Addressing the COVID-19 Mental Health Crisis: A Perspective on Using Interdisciplinary Universal Interventions

Mental health is reaching a crisis point due to the ramifications of COVID-19. In an attempt to curb the spread of the virus and circumvent health systems from being overwhelmed, governments have imposed regulations such as lockdown restrictions and home confinement. These restrictions, while effective for infection control, have contributed to poorer lifestyle behaviors. Currently, Positive Psychology and Lifestyle Medicine are two distinct but complimentary disciplines that offer an array of evidence-based approaches for promoting mental health and well-being across a universal population. However, these strategies for improving mental health are typically used in isolation. This perspective calls for a new paradigm shift to create and rollout well-designed interdisciplinary universal multicomponent mental health interventions that integrates the benefits of both disciplines, and uses innovative digital mental health solutions to achieve scalability and accessibility within the limitations and beyond the COVID-19 lockdown and restrictions

The Influence of Human Support on the Effectiveness of Digital Mental Health Promotion Interventions for the General Population

Mental wellbeing amongst the general population is languishing—exacerbated by the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health promotion interventions, that improve mental health literacy and encourage adoption of evidence-informed practical strategies are essential. However, attrition and non-adherence are problematic in digital interventions. Human support is often applied as an antidote; yet, there is a paucity of randomized trials that compare different human support conditions amongst general population cohorts. Limited trials generally indicate that human support has little influence on adherence or outcomes in DMHPIs. However, providing participants autonomy to self-select automated support options may enhance motivation and adherence

The Influence of Three Modes of Human Support on Attrition and Adherence to a Web- and Mobile App–Based Mental Health Promotion Intervention in a Nonclinical Cohort: Randomized Comparative Study

Background: The escalating prevalence of mental health disorders necessitates a greater focus on web- and mobile app–based mental health promotion initiatives for nonclinical groups. However, knowledge is scant regarding the influence of human support on attrition and adherence and participant preferences for support in nonclinical settings. Objective: This study aimed to compare the influence of 3 modes of human support on attrition and adherence to a digital mental health intervention for a nonclinical cohort. It evaluated user preferences for support and assessed whether adherence and outcomes were enhanced when participants received their preferred support mode. Methods: Subjects participated in a 10-week digital mental health promotion intervention and were randomized into 3 comparative groups: standard group with automated emails (S), standard plus personalized SMS (S+pSMS), and standard plus weekly videoconferencing support (S+VCS). Adherence was measured by the number of video lessons viewed, points achieved for weekly experiential challenge activities, and the total number of weeks that participants recorded a score for challenges. In the postquestionnaire, participants ranked their preferred human support mode from 1 to 4 (S, S+pSMS, S+VCS, S+pSMS & VCS combined). Stratified analysis was conducted for those who received their first preference. Preintervention and postintervention questionnaires assessed well-being measures (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing). Results: Interested individuals (N=605) enrolled on a website and were randomized into 3 groups (S, n=201; S+pSMS, n=202; S+VCS, n=201). Prior to completing the prequestionnaire, a total of 24.3% (147/605) dropped out. Dropout attrition between groups was significantly different (P=.009): 21.9% (44/201) withdrew from the S group, 19.3% (39/202) from the S+pSMS group, and 31.6% (64/202) from the S+VCS group. The remaining 75.7% (458/605) registered and completed the prequestionnaire (S, n=157; S+pSMS, n=163; S+VCS, n=138). Of the registered participants, 30.1% (138/458) failed to complete the postquestionnaire (S, n=54; S+pSMS, n=49; S+VCS, n=35), but there were no between-group differences (P=.24). For the 69.9% (320/458; S, n=103; S+pSMS, n=114; S+VCS, n=103) who completed the postquestionnaire, no between-group differences in adherence were observed for mean number of videos watched (P=.42); mean challenge scores recorded (P=.71); or the number of weeks that challenge scores were logged (P=.66). A total of 56 participants (17.5%, 56/320) received their first preference in human support (S, n=22; S+pSMS, n=26; S+VCS, n=8). No differences were observed between those who received their first preference and those who did not with regard to video adherence (P=.91); challenge score adherence (P=.27); or any of the well-being measures including, mental health (P=.86), vitality (P=.98), depression (P=.09), anxiety (P=.64), stress (P=.55), life satisfaction (P=.50), and flourishing (P=.47). Conclusions: Early dropout attrition may have been influenced by dissatisfaction with the allocated support mode. Human support mode did not impact adherence to the intervention, and receiving the preferred support style did not result in greater adherence or better outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.asp

The Effectiveness of an Online Interdisciplinary Intervention for Mental Health Promotion: A Randomized Controlled Trial

Background There is an urgent need for efficacious interventions to combat the global mental health crisis, and mental health promotion and primary prevention approaches are paramount. The aim of this study is to examine whether an online interdisciplinary intervention that incorporates evidence-based strategies from the disciplines of Lifestyle Medicine and Positive Psychology improves measures of mental health and emotional wellness. Methods A randomized controlled trial with a wait-list control (N = 425, aged 46.97 ± 14.5, 69.9% females) was conducted in Australia and New Zealand. The intervention group participated in a 10-week online interdisciplinary intervention. Primary outcome measures of mental health and emotional wellness were taken at baseline (Week 1), post-intervention (Week 12), and 12 weeks post-intervention (Week 24). The wait-list control completed the same assessments. Results General Linear Modelling analyses indicated that the intervention group experienced significantly greater improvements than the wait-list control group over time in all outcome measures: mental health (F(319) = 7.326, p = 0.007) and vitality (F(319) = 9.445, p = 0.002) subscales of the Short Form Survey (SF-36); depression (F(319) = 7.841, p = 0.005), anxiety (F(319) = 4.440, p = 0.36) and stress (F(319) = 12.494, p \u3c 0.001) scales of the Depression, Anxiety and Stress Scale (DASS-21); and life satisfaction (F(319) = 8.731, p = 0.003) as measured by the Satisfaction With Life Scale. Within the intervention group, significant improvements were observed from Week 1 to 12 in all outcome measures: mental health (10%, t(167) = − 6.423), p \u3c 0.001, dz = 0.50), vitality (22%, t(167) = − 7.043, p \u3c 0.001, dz = 0.54), depression (− 41%, t(167) = 6.189, p \u3c 0.001, dz = 0.48), anxiety (− 38%, t(167) = 5.030, p \u3c 0.001, dz = 0.39), stress (− 31%, t(167) = 6.702, p \u3c 0.001, dz = 0.52) and life satisfaction (8%, t(167) = − 6.199, p \u3c 0.001, dz = 0.48). Improvements in the outcome measures remained significant in the intervention group at 12 weeks post-intervention. Conclusion The online interdisciplinary intervention improved measures of mental health and emotional wellness suggesting that such interventions may be useful for mental health promotion and prevention

The Effect of an Online Multimodal Lifestyle Intervention on Mental Health and Emotional Wellness: A Randomised Control Trial

PURPOSE: This study examined the effect of an online multimodal lifestyle intervention, which incorporated evidence-based strategies from Lifestyle Medicine and Positive Psychology, on the mental health and emotional wellness of adults throughout Australia and New Zealand. BACKGROUND: Common mental health disorders have reached epidemic proportions worldwide (1). In the US, one in five adults have a common mental health disorder (2), and in Australia, a similar number have experienced an affective disorder in the past twelve months (3). Antidepressants are ranked in the top three most commonly used therapeutic drug classes in the US (4), and are the most commonly used psychotropic medications in Australia (5). A new paradigm is needed focusing on primary prevention to address this burgeoning mental health problem. METHODS: 508 individuals self-selected to participate in the study and were randomized to an intervention or delay-controlled group. Both groups completed an online survey using validated instruments which assessed the participantsʼ emotional wellness at three intervals: baseline, and at 3 months and 6 months post-intervention. 425 individuals completed the baseline assessment and entered the study (intervention n=217, control group n=208), and 359 (84%) completed the post intervention questionnaire. The intervention group participated in a 10-week online multimodal lifestyle intervention, called “The Live More Project” also known as The Lift Project”(6). RESULTS: Overall, the cohort was in the ‘normal’ range at baseline for the domains of emotional wellness measured. At 3 months, significant reductions were observed in symptoms of ‘depression’ (-31%, p\u3c0.001), ‘anxiety’ (-43%, p\u3c0.001) and ‘stress’ (-22%, p\u3c0.001) in the intervention compared to the control group. Significant improvements were observed in ‘mental health’ (8%, p\u3c0.001), ‘vitality’ (18%, p\u3c0.001) and overall ‘life 2 satisfaction’ (8%, p\u3c0.001). Improvements in the measures of mental health and emotional wellness were generally sustained in the 6-month follow-up. CONCLUSIONS: This study supports the use of an online multimodal lifestyle intervention combining strategies from Lifestyle Medicine and Positive Psychology for the promotion of mental health and emotional wellness among normal populations (i.e. primary prevention). Further analyses will examine the impact of the intervention on subnormal populations to assess its potential role in secondary and tertiary prevention

The Influence of Human Support on the Effectiveness of an Online Mental Wellbeing Intervention

Purpose: To compare the influence of three modes of human support on the outcomes of an online, lifestyle-focused mental health promotion intervention. Background: There is a need for efficacious lifestyle interventions to promote the mental wellbeing of both healthy and clinical cohorts. Evidence regarding the usefulness of adding human support (i.e. guidance) to improve the outcomes of online interventions for clinical populations is mixed,1-3 however little is known about healthy cohorts. Methods: A total of 458 participants self-selected to participate in a 10-week online, multimodal lifestyle intervention that addressed mental wellbeing. The participants were randomized into three groups, differentiated by support mode: standard - automated emails only (S); standard plus personalised SMS messages (S+pSMS); standard plus videoconference support (S+VCS). At pre- and post-intervention, the participants completed the following measures: the ‘mental health’ and ‘vitality’ sub-scales from the Short Form Health Survey (SF-36); Depression Anxiety and Stress Scales (DASS-21); Satisfaction With Life (SWL) scale; and Flourishing scale. Results: A total of 320 participants (S, n=103; S+pSMS, n=114; S+VCS, n=103) completed the study. Significant within-group changes were recorded from pre- to post-intervention in all groups for every outcome measure (PP=0.77), vitality (P=0.65), depression (P=0.93), anxiety (P=0.25), stress (P=0.57), SWL (P=0.65) or flourishing (P=0.99). Attendance at the weekly videoconference support sessions was poor, but those who attended seven or more of the ten sessions experienced significantly better outcomes in mental health (P=.006, d=0.71), vitality (P=.005, d=0.73), depression (P=.04, d=0.54), and SWL (P=.046, d=0.50), than those who attended less than seven. Conclusions: A lifestyle-focused, online mental health promotion intervention enhanced measures of mental wellbeing among a healthy cohort, irrespective of the human support provided. Supplementing a psychological intervention with videoconference support might improve outcomes, when attendance is optimised

The Effective of a Digital Multicomponent Interdisciplinary Intervention on the Mental Health and Wellbeing of a Nonclinical Australasian Cohort

The prevalence of depression and anxiety before the COVID-19 pandemic was estimated at 586 million worldwide, and this figure has subsequently increased. The current paradigm for preventing and managing mental health is predicated primarily on pharmacotherapy. This approach is not working, and there are urgent calls to use integrated non-pharmacological strategies. Studies have demonstrated the effectiveness of lifestyle medicine and positive psychology interventions to enhance mental health and wellbeing. However, no randomized controlled trial (RCT) has examined the effectiveness of a digital multicomponent interdisciplinary intervention for improving mental health and wellbeing in a nonclinical setting. In addition, the literature is sparse in understanding the gender and age responsiveness to digital mental wellbeing interventions. This thesis utilised two experimental studies (Study 1, randomized controlled trial, n=421; and Study 2, a randomized comparative study, n=458) to assess the effectiveness of a ten-week digital multicomponent interdisciplinary mental wellbeing intervention that used Persuasive System Design (PSD), principles and combined strategies from lifestyle medicine and positive psychology. The participants completed a questionnaire at baseline and post-intervention that assessed their mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing. Study 1 also included follow-up at 12 weeks post-intervention. Intervention adherence and engagement were also assessed. This thesis presents the findings of the studies in a coherent series of publications in scholarly journals and highlights several significant findings. First, the digital multicomponent interdisciplinary mental wellbeing intervention significantly improved all mental health and wellbeing measures amongst the Australasian nonclinical cohort. The outcomes measures remained significant at 12 weeks post-intervention for the intervention group. Second, the studies observed larger effect sizes than previous studies that utilised single-modality interventions, suggesting that a multicomponent interdisciplinary approach may yield compounding benefits. Third, gender and age did not influence adherence to the intervention that employed PSD principles to improve mental health and wellbeing. Last, the studies reported low attrition rates compared to the existing literature, which typically finds adherence and attrition problematic for digital delivery. In summary, a digital multicomponent interdisciplinary mental wellbeing intervention that uses a lifestyle medicine and positive psychology approach, and employs PSD principles, can significantly increase mental health and wellbeing across gender and age groups. Amid COVID-19 pandemic, there is an urgent need to implement interventions at a population-level–such as the one used in this thesis–that are cost-effective and easily disseminated. This thesis informs a potential way forward

The Influence of Gender and Age on the Outcomes of and Adherence to a Digital Interdisciplinary Mental Health Promotion Intervention in an Australasian Nonclinical Setting: Cohort Study

Background The global prevalence of mental health disorders is at a crisis point, particularly in the wake of COVID-19, prompting calls for the development of digital interdisciplinary mental health promotion interventions (MHPIs) for nonclinical cohorts. However, the influence of gender and age on the outcomes of and adherence to MHPIs is not well understood. Objective The aim of this study was to determine the influence of gender and age on the outcomes of and adherence to a 10-week digital interdisciplinary MHPI that integrates strategies from positive psychology and lifestyle medicine and utilizes persuasive systems design (PSD) principles in a nonclinical setting. Methods This study involved 488 participants who completed the digital interdisciplinary MHPI. Participants completed a pre and postintervention questionnaire that used: (1) the “mental health” and “vitality” subscales from the Short Form 36 (SF-36) Health Survey; (2) the Depression, Anxiety and Stress Scale (DASS-21); and (3) Satisfaction With Life Scale (SWL). Adherence to the digital interdisciplinary MHPI was measured by the number of educational videos the participants viewed and the extent to which they engaged in experiential challenge activities offered as part of the program. Results On average, the participants (N=488; mean age 47.1 years, SD 14.1; 77.5% women) demonstrated statistically significant improvements in all mental health and well-being outcome measures, and a significant gender and age interaction was observed. Women tended to experience greater improvements than men in the mental health and well-being measures, and older men experienced greater improvements than younger men in the mental health and vitality subscales. Multiple analysis of variance results of the adherence measures indicated a significant difference for age but not gender. No statistically significant interaction between gender and age was observed for adherence measures. Conclusions Digital interdisciplinary MHPIs that utilize PSD principles can improve the mental health and well-being of nonclinical cohorts, regardless of gender or age. Hence, there may be a benefit in utilizing PSD principles to develop universal MHPIs such as that employed in this study, which can be used across gender and age groups. Future research should examine which PSD principles optimize universal digital interdisciplinary MHPIs. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12619000993190; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377889 and Australian New Zealand Clinical Trials Registry ACTRN12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx </jats:sec

The Influence of Gender and Age on the Outcomes of and Adherence to a Digital Interdisciplinary Mental Health Promotion Intervention in an Australasian Nonclinical Setting: Cohort Study (Preprint)

BACKGROUND The global prevalence of mental health disorders is at a crisis point, particularly in the wake of COVID-19, prompting calls for the development of digital interdisciplinary mental health promotion interventions (MHPIs) for nonclinical cohorts. However, the influence of gender and age on the outcomes of and adherence to MHPIs is not well understood. OBJECTIVE The aim of this study was to determine the influence of gender and age on the outcomes of and adherence to a 10-week digital interdisciplinary MHPI that integrates strategies from positive psychology and lifestyle medicine and utilizes persuasive systems design (PSD) principles in a nonclinical setting. METHODS This study involved 488 participants who completed the digital interdisciplinary MHPI. Participants completed a pre and postintervention questionnaire that used: (1) the “mental health” and “vitality” subscales from the Short Form 36 (SF-36) Health Survey; (2) the Depression, Anxiety and Stress Scale (DASS-21); and (3) Satisfaction With Life Scale (SWL). Adherence to the digital interdisciplinary MHPI was measured by the number of educational videos the participants viewed and the extent to which they engaged in experiential challenge activities offered as part of the program. RESULTS On average, the participants (N=488; mean age 47.1 years, SD 14.1; 77.5% women) demonstrated statistically significant improvements in all mental health and well-being outcome measures, and a significant gender and age interaction was observed. Women tended to experience greater improvements than men in the mental health and well-being measures, and older men experienced greater improvements than younger men in the mental health and vitality subscales. Multiple analysis of variance results of the adherence measures indicated a significant difference for age but not gender. No statistically significant interaction between gender and age was observed for adherence measures. CONCLUSIONS Digital interdisciplinary MHPIs that utilize PSD principles can improve the mental health and well-being of nonclinical cohorts, regardless of gender or age. Hence, there may be a benefit in utilizing PSD principles to develop universal MHPIs such as that employed in this study, which can be used across gender and age groups. Future research should examine which PSD principles optimize universal digital interdisciplinary MHPIs. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12619000993190; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377889 and Australian New Zealand Clinical Trials Registry ACTRN12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx </sec