JMIR Publications

ABSTRACT

Background:

Technology can help provide accessible and inexpensive behavioral health care to those in need. The Dartmouth PATH Program is a multimedia-based computerized cognitive behavioral therapy tool designed to address stress, depression, and conflict management. The program maintains anonymity and requires no identifiable information from the user (eg, e-mail address). The stress and depression modules ask users to return to the program for six weekly visits. This program was shaped into an open-access resource and grew in popularity during the COVID-19 pandemic.

Objective:

The primary aim was assessing the effectiveness, acceptability, and usability of a validated computer-based health program as a stand-alone therapy tool for depression, stress, and conflict management during the COVID-19 pandemic. A secondary objective was understanding the high dropout rates associated with online behavioral programs by contrasting the use and efficacy of the program for individuals who completed one session with those who returned and completed multiple sessions. The final objective was to determine users’ levels of stress and depression and the nature of problems and triggers they reported during the pandemic.

Methods:

Acceptability and usability data were analyzed using non-parametric statistics. Self-reported stress and depression scores over time were analyzed using linear mixed-effect models. Data were collected from April through October 2020.

Results:

The usability scores showed that participants found the Mood and Stress modules usable. Ratings on an Assessment of Self-Guided Treatment questionnaire showed that participants found Mood, Stress, and Conflict modules acceptable. Symptoms of stress as measured by the Perceived Stress Scale showed a significant improvement over time (P=0.03). There was a 20% (SD 35.2, P=0.6) decrease in depression severity level between sessions 1 and 2, and a significant decrease in the depressive symptoms over all timepoints (P=0.01). Only 19% of those who completed one Mood session returned to complete additional sessions.

Conclusions:

The PATH program was well-received, and preliminary findings indicate it improves self-reported stress and depression symptom in those who complete the modules. The attrition rate was high, likely exacerbated by the anonymity which precluded sending reminders. This program has the potential to reduce symptoms of depression, stress, and conflict burden and improve the mental health of those in need. Clinical Trial: ClinicalTrials.gov NCT 02726061.