Brief Digital Interventions to Support the Psychological Well-being of NHS Staff During the COVID-19 Pandemic: 3-Arm Pilot Randomized Controlled Trial

Abstract

Background Health and social care staff are at high risk of experiencing adverse mental health (MH) outcomes during the COVID-19 pandemic. Hence, there is a need to prioritize and identify ways to effectively support their psychological well-being (PWB). Compared to traditional psychological interventions, digital psychological interventions are cost-effective treatment options that allow for large-scale dissemination and transcend social distancing, overcome rurality, and minimize clinician time. Objective This study reports MH outcomes of a Consolidated Standards of Reporting Trials (CONSORT)-compliant parallel-arm pilot randomized controlled trial (RCT) examining the potential usefulness of an existing and a novel digital psychological intervention aimed at supporting psychological health among National Health Service (NHS) staff working through the COVID-19 pandemic. Methods NHS Highland (NHSH) frontline staff volunteers (N=169) were randomly assigned to the newly developed NHSH Staff Wellbeing Project (NHSWBP), an established digital intervention (My Possible Self [MPS]), or a waitlist (WL) group for 4 weeks. Attempts were made to blind participants to which digital intervention they were allocated. The interventions were fully automated, without any human input or guidance. We measured 5 self-reported psychological outcomes over 3 time points: before (baseline), in the middle of (after 2 weeks), and after treatment (4 weeks). The primary outcomes were anxiety (7-item General Anxiety Disorder), depression (Patient Health Questionnaire), and mental well-being (Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes included mental toughness (Mental Toughness Index) and gratitude (Gratitude Questionnaire-6). Results Retention rates mid- and postintervention were 77% (n=130) and 63.3% (n=107), respectively. Postintervention, small differences were noted between the WL and the 2 treatment groups on anxiety (vs MPS: Cohen d=0.07, 95% CI –0.20 to 0.33; vs NHSWBP: Cohen d=0.06, 95% CI –0.19 to 0.31), depression (vs MPS: Cohen d=0.37, 95% CI 0.07-0.66; vs NHSWBP: Cohen d=0.18, 95% CI –0.11 to 0.46), and mental well-being (vs MPS: Cohen d=–0.04, 95% CI –0.62 to –0.08; vs NHSWBP: Cohen d=–0.15, 95% CI –0.41 to 0.10). A similar pattern of between-group differences was found for the secondary outcomes. The NHSWBP group generally had larger within-group effects than the other groups and displayed a greater rate of change compared to the other groups on all outcomes, except for gratitude, where the rate of change was greatest for the MPS group. Conclusions Our analyses provided encouraging results for the use of brief digital psychological interventions in improving PWB among health and social care workers. Future multisite RCTs, with power to reliably detect differences, are needed to determine the efficacy of contextualized interventions relative to existing digital treatments. Trial Registration ISRCTN Registry (ISRCTN) ISRCTN18107122; https://www.isrctn.com/ISRCTN18107122

Interventions to support the mental health and well-being of front-line healthcare workers in hospitals during pandemics: an evidence review and synthesis

“…Figure 1 presents the PRISMA flow diagram of the study review and selection process. Overall, 27 papers from 26 studies (2 papers reported aspects of the same study) met the inclusion criteria 26–52. Heterogeneity of study designs and the outcomes reported meant that it was not possible to synthesise the effects of each outcome.…”

“…Most studies (22/26) related to the COVID-19 pandemic,29–33 35–522 related to influenza26 27 and 1 study to SARS28 and 1 to Ebola 34. A substantive number of interventions were premised on mitigating acute stress to prevent or minimise longer-term mental health problems.…”

“…A substantive number of interventions were premised on mitigating acute stress to prevent or minimise longer-term mental health problems. Overall, 3 studies described pandemic preparedness interventions,26 27 38 23 described interventions delivered during pandemics28–33 35–37 39–52 and 1 described a postpandemic intervention 34. These can be broadly be classified into preparedness and responsiveness to pandemics.…”

“…Twenty-four studies reported mental health outcomes for interventions delivered during or after a pandemic 28–37 39–52. Most studies (18/24) were individually directed with diverse aims that included: improving sleep, or decreasing stress, anxiety, depression, burnout and Post Traumatic Stress Disorder (PTSD).…”

“…Seven studies explored elements of relaxation, mindfulness and meditation 37 39 45–48 52. Three studies examined exercise-based interventions,35 36 50 two each focused on cognitive–behavioural therapy (CBT)-based interventions34 51 or mobile apps43 44 and three explored other interventions 29 30 40 49…”