Have Sex with Men Center (SCMC), a community-based organization that provides HIV-related services in Shanghai, China. Eligible participants were randomly assigned to a 4-week mHealth intervention or control arm (treatment as usual). The intervention included individual skills learning using an app, online skills group facilitated by trained SCMC staff, and on-demand skills coaching by trained SCMC staff. Both groups completed weekly surveys for 4 weeks. Quantitative data were analyzed using linear mixed-effects models to evaluate the intervention's impact on primary outcomes (depression, anxiety, quality of life, medication adherence) and intermediate outcomes (emotion regulation difficulties, HIV-related stigma, and coping self-efficacy). Quantitative and qualitative data on intervention feasibility, acceptability, and app usability were analyzed using content analysis and supplemented with quantitative data summarized with descriptive statistics. Of the 64 people who completed the screening survey, 31 enrolled and completed the study without dropping out. The intervention (n = 16) and control arm (n = 14) did not differ in demographic characteristics, primary outcomes, or intermediate outcomes at baseline. Most participants were 23-30 years old, college-educated, employed, and single. Overall, the intervention was perceived to be highly feasible and acceptable, with above-average app usability. Compared to the control group, time was significantly associated with a greater decrease in the following outcomes in the intervention group: depression (β = - 0.73, 95% CI [-1.37, - 0.10]), emotion regulation difficulties (β = - 1.56, 95% CI [-2.72, - 0.41]), specifically non-acceptance of emotions (β = - 0.48, 95% CI [- 0.88, - 0.09]), and impact of emotions on goals (β = - 0.37, 95% CI [- 0.72, - 0.03]). Participants in the intervention group also showed more improvement in HIV mastery (β = 0.37, 95% CI [0.01, 0.74]), life satisfaction (β = 0.85, 95% CI [0.11, 1.59], coping efficacy around emotions (β = 0.97, 95% CI [0.06, 1.88]), and seeking social support from family and friend (β = 0.82, 95% CI [0.08, 1.57], compared with the control group. The DBT-informed mHealth intervention is acceptable and feasible among MSM living with HIV in China. The intervention shows promise in reducing depression and emotional regulation difficulties and warrant further investigation through definitive trials. This work has important implications for cross-cultural adaptations and extensions of traditional evidence-based treatment into digital mental health interventions to improve mental health outcomes among people living with HIV.