Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 20, 2018
Open Peer Review Period: Apr 23, 2018 - Jun 18, 2018
Date Accepted: Apr 26, 2019
(closed for review but you can still tweet)
A multi-centre pragmatic randomized controlled trial of a web-based mental health platform in individuals seeking specialized mental health care services
ABSTRACT
Background:
Web-based self-directed mental health applications are rapidly emerging as a solution to health service gaps and unmet needs for information and support.
Objective:
The aim of this study was to determine if a multi-component web-based moderated mental health application could benefit individuals with mental health symptoms severe enough to warrant specialized mental health care.
Methods:
A multi-centre, pragmatic randomized controlled trial was conducted across several outpatient mental health programs affiliated with 3 hospital programs in Ontario, Canada. Individuals referred to or receiving treatment, 16 years of age or older, with access to the internet and an email address, and having the ability to navigate a web-based mental health application were eligible. 812 participants were randomized 2:1 to receive immediate (ITG) or delayed (DTG) access for 3 months to the Big White WallTM, a web-based multi-component mental health intervention based in the United Kingdom and New Zealand. The primary outcome was total score on the Recovery Assessment Scale, revised (RAS-r) measuring mental health recovery. Secondary outcomes were total scores on the Patient Health Questionnaire-9 item (PHQ-9), the Generalized Anxiety Disorder Questionnaire-7 item (GAD-7), the EQ-5D-5L, and the Community Integration Questionnaire (CIQ). An exploratory analysis examined the association between actual BWW use (categorized into quartiles) and outcomes among study completers.
Results:
Intervention participants achieved small, statistically significant increases in adjusted RAS-r score (4.97 points, 95% CI 2.90 to 7.05), and decreases in PHQ-9 score (-1.83 points, 95% CI -2.85 to -0.82) and GAD-7 score (-1.55 points, 95% CI -2.42 to -0.70). Follow-up was achieved for 446 (55%) at 3 months; 48% of ITG participants, and 69% of DTG participants. Only 58% of ITG participants logged on more than once. Some higher BWW user groups had significantly greater improvements in PHQ-9 and GAD-7 relative to the lowest use group.
Conclusions:
The web-based application may be beneficial, however, many participants did not engage in an ongoing way. This has implications for patient selection and engagement as well as delivery and funding structures for similar web-based interventions. Clinical Trial: Clinicaltrials.gov NCT02896894. Registered on 31 August 2016 (retrospectively registered). https://clinicaltrials.gov/ct2/show/NCT02896894
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.