Text4Hope Effectiveness in Reducing Psychological Symptoms among Young Adults in Canada: Longitudinal and Naturalistic Controlled Program Evaluation

Background: Chronic stress, anxiety, and depression are psychological problems that can hurt young adults, interfering with their everyday function, academic achievement, and interpersonal relationships. This study aimed to assess the impact of Text4Hope, an online mental health service, on the psychological well-being of young adults. Methods: This study adopted both longitudinal and naturalistic controlled trial designs. It examined clinical outcomes in young adult (≤26 years old) subscribers of Text4Hope who completed surveys at baseline and six weeks and compared clinical parameters in two groups of subscribers. The first group comprised the intervention group (IG) (young adult subscribers who received once-daily supportive text messages for six weeks and completed sixth-week evaluation measures between 26 April and 12 July 2020), and the second group was the control group (CG) (young adult subscribers who joined Text4Hope in the same time frame and completed a baseline survey and were yet to receive any text messages). The prevalence of moderate to high stress, anxiety, and depression was measured at baseline and six weeks in the longitudinal study and between the two groups for the naturalistic controlled study using the Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder 7-item (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Inferential statistics, including the t-test, McNemar test, chi-square, and binary logistic regression analyses, were used to evaluate the differences in the prevalence and severity of the psychological symptoms. Results: In the longitudinal study, of the 9214 subscribers to Text4Hope who completed the baseline survey, 1047 (11.4%) were identified as youth. For the young adult subscribers who completed both the baseline and sixth-week surveys (n = 114), a significant reduction in the prevalence of moderate to high stress (8%) and likely GAD (20%) from baseline to six weeks was reported. Similarly, there was a significant reduction in the mean scores on the PSS-10, GAD-7, and Composite Mental Health score but not the PHQ-9 from baseline to six weeks. The largest reduction in mean scores was for the GAD-7 scale (18.4%), with a small effect size overall. For the naturalistic study, the IG included 173 young adult subscribers of Text4Hope who completed the sixth-week survey compared to 92 subscribers in the CG who completed the baseline survey during the designated period. There was a significantly lower prevalence for likely Moderate Depressive Disorder (MDD) (25.2%) and suicidal thoughts/thoughts of self-harm (48.4%), with a small effect size in the IG compared to the CG. Similarly, lower mean scores were reported for all outcome variables in the IG compared to the CG, with a small to medium effect size. The receipt of daily supportive text messages for six weeks resulted in significantly lower odds of both likely GAD and experiencing thoughts of self-harm or death wish while controlling for sociodemographic characteristics. Conclusions: The Text4Hope service is an effective tool for mental health support for young adult subscribers. Young adults receiving the service exhibited a reduction in psychological symptoms, including thoughts of self-harm or death wish. This population-level intervention program can be used to effectively support young adult mental health and in suicide prevention programs.

[1]  Yifeng Wei,et al.  Can ResilienceNHope, an evidence-based text and email messaging innovative suite of programs help to close the psychological treatment and mental health literacy gaps in college students? , 2022, Frontiers in Public Health.

[2]  A. Greenshaw,et al.  Naturalistic randomized controlled trial demonstrating effectiveness of Text4Hope in supporting male population mental health during the COVID-19 pandemic , 2022, Frontiers in Public Health.

[3]  Yifeng Wei,et al.  Burnout and Associated Psychological Problems Among Teachers and the Impact of the Wellness4Teachers Supportive Text Messaging Program: Protocol for a Cross-sectional and Program Evaluation Study , 2022, JMIR research protocols.

[4]  Syed Asad Ali,et al.  Characteristics of mobile phone access and usage among caregivers in Pakistan - A mHealth survey of urban and rural population , 2021, Int. J. Medical Informatics.

[5]  S. Walitza,et al.  Stress and Mental Health among Children/Adolescents, Their Parents, and Young Adults during the First COVID-19 Lockdown in Switzerland , 2021, International journal of environmental research and public health.

[6]  A. Greenshaw,et al.  COVID-19 Pandemic: Gender difference in satisfaction with a daily supportive text message program (Text4Hope) and anticipated receptivity for technology-based health support during emergencies-Cross Sectional Survey. , 2021, JMIR mHealth and uHealth.

[7]  A. Greenshaw,et al.  Text4Hope: Receiving Daily Supportive Text Messages for 3 Months During the COVID-19 Pandemic Reduces Stress, Anxiety, and Depression , 2021, Disaster medicine and public health preparedness.

[8]  A. Greenshaw,et al.  Mental Health Outreach via Supportive Text Messages during the COVID-19 Pandemic: Improved Mental Health and Reduced Suicidal Ideation after Six Weeks in Subscribers of Text4Hope Compared to a Control Population , 2021, International journal of environmental research and public health.

[9]  L. Wozney,et al.  Text Message Interventions in Adolescent Mental Health and Addiction Services: Scoping Review , 2021, JMIR mental health.

[10]  R. Juster,et al.  [Mobile Applications to Promote Youth Mental Health: Opportunities and Challenges]. , 2021, Santé mentale au Québec.

[11]  A. Greenshaw,et al.  Changes in Stress, Anxiety, and Depression Levels of Subscribers to a Daily Supportive Text Message Program (Text4Hope) During the COVID-19 Pandemic: Cross-Sectional Survey Study , 2020, JMIR mental health.

[12]  A. Greenshaw,et al.  COVID-19 Pandemic: Age-Related Differences in Measures of Stress, Anxiety and Depression in Canada , 2020, International journal of environmental research and public health.

[13]  A. Greenshaw,et al.  Closing the Psychological Treatment Gap During the COVID-19 Pandemic With a Supportive Text Messaging Program: Protocol for Implementation and Evaluation , 2020, JMIR research protocols.

[14]  Yeen Huang,et al.  Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey , 2020, Psychiatry Research.

[15]  Elizabeth Kehoe,et al.  Alcohol Use Disorder and Comorbid Depression: A Randomized Controlled Trial Investigating the Effectiveness of Supportive Text Messages in Aiding Recovery. , 2019, Alcohol and alcoholism.

[16]  P. Chue,et al.  Randomized controlled pilot trial of supportive text messaging for alcohol use disorder patients. , 2018, Journal of substance abuse treatment.

[17]  J. Pêgo,et al.  A Key Role for Neurotensin in Chronic-Stress-Induced Anxiety-Like Behavior in Rats , 2018, Neuropsychopharmacology.

[18]  A. Greenshaw,et al.  Randomized controlled pilot trial of supportive text messages for patients with depression , 2017, BMC Psychiatry.

[19]  P. Greengard,et al.  Cellular and molecular basis for stress-induced depression , 2016, Molecular Psychiatry.

[20]  A. Greenshaw,et al.  Cross-sectional survey evaluating Text4Mood: mobile health program to reduce psychological treatment gap in mental healthcare in Alberta through daily supportive text messages , 2016, BMC Psychiatry.

[21]  Jeffrey T. Howard,et al.  Major Depressive Disorder and Public School Teachers: Evaluating Occupational and Health Predictors and Outcomes , 2015 .

[22]  E. Venkatarao,et al.  Stress, anxiety & depression among medical undergraduate students & their socio-demographic correlates , 2015, The Indian journal of medical research.

[23]  D. Doku,et al.  Suicidal Behaviour and Related Risk Factors among School-Aged Youth in the Republic of Benin , 2014, PloS one.

[24]  D. McLoughlin,et al.  Perception of patients with alcohol use disorder and comorbid depression about the usefulness of supportive text messages. , 2013, Technology and health care : official journal of the European Society for Engineering and Medicine.

[25]  D. McLoughlin,et al.  Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomised trial. , 2012, Journal of affective disorders.

[26]  R. Kessler,et al.  Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States , 2012, International journal of methods in psychiatric research.

[27]  P. Valkenburg,et al.  Online communication among adolescents: an integrated model of its attraction, opportunities, and risks. , 2011, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[28]  J. Garber,et al.  Comorbidity of Anxiety and Depression in Youth: Implications for Treatment and Prevention. , 2010, Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association.

[29]  Golda S. Ginsburg,et al.  Clinical characteristics of anxiety disordered youth. , 2010, Journal of anxiety disorders.

[30]  W. Katon,et al.  Factors associated with detection and receipt of treatment for youth with depression and anxiety disorders. , 2010, Academic pediatrics.

[31]  R. Blonk,et al.  Factors Associated with Work Participation and Work Functioning in Depressed Workers: A Systematic Review , 2010, Journal of Occupational Rehabilitation.

[32]  Antonia Papastylianou,et al.  Teachers’ burnout, depression, role ambiguity and conflict , 2009 .

[33]  Anil Shukla,et al.  Burnout in indian teachers , 2008 .

[34]  G. Fitzmaurice,et al.  Change in Prevalence of Psychiatric Disorders From Ages 21 to 30 in a Community Sample , 2007, The Journal of nervous and mental disease.

[35]  R. Spitzer,et al.  The PHQ-9 , 2001, Journal of General Internal Medicine.

[36]  W. Rogers,et al.  Job performance deficits due to depression. , 2006, The American journal of psychiatry.

[37]  B. Löwe,et al.  A brief measure for assessing generalized anxiety disorder: the GAD-7. , 2006, Archives of internal medicine.

[38]  Sarah A. Mustillo,et al.  Prevalence and development of psychiatric disorders in childhood and adolescence. , 2003, Archives of general psychiatry.

[39]  W. Schaufeli,et al.  Job burnout. , 2001, Annual review of psychology.

[40]  P. Lewinsohn,et al.  Impact of comorbidity on a cognitive-behavioral group treatment for adolescent depression. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[41]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[42]  G. Canino,et al.  Psychopathology associated with suicidal ideation and attempts among children and adolescents. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[43]  D. Wigle,et al.  Suicide in Canada: an epidemiological assessment. , 1990, Canadian journal of public health = Revue canadienne de sante publique.

[44]  C. Maslach Stress, burnout, and workaholism. , 1986 .

[45]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.