JMIR Publications

ABSTRACT

Background:

Depression has a profound effect on population health. While using web-based mental health programs to prevent depression has been found to be effective in deceasing depression incidence, there are obstacles preventing their use as reflected by low rates of usage and adherence.

Objective:

The objectives of the study are to understand: a) the barriers and reluctance to using web-based mental health programs for the prevention of depression, and b) any possible dangers or concerns regarding the use of such programs.

Methods:

BroMatters and HardHat were two randomized controlled trials (RCT) that evaluated the effectiveness of e-mental health programs for preventing workplace depression. In the BroMatters RCT, only working men who were at high risk of having a major depressive episode (MDE) were included. Male participants were assigned to be in the control group or one of the two intervention groups. Control participants had access to general depression information on the BroMatters website. Intervention group 1 had access to BroMatters and BroHealth, the depression prevention program; intervention group 2 had access to BroMatters and BroHealth along with weekly access to a qualified coach via telephone. The HardHat trial targeted men and women at high risk of developing a MDE. Participants in the intervention group were given access the HardHat depression prevention program (with a web-based coach) while access was withheld until after the study for the control group. The current qualitative study recruited participants from the intervention groups of the two RCTs. Two groups of participants were recruited from the BroMatters study (n = 41 after the initial qualitative interview and n = 20 from one month after the final quantitative interview) and one group was recruited from the HardHat RCT one month after the initial quantitative interview (n = 16). Semi-structured interviews were performed with recruited participants (N = 77 total) and analyzed using content analysis.

Results:

There were both personal and program-level barriers to program use. The three personal level barriers included time, stress level and perception of prevention. Content, medium and dangers were program level barriers to the use of web-based mental health programs. A large amount of text and functionality issues within the program decreased engagement. Dangers associated with web-based mental health programs are privacy and not getting adequate help for severe symptoms.

Conclusions:

There are personal and program level barriers to the utilization of web-based mental health programs. Stigmatization of help seeking for depression symptoms effect the time spent on the program as well as population perception of depression. Certain barriers may be mitigated by program updates while others may require a complete shift in the perception of depression prevention.