Text4PTSI: A Promising Supportive Text Messaging Program to Mitigate Psychological Symptoms in Public Safety Personnel

Abstract

Background: Public safety personnel experience various mental health conditions due to their work’s complex and demanding nature. There are barriers to seeking support and treatment; hence, providing innovative and cost-effective interventions can help improve mental health symptoms in public safety personnel. Objective: The study aimed to evaluate the impact of Text4PTSI on depression, anxiety, trauma, and stress-related symptoms, and the resilience of public safety personnel after six months of providing supportive text message intervention. Methods: Public safety personnel subscribed to Text4PTSI and received daily supportive and psychoeducational SMS text messages for six months. Participants were invited to complete standardized self-rated web-based questionnaires to assess depression, anxiety, posttraumatic stress disorder (PTSD), and resilience symptoms measured on the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 scale (GAD-7), Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), and the Brief Resilience Scale (BRS), respectively. The assessment of mental health conditions was conducted at baseline (enrolment) and six weeks, three months, and six months after enrollment. Results: One hundred and thirty-one subscribers participated in the Text4PTSI program, and eighteen completed both the baseline and any follow-up survey. A total of 31 participants completed the baseline survey and 107 total surveys were recorded at all follow-up time points. The baseline prevalence of psychological problems among public safety personnel were as follows: likely major depressive disorder (MDD) was 47.1%, likely generalized anxiety disorder (GAD) was 37.5%, low resilience was 22.2%, and likely PTSD was 13.3%. At six months post-intervention, the prevalence of likely MDD, likely GAD, and likely PTSD among respondents reduced; however, a statistically significant reduction was reported only for likely MDD (−35.3%, X2 (1) = 2.55, p = 0.03). There was no significant change in the prevalence of low resilience between baseline and post-intervention. There was a decrease in the mean scores on the PHQ-9, GAD-7, PCL-C, and the BRS from baseline to post-intervention by 25.8%, 24.7%, 9.5%, and 0.3%, respectively. However, the decrease was only statistically significant for the mean change in GAD-7 scores with a low effect size (t (15) = 2.73, p = 0.02). Conclusions: The results of this study suggest a significant reduction in the prevalence of likely MDD as well as the severity of anxiety symptoms from baseline to post-intervention for subscribers of the Text4PTSI program. Text4PTSI is a cost-effective, convenient, and easily scalable program that can augment other services for managing the mental health burdens of public safety personnel.

User Satisfaction With a Daily Supportive Text Message Program (Text4PTSI) for Public Safety Personnel: Longitudinal Cross-Sectional Study

“…Additionally, PSP often work long and irregular hours, making it challenging to maintain a healthy lifestyle and work-life balance. Another source of stress for PSP may include the culture of their organizations [ 6 ]. Many public safety agencies have a culture of stoicism and toughness, which can discourage employees from seeking help for mental health problems.…”

“…When supportive intervention is provided, most studies have demonstrated a decrease in mental health symptoms. For example, in a longitudinal study to assess the effectiveness of an SMS text message intervention, PSP who subscribed to the texting program reported that they were able to manage depression, anxiety, and other psychological symptoms [ 6 ]. Similarly, 10 randomized controlled trials providing therapeutic intervention through texting demonstrated a substantial improvement in psychological symptoms compared to conventional treatment [ 27 ].…”

Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study

“…Another related service, the Text4Hope-Addiction program, was introduced to people living with substance use disorders; the service reported significant improvement in standardized measures for craving, anxiety, and depression in subscribers [ 45 ]. Similarly, the Text4PTSI program significantly reduced psychological distress among public safety personnel postintervention [ 25 , 26 ].…”

“…SMS text messaging services such as Text4Support effectively reduced the risk of harm to self and other harm symptoms after 6 months of intervention in a randomized controlled trial [ 23 ] and improved distress, anxiety, and depression in clinical samples [ 24 ]. Similarly, the Text4PTSI program has achieved fidelity and significantly reduced psychological distress among public safety personnel post intervention [ 25 , 26 ]. SMS text message–based population-level messaging programs have reported user satisfaction rates of well over 80%, and most subscribers have reported feeling connected to support systems and improving their ability to manage anxiety, depression, and general life issues, suggesting an improvement in mental health literacy [ 15 , 27 - 29 ].…”

Mitigating Psychological Problems Associated with the 2023 Wildfires in Alberta and Nova Scotia: Six-Week Outcomes from the Text4Hope Program

“…In light of the psychological impact of wildfires, developing effective support and intervention strategies is essential to mitigate the long-term psychological impact on affected populations. Innovative, cost-efficient, technologically enabled, and easily scalable interventions, such as daily supportive SMS text messaging [14][15][16][17], may hold the key to the provision of support to impacted communities during and after wildfires. While the use of text messaging as an intervention in mental health has been explored in various contexts, its application in a wildfire-impacted population is a novel area for research [1,18].…”