背景:精神疾病是全球普遍存在的公共卫生问题。居民弱势群体,例如生活在农村医疗服务不足地区(MUA)或精神卫生提供者短缺地区(MHPSAs)的人,面临着获得精神卫生保健的独特障碍。尽管使用关系代理技术的数字心理健康干预措施有所增加,对它们的使用模式知之甚少,功效,以及居民弱势群体的好感。
目的:本研究旨在探讨应用程序使用的差异,治疗联盟,心理健康结果,以及住宅子群体的满意度(大都市,非大都市,或农村),MUAs(是或否),以及基于智能手机的用户中的MHPSA(是或否),数字心理健康干预,WoebotLIFE(WB-LIFE)。WB-LIFE旨在帮助用户更好地理解和管理他们的情绪和功能关系代理,Woebot,通过基于文本的消息交谈。
方法:我们使用了一项探索性研究,该研究检查了在8周内注册的255名成年人的数据,WB-LIFE的单臂试验。分析比较了应用程序使用水平和治疗联盟总分以及子量表(目标,任务,和债券),心理健康结果(抑郁和焦虑症状,压力,弹性,和倦怠),以及住宅子群体的计划满意度。
结果:很少有研究参与者居住在非大都市地区(25/255,10%)或农村地区(3/255,1%)。排除对这一变量的估计。尽管大部分都是大都市样本,近39%(99/255)存在于MUA中,55%(141/255)存在于MHPSA中。根据MUA或MHPSA状态,应用程序使用或满意度没有显着差异。抑郁症状也没有差异,焦虑,压力,弹性,或者倦怠,在中等范围或更高范围(患者健康问卷-8项量表≥10)的人群中,MUA参与者的基线抑郁症状高于非MUA参与者(分别为16.50vs14.41;P=.01).尽管工作联盟得分因MHPSA地位而没有差异,那些居住在MUA的人有更高的目标(双尾t203.47=2.21;P=.03),和债券(t203.47=1.94;P=0.05)在第3天得分(t192.98=2.15;P=0.03),与未生活在MUA中的人相比,第8周的目标得分更高(t186.19=2.28;P=0.02)。
结论:尽管这项研究没有招募许多来自农村或非大城市的参与者,相当大的比例存在于MUA或MHPSA中。分析显示,在应用程序使用方面几乎没有差异,治疗联盟,心理健康结果(包括基线水平),在为期8周的研究中,MUA或MHPSA状态的满意度。研究结果表明,脆弱的居住人群可能会从使用数字代理指导的认知行为疗法中受益。
背景:ClinicalTrials.govNCT05672745;https://clinicaltrials.gov/study/NCT05672745。
BACKGROUND: Mental illness is a pervasive worldwide public health issue. Residentially vulnerable populations, such as those living in rural medically
underserved areas (MUAs) or mental health provider shortage areas (MHPSAs), face unique access barriers to mental health care. Despite the growth of digital mental health interventions using relational agent technology, little is known about their use patterns, efficacy, and favorability among residentially vulnerable populations.
OBJECTIVE: This
study aimed to explore differences in app use, therapeutic alliance, mental health outcomes, and satisfaction across residential subgroups (metropolitan, nonmetropolitan, or rural), MUAs (yes or no), and MHPSAs (yes or no) among users of a smartphone-based, digital mental health intervention, Woebot LIFE (WB-LIFE). WB-LIFE was designed to help users better understand and manage their moods and features a relational agent, Woebot, that converses through text-based messages.
METHODS: We used an exploratory
study that examined data from 255 adults enrolled in an 8-week, single-arm
trial of WB-LIFE. Analyses compared levels of app use and therapeutic alliance total scores as well as subscales (goal, task, and bond), mental health outcomes (depressive and anxiety symptoms, stress, resilience, and burnout), and program satisfaction across residential subgroups.
RESULTS: Few
study participants resided in nonmetropolitan (25/255, 10%) or rural (3/255, 1%) areas, precluding estimates across this variable. Despite a largely metropolitan sample, nearly 39% (99/255) resided in an MUA and 55% (141/255) in an MHPSA. There were no significant differences in app use or satisfaction by MUA or MHPSA status. There also were no differences in depressive symptoms, anxiety, stress, resilience, or burnout, with the exception of MUA participants having higher baseline depressive symptoms among those starting in the moderate range or higher (Patient Health Questionnaire-8 item scale≥10) than non-MUA participants (mean 16.50 vs 14.41, respectively; P=.01). Although working alliance scores did not differ by MHPSA status, those who resided in an MUA had higher goal (2-tailed t203.47=2.21; P=.03), and bond (t203.47=1.94; P=.05) scores at day 3 (t192.98=2.15; P=.03), and higher goal scores at week 8 (t186.19=2.28; P=.02) as compared with those not living in an MUA.
CONCLUSIONS: Despite the study not recruiting many participants from rural or nonmetropolitan populations, sizable proportions resided in an MUA or an MHPSA. Analyses revealed few differences in app use, therapeutic alliance, mental health outcomes (including baseline levels), or satisfaction across MUA or MHPSA status over the 8-week study. Findings suggest that vulnerable residential populations may benefit from using digital agent-guided cognitive behavioral therapy.
BACKGROUND: ClinicalTrials.gov NCT05672745; https://clinicaltrials.gov/study/NCT05672745.