A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study

Abstract

Background Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19–related depression and anxiety symptoms among people who speak English and Spanish in the United States. Objective This paper describes the changes in StayWell participants’ anxiety and depression levels after 60 days of exposure to skills-based SMS text messages. Methods We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. Results The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of –1.72 (95% CI –2.35 to –1.09) in PHQ-8 scores and –0.48 (95% CI –0.71 to –0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively. Conclusions StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health. Trial Registration ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID) RR2-10.2196/23592

Tele‐medicine and improvement of mental health problems in COVID‐19 pandemic: A systematic review

“…This paper described the changes in StayWell participants' anxiety and depression levels after 60 days of exposure. The study's results showed statistically significant reductions in both depression and anxiety scores from baseline ( p < 0.001) (Aguilera et al., 2021 ).…”

“…Participants were individuals prone to mental illnesses like depression and GAD due to the COVID‐19 pandemic and its consequences on lifestyle. Interventions in these studies consisted of a wide range of telecommunication methods, including telephone contacts (Alessi et al., 2021 , 2022 ; Kahlon et al., 2021 ; Lai, Yan, et al., 2020 ), messaging platforms (Aguilera et al., 2021 ), online methods, for example, videoconference, and online apps (Al‐Alawi et al., 2021 ; Fiol‐DeRoque et al., 2021 ; Lai, Yan, et al., 2020 ; Sanchez‐Guarnido et al., 2021 ; Shapira et al., 2021 ; Summers et al., 2021 ; Watts et al., 2020 ; Weerkamp‐Bartholomeus et al., 2020 ). The outcome assessment was different between the articles.…”

“…The risk of bias assessment of the experimental studies according to the Cochrane tool is presented in Table 3 . Only two studies (Aguilera et al., 2021 ; Summers et al., 2021 ) have a high risk of bias in the cases of allocation concealment, blinding of participants, and blinding of outcome (Table 3 ).…”

Digital Screening and Automated Resource Identification System to Address COVID-19–Related Behavioral Health Disparities: Feasibility Study

“…As such, the COVID-19 pandemic has exacerbated the already existent need for scalable, accessible, and affordable DMH, particularly for vulnerable communities [ 47 ]. Although multiple studies of pandemic-specific DMH interventions have occurred [ 48 ], the ENERGY System is unique in its intended use (ie, single or repeated use) and potential for extended utility beyond the pandemic (eg, compliant with but not centered upon social distancing practices). However, to be useful for communities moving forward, multiple limitations will need to be addressed.…”

Tecnologias de informação e comunicação para o enfrentamento da violência contra a mulher em atividades de ensino remoto emergencial de enfermagem durante a pandemia da COVID-19

“…It is worth mentioning that, during the pandemic, other experiences that used text messages via cell phones and smartphones were promising for coping with harmful effects on the mental health of people in confinement (Agyapong et al, 2021;Aguilera et al, 2021). Thus, ICT use in the pandemic may lead to adaptations in the teaching process, possibly extending to the post-pandemic period, considering that the strategies adopted in this exceptional moment point to the remote teaching modality deepening or the hybrid teaching model implementation (Rodrigues et al, 2020).…”