JMIR Publications

ABSTRACT

Background:

During the COVID-19 pandemic, health care professionals experienced high levels of depression. Limited research has highlighted effective interventions to improve mental health during epidemics. It remains unclear whether Internet-based cognitive behavioral therapy (iCBT) programs are effective in improving the mental health of health care workers during the COVID-19 pandemic.

Objective:

The aim of the present study was to evaluate the effectiveness of a smartphone-based iCBT stress management program on reducing depression of nurses in Vietnam and Thailand.

Methods:

From March–April 2022, a two-arm, parallel-group randomized controlled trial was implemented. One arm offered a seven-week self-guided iCBT program, and the other only surveyed as a control arm. Full-time nurses were recruited from six hospitals, two hospitals in Vietnam and four hospitals in Thailand. The primary outcome was depression measured by the Depression, Anxiety and Stress Scale - 21 Items. Follow-up surveys to measure the change in depression were conducted at three and six months after baseline. Mixed modeling for repeated measures was used to test the effects of the intervention compared with the control for the follow-ups.

Results:

A total of 1203 nurses were included in the study: 602 in the intervention group and 601 in the control group. The follow-up rate at three and six months ranged from 85.7%–87.5%. The completion rate for the program was 68.1%. The group difference in depression was significant at the three-month follow-up (coefficient=-0.92, 95% CI [-1.66, -0.18], P=.02) and non-significant at the six-month follow-up (coefficient=-0.33, 95% CI [-1.11, 0.45], P=.41). The estimated effect sizes (d) were -0.15 and -0.06, respectively.

Conclusions:

The present study demonstrated that the smartphone-based iCBT program was effective in reducing depression at the three-month follow-up among hospital nurses in Vietnam and Thailand during the COVID-19 pandemic. It is a promising approach to reduce depression of nurses during an infectious disease pandemic. Clinical Trial: Clinical Trials Registry (UMIN-CTR, ID=UMIN000044145).