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Step-by-Step, an E-Mental Health Intervention for Depression: A Mixed Methods Pilot Study From Lebanon
BACKGROUND: E-mental health is an established mode of delivering treatment for common mental disorders in many high income countries. However, evidence of its effectiveness in lower income countries is lacking. This mixed methods study presents lessons learned and preliminary data on the feasibility...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034323/ https://www.ncbi.nlm.nih.gov/pubmed/32116815 http://dx.doi.org/10.3389/fpsyt.2019.00986 |
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author | Harper Shehadeh, Melissa Joanne Abi Ramia, Jinane Cuijpers, Pim El Chammay, Rabih Heim, Eva Kheir, Wissam Saeed, Khalid van Ommeren, Mark van’t Hof, Edith Watts, Sarah Wenger, Andreas Zoghbi, Edwina Carswell, Kenneth |
author_facet | Harper Shehadeh, Melissa Joanne Abi Ramia, Jinane Cuijpers, Pim El Chammay, Rabih Heim, Eva Kheir, Wissam Saeed, Khalid van Ommeren, Mark van’t Hof, Edith Watts, Sarah Wenger, Andreas Zoghbi, Edwina Carswell, Kenneth |
author_sort | Harper Shehadeh, Melissa Joanne |
collection | PubMed |
description | BACKGROUND: E-mental health is an established mode of delivering treatment for common mental disorders in many high income countries. However, evidence of its effectiveness in lower income countries is lacking. This mixed methods study presents lessons learned and preliminary data on the feasibility of a minimally guided e-mental health intervention in Lebanon. The aim was to pilot test Step-by-Step, a WHO guided e-mental health intervention, and research methods prior to future, controlled testing. METHODS: Participants were recruited using social media and advertisements in primary care clinics. Participants completed baseline and post-intervention questionnaires on depression symptoms (primary outcome, PHQ-8), anxiety symptoms, well-being, disability and self-perceived problem severity, and a client satisfaction questionnaire. In addition, seven completers, four drop-outs, 11 study staff, and four clinic managers were interviewed with responses thematically analyzed. Website analytics were used to understand participant behavior when using the website. RESULTS: A total of 129 participants signed up via the Step-by-Step website. Seventy-four participants started session 1 after completing pre-test questionnaires and 26 completed both baseline and post-intervention data. Among those who completed post-assessments, depression symptoms improved (PHQ-8 scores (t=5.62, p < 0.001 two-tailed, df = 25). Wilcoxon signed ranks tests showed a significant difference between baseline and post-Step-by-Step scores on all secondary outcome measures. Client satisfaction data was positive. Interview responses suggested that the intervention could be made more appropriate for younger, single people, more motivating, and easier to use. Those who utilized the support element of the intervention were happy with their relationship with the non-specialist support person (e-helper), though some participants would have preferred specialist support. E-helpers would have liked more training on complex cases. Website analytics showed that many users dropped out before intervention start, and that some re-entered screening data having been excluded from the study. CONCLUSION: Step-by-Step skills and techniques, model of service integration, and its non-specialist support element are acceptable. Though the sample was small and non-controlled and drop-out was high, results suggest that it may be effective in reducing depression and anxiety symptoms and increasing well-being. Lessons learned will inform content revision, the development of an app version of Step-by-Step, and the research methodology of upcoming effectiveness studies. |
format | Online Article Text |
id | pubmed-7034323 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-70343232020-02-28 Step-by-Step, an E-Mental Health Intervention for Depression: A Mixed Methods Pilot Study From Lebanon Harper Shehadeh, Melissa Joanne Abi Ramia, Jinane Cuijpers, Pim El Chammay, Rabih Heim, Eva Kheir, Wissam Saeed, Khalid van Ommeren, Mark van’t Hof, Edith Watts, Sarah Wenger, Andreas Zoghbi, Edwina Carswell, Kenneth Front Psychiatry Psychiatry BACKGROUND: E-mental health is an established mode of delivering treatment for common mental disorders in many high income countries. However, evidence of its effectiveness in lower income countries is lacking. This mixed methods study presents lessons learned and preliminary data on the feasibility of a minimally guided e-mental health intervention in Lebanon. The aim was to pilot test Step-by-Step, a WHO guided e-mental health intervention, and research methods prior to future, controlled testing. METHODS: Participants were recruited using social media and advertisements in primary care clinics. Participants completed baseline and post-intervention questionnaires on depression symptoms (primary outcome, PHQ-8), anxiety symptoms, well-being, disability and self-perceived problem severity, and a client satisfaction questionnaire. In addition, seven completers, four drop-outs, 11 study staff, and four clinic managers were interviewed with responses thematically analyzed. Website analytics were used to understand participant behavior when using the website. RESULTS: A total of 129 participants signed up via the Step-by-Step website. Seventy-four participants started session 1 after completing pre-test questionnaires and 26 completed both baseline and post-intervention data. Among those who completed post-assessments, depression symptoms improved (PHQ-8 scores (t=5.62, p < 0.001 two-tailed, df = 25). Wilcoxon signed ranks tests showed a significant difference between baseline and post-Step-by-Step scores on all secondary outcome measures. Client satisfaction data was positive. Interview responses suggested that the intervention could be made more appropriate for younger, single people, more motivating, and easier to use. Those who utilized the support element of the intervention were happy with their relationship with the non-specialist support person (e-helper), though some participants would have preferred specialist support. E-helpers would have liked more training on complex cases. Website analytics showed that many users dropped out before intervention start, and that some re-entered screening data having been excluded from the study. CONCLUSION: Step-by-Step skills and techniques, model of service integration, and its non-specialist support element are acceptable. Though the sample was small and non-controlled and drop-out was high, results suggest that it may be effective in reducing depression and anxiety symptoms and increasing well-being. Lessons learned will inform content revision, the development of an app version of Step-by-Step, and the research methodology of upcoming effectiveness studies. Frontiers Media S.A. 2020-02-12 /pmc/articles/PMC7034323/ /pubmed/32116815 http://dx.doi.org/10.3389/fpsyt.2019.00986 Text en Copyright © 2020 Harper Shehadeh, Abi Ramia, Cuijpers, El Chammay, Heim, Kheir, Saeed, van Ommeren, van’t Hof, Watts, Wenger, Zoghbi and Carswell http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Psychiatry Harper Shehadeh, Melissa Joanne Abi Ramia, Jinane Cuijpers, Pim El Chammay, Rabih Heim, Eva Kheir, Wissam Saeed, Khalid van Ommeren, Mark van’t Hof, Edith Watts, Sarah Wenger, Andreas Zoghbi, Edwina Carswell, Kenneth Step-by-Step, an E-Mental Health Intervention for Depression: A Mixed Methods Pilot Study From Lebanon |
title | Step-by-Step, an E-Mental Health Intervention for Depression: A Mixed Methods Pilot Study From Lebanon |
title_full | Step-by-Step, an E-Mental Health Intervention for Depression: A Mixed Methods Pilot Study From Lebanon |
title_fullStr | Step-by-Step, an E-Mental Health Intervention for Depression: A Mixed Methods Pilot Study From Lebanon |
title_full_unstemmed | Step-by-Step, an E-Mental Health Intervention for Depression: A Mixed Methods Pilot Study From Lebanon |
title_short | Step-by-Step, an E-Mental Health Intervention for Depression: A Mixed Methods Pilot Study From Lebanon |
title_sort | step-by-step, an e-mental health intervention for depression: a mixed methods pilot study from lebanon |
topic | Psychiatry |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034323/ https://www.ncbi.nlm.nih.gov/pubmed/32116815 http://dx.doi.org/10.3389/fpsyt.2019.00986 |
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