JMIR Publications

ABSTRACT

Background:

People with intellectual disability experience rates of mental illness up to three times higher than the general population, yet face significant barriers to care, including limited clinician expertise, diagnostic overshadowing, and exclusion from key mental health services. Electronic mental health (eMH) interventions have demonstrated effectiveness in the general population and may address these barriers for people with intellectual disability by providing accessible, tailored treatment.

Objective:

This study examined the ability of Healthy Mind, a self-guided, web-based transdiagnostic mental health program designed specifically for people with borderline-to-mild intellectual disability, to reduce symptoms of anxiety and depression and improving functioning in people with intellectual disability.

Methods:

In a single-arm uncontrolled design, Australian residents aged ≥16 years with a diagnosis of borderline or mild intellectual disability, and mild-to-moderate symptoms of depression or anxiety on the Anxiety, Depression and Mood Scale (ADAMS), were recruited online and offered access to Healthy Mind. Assistance a nominated supporter was optional. Primary outcomes were symptoms of depression and anxiety (ADAMS). Secondary outcomes were psychological distress (Kessler-10; K10) and functional impairment (WHO Disability Assessment Schedule 2.0; WHO-DAS). Outcomes were assessed at baseline, 8 weeks, and 3 months. Eighty participants (mean age 27.8 years, 46% female, 49% identifying as Aboriginal and/or Torres Strait Islander) enrolled; 61% nominated a supporter. Data were analysed using multilevel models with random intercepts for participants.

Results:

No significant changes were found in ADAMS depression or anxiety scores from baseline to post-intervention or follow-up. Similarly, no significant effects were found for K10 or WHO-DAS scores, except for an improvement in K10 scores between baseline and 3 months when controlling for cognitive functioning (n=15). Having a supporter was associated with lower baseline distress but did not moderate treatment effects. Engagement with Healthy Mind was low: 42.5% did not access the program, and among those who did, the median number of completed modules was seven (of 30). Greater module completion was associated with slightly higher WHO-DAS scores post-intervention.

Conclusions:

This trial did not demonstrate significant improvements in mental health or functioning associated with Healthy Mind, likely due to low engagement, reduced statistical power, and the absence of a control group. Nonetheless, the study demonstrates the feasibility of recruiting and retaining people with intellectual disability in fully online trials and highlights the urgent need for strategies to improve engagement, including gamification, personalised content, and integrated social features. eMH remains a promising avenue for addressing the substantial mental health service gap for people with intellectual disability. Clinical Trial: ACTRN12620000113954