BACKGROUND Singapore, like the rest of Asia, faces persistent challenges to mental health promotion including stigma around unwellness and seeking treatment, low mental health literacy, a lack of trained mental health personnel, and underdevelopment of mental healthcare ecosystems. The COVID-19 pandemic created a surge in mental healthcare needs, giving new impetus to addressing these shortcomings. The pandemic situation also accelerated the acceptance and adoption of digital health solutions, creating a new opportunity for innovative approaches to quickly scale solutions to address mental healthcare needs in the region. OBJECTIVE In June 2020, a subsidiary of the Singaporean government launched mindline.sg, a digital mental health resource website that has grown to include over 500 curated local mental health resources, a clinically validated self-assessment tool for depression and anxiety, an AI chatbot from Wysa designed to deliver digital therapeutic exercises, and a tailored version of the website for working adults called mindline at work. Carefully selected resources on causative factors (such as financial and employment stress) are also provided. The platform was developed to be anonymous and to contain authoritative and localised content at multiple levels of progressive engagement. The goal of the platform is to empower Singapore residents to take charge of their own mental health and to be able to offer basic support to those around them through the ease and convenience of a barrier-free digital solution. METHODS Website utilisation is primarily measured through click-level data analytics captured via Google Analytics and custom APIs, which in turn drive a customised analytics infrastructure based on Metabase. Unique, non-bounced, engaged, and return users are reported. Self-assessments are recorded only if completed, and Wysa AI chatbot usage is only measured if a user lands on Wysa’s platform. RESULTS In the two years following launch (1 July 2020 through 30 June 2022), the website received over 447,000 visitors (about 15% of the target population of three million), 62% of which explore the site or engage with resources, and about 10% of those engaged users return. The most popular features on the platform were the dialogue-based therapeutic exercises delivered by the chatbot and the self-assessment tool, which were used by 25.5% and 10.8% of non-bounced visitors, respectively. On mindline at work, the rates of non-bounced visitors who explored the site (i.e., spent 40 seconds or more exploring resources) and who returned were 51.6% and 13.4% over a year, respectively, compared to 35.2% and 11.4%, respectively, on the generic mindline.sg site in the same year. CONCLUSIONS The site has achieved desired reach and has seen a strong growth rate in the number of visitors. Substantial and sustained digital marketing campaigns and strategic outreach partnerships, supported by an appropriate analytics infrastructure, are required to achieve this level of reach for such a platform. The site was careful to preserve anonymity, limiting the detail of analytics. Nevertheless, it was observed that the digital therapeutic exercises delivered by the AI chatbot and the self-assessment tool were among the most popular features of the site and improved user engagement. The customised site for working adults appears to have achieved higher engagement than the site designed for the general population. The good levels of overall adoption encourage us to believe that mild-to-moderate mental health conditions, and the social factors that underly them, are amenable to digital interventions. While mindline.sg was primarily used in Singapore, we believe that similar solutions with local customisation are widely and globally applicable.

Background The website mindline.sg is a stress management and coping website that can be accessed anonymously in Singapore for free. Although designed to serve individuals who are well or have mild depression and anxiety symptoms, mindline.sg may potentially be used by clinicians as an adjunct therapeutic aid for patients with clinically diagnosed mental disorders. Objective This study aims to determine the perceived usability, acceptability, and usefulness of mindline.sg among individuals with diagnosed mental disorders in a clinical setting. Methods A cross-sectional study with 173 participants was conducted in the waiting room of a psychiatrist’s office at the National University Hospital in Singapore. Participants waiting for an appointment were given 30 minutes and a simple set of instructions to use three features of mindline.sg. They subsequently answered a set of web-based survey questions via their smartphones, including a 16-item subset of the Post-Study System Usability Questionnaire (PSSUQ) for usability measurement and 5 questions designed to understand the perceived usefulness and acceptability of mindline.sg. Multiple linear regression is used to determine the associated demographic factors with overall PSSUQ score. A chi-square test is performed to investigate associations of psychiatric condition with users’ responses on acceptability and perceived usefulness of mindline.sg. For this study, P<.05 is considered significant. Results We observed that the overall (mean 2.86, SD 1.46), system usefulness (mean 2.74, SD 1.46), and information quality (mean 2.98, SD 1.33) subscores of the PSSUQ survey are within a 99% CI of a literature-derived norm, which all have the interpretation of having high perceived usability. However, interface quality (mean 2.98, SD 1.33) scored lower than the literature-derived norm, although it is still better than the neutral score of 4. We find participants with lower than a General Certificate of Education O-Level or N-Level education tend to give a lower usability score as compared to others (β=.49; P=.02). Participants who have not been hospitalized previously due to their condition are also more likely to give a lower PSSUQ score as compared to individuals who have been hospitalized (β=.18; P=.03). The platform mindline.sg is also deemed to be generally useful and acceptable with all the survey questions receiving more than a 60% positive response. We found no association between the type(s) of self-reported psychiatric disorder(s) and the perceived usefulness and acceptability of mindline.sg. Conclusions Our results show that mindline.sg is generally perceived as usable and acceptable by individuals with a diagnosed mental disorder in Singapore. The study suggests improving usability among individuals with lower education levels. Particularly promising is the finding that previously hospitalized individuals have significantly higher perceived usability and satisfaction of the website, suggesting potential impact could be found among a moderately to severely at-risk clinical population. The effectiveness of mindline.sg as an adjunct therapy for individuals with diagnosed mental disorders should therefore be explored in future studies.

BACKGROUND Singapore, like the rest of Asia, faces persistent challenges to mental health promotion including stigma around unwellness and seeking treatment, low mental health literacy, a lack of trained mental health personnel, and underdevelopment of mental healthcare ecosystems. The COVID-19 pandemic created a surge in mental healthcare needs, giving new impetus to addressing these shortcomings. The pandemic situation also accelerated the acceptance and adoption of digital health solutions, creating a new opportunity for innovative approaches to quickly scale solutions to address mental healthcare needs in the region. OBJECTIVE In June 2020, the MOH Office for Healthcare Transformation (MOHT) in Singapore launched mindline.sg, a digital mental health resource website that has grown to include over 500 curated local mental health resources, a clinically validated self-assessment tool for depression and anxiety, an AI chatbot from Wysa designed to deliver digital therapeutic exercises, and a tailored version of the website for working adults called mindline at work. Carefully selected resources on causative factors (such as financial and employment stress) are also provided. The platform was developed to be anonymous and to contain authoritative and localised content at multiple levels of progressive engagement. The goal of the platform is to empower Singapore residents to take charge of their own mental health and to be able to offer basic support to those around them through the ease and convenience of a barrier-free digital solution. METHODS Website utilisation is primarily measured through click-level data analytics captured via Google Analytics and custom APIs, which in turn drive a customised analytics infrastructure based on Metabase. Unique, non-bounced, engaged, and return users are reported. Self-assessments are recorded only if completed, and Wysa AI chatbot usage is only measured if a user lands on Wysa’s platform. RESULTS In the two years following launch (1 July 2020 through 30 June 2022), the website received over 447,000 visitors (about 15% of the target population of three million), 62% of which explore the site or engage with resources, and about 10% of those engaged users return. The most popular features on the platform were the dialogue-based therapeutic exercises delivered by the chatbot and the self-assessment tool, which were used by 25.5% and 10.8% of non-bounced visitors, respectively. On mindline at work, the rates of non-bounced visitors who explored the site (i.e., spent 40 seconds or more exploring resources) and who returned were 51.6% and 13.4% over a year, respectively, compared to 35.2% and 11.4%, respectively, on the generic mindline.sg site in the same year. CONCLUSIONS The site has achieved desired reach and has seen a strong growth rate in the number of visitors. Substantial and sustained digital marketing campaigns and strategic outreach partnerships, supported by an appropriate analytics infrastructure, are required to achieve this level of reach for such a platform. The site was careful to preserve anonymity, limiting the detail of analytics. Nevertheless, it was observed that the digital therapeutic exercises delivered by the AI chatbot and the self-assessment tool were among the most popular features of the site and improved user engagement. The customised site for working adults appears to have achieved higher engagement than the site designed for the general population. The good levels of overall adoption encourage us to believe that mild-to-moderate mental health conditions, and the social factors that underly them, are amenable to digital interventions. While mindline.sg was primarily used in Singapore, we believe that similar solutions with local customisation are widely and globally applicable.

Mental health issues and needs have increased substantially since the onset of the COVID-19 pandemic. However, health policy and decision-makers do not have adequate data and tools to predict population-level mental health demand, especially amid a crisis. This study investigates whether situational indicators and social media emotions can be effectively used to predict public mental health needs. We collected time-series data from multiple sources in Singapore between 1 July 2020 and 31 December 2021, including daily-level records of situation indicators, emotions expressed on social media, and mental health needs measured by the number of public visits to the emergency room of the country's largest psychiatric hospital, and use of government-initiated online mental health self-help portal. Compared to mental health needs data alone, social media emotions were found to have significant Granger-causality effects with as early as four to five days lag length. Each resulted in a statistically significant enhancement in predicting the public's visits to the emergency room and the online self-help portal (e.g., Facebook Anger Count on emergency room visits, χ2 = 13·7, P = ·0085**). In contrast, situational indicators such as daily new cases had Granger-causality effects (χ2 = 10·3, P = ·016*) with a moderate lag length of three days. The findings indicate that emotions algorithmically extracted from social media platforms can provide new indicators for tracking and forecasting population-level mental health states and needs.

BACKGROUND The website <i>mindline.sg</i> is a stress management and coping website that can be accessed anonymously in Singapore for free. Although designed to serve individuals who are well or have mild depression and anxiety symptoms, <i>mindline.sg</i> may potentially be used by clinicians as an adjunct therapeutic aid for patients with clinically diagnosed mental disorders. OBJECTIVE This study aims to determine the perceived usability, acceptability, and usefulness of <i>mindline.sg</i> among individuals with diagnosed mental disorders in a clinical setting. METHODS A cross-sectional study with 173 participants was conducted in the waiting room of a psychiatrist’s office at the National University Hospital in Singapore. Participants waiting for an appointment were given 30 minutes and a simple set of instructions to use three features of <i>mindline.sg</i>. They subsequently answered a set of web-based survey questions via their smartphones, including a 16-item subset of the Post-Study System Usability Questionnaire (PSSUQ) for usability measurement and 5 questions designed to understand the perceived usefulness and acceptability of <i>mindline.sg</i>. Multiple linear regression is used to determine the associated demographic factors with overall PSSUQ score. A chi-square test is performed to investigate associations of psychiatric condition with users’ responses on acceptability and perceived usefulness of <i>mindline.sg</i>. For this study, <i>P</i>&lt;.05 is considered significant. RESULTS We observed that the overall (mean 2.86, SD 1.46), system usefulness (mean 2.74, SD 1.46), and information quality (mean 2.98, SD 1.33) subscores of the PSSUQ survey are within a 99% CI of a literature-derived norm, which all have the interpretation of having high perceived usability. However, interface quality (mean 2.98, SD 1.33) scored lower than the literature-derived norm, although it is still better than the neutral score of 4. We find participants with lower than a General Certificate of Education O-Level or N-Level education tend to give a lower usability score as compared to others (β=.49; <i>P</i>=.02). Participants who have not been hospitalized previously due to their condition are also more likely to give a lower PSSUQ score as compared to individuals who have been hospitalized (β=.18; <i>P</i>=.03). The platform <i>mindline.sg</i> is also deemed to be generally useful and acceptable with all the survey questions receiving more than a 60% positive response. We found no association between the type(s) of self-reported psychiatric disorder(s) and the perceived usefulness and acceptability of <i>mindline.sg</i>. CONCLUSIONS Our results show that <i>mindline.sg</i> is generally perceived as usable and acceptable by individuals with a diagnosed mental disorder in Singapore. The study suggests improving usability among individuals with lower education levels. Particularly promising is the finding that previously hospitalized individuals have significantly higher perceived usability and satisfaction of the website, suggesting potential impact could be found among a moderately to severely at-risk clinical population. The effectiveness of <i>mindline.sg</i> as an adjunct therapy for individuals with diagnosed mental disorders should therefore be explored in future studies.