Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 21, 2019
Date Accepted: Jun 13, 2020
A Novel Multi-modal Online Service (MOST+) for Help-Seeking Young People experiencing Mental ill-health: a Pilot Evaluation within a National Youth E-Mental Health Service
ABSTRACT
Background:
Mental ill-health is the leading cause of disability worldwide. 75% of mental health conditions emerge between the ages of 12 and 25. Unfortunately, due to lack of resources, the majority of young people suffering from mental-ill health have no access to evidence-based support. In addressing this gap, our team has developed a multimodal, scalable online mental health service (MOST+) merging: real-time, clinician-delivered web chat counselling, interactive user-directed online therapy, expert and peer moderation, and secure peer-to-peer social networking.
Objective:
The primary objective of this study was to ascertain the feasibility, acceptability, and safety of MOST+. Secondary aims were to assess pre-post changes in clinical, psychosocial and wellbeing outcomes and to explore the correlations between system usage, perceived helpfulness, and secondary outcome variables.
Methods:
157 help-seeking young people seeking help from a national youth e-mental health service were recruited over 5 weeks. MOST+ was active for 9 weeks. All participants had access to interactive user-directed online therapy and integrated web chat counselling. Additional access to peer-to-peer social networking was granted to 73 participants (46%) whose age could be confirmed and for whom it was deemed safe. The intervention was evaluated via an uncontrolled single-group study.
Results:
Ninety-three participants completed the follow-up assessment. Baseline measures indicated that most participants suffered from moderate (33%) to severe (61%) mental health conditions. All a priori feasibility, acceptability and safety criteria were met. Participants provided mean scores of 3.5 (out of 5) on ease of use (M=3.7, SD=1.1), relevancy (M=3.9, SD=1.0), helpfulness (M=3.5, SD=0.9) and overall experience (M= 3.9, SD=0.8). 98% reported a positive experience using MOST+, 86% considered it helpful, 82% reported that using MOST+ helped them feel better, 86% felt more socially connected using it and 92% would recommend it to others. No serious adverse events or inappropriate use were detected during the study and 97% participants reported feeling safe. There were statistically significant improvements in eight of 11 secondary outcomes assessed: psychological distress (d=-0.39, p< 0.001), perceived stress (d=-0.44, p<0.001), psychological wellbeing (d=0.51, p<0.001), depression (d=-0.29, p=0.008), loneliness (d=-0.23, p=0.04), social support (d=0.30, p=0.004), autonomy (d=0.36, p=0.001) and self-competence (d=0.30, p=0.005). There were significant correlations between indicators of system usage, perceived helpfulness as well as number of secondary outcome variables.
Conclusions:
MOST+ is a feasible, acceptable and safe online clinical service for young people suffering from mental ill-health. The high level of perceived helpfulness, the significant improvements in secondary outcomes, and the correlations between indicators of system usage and outcomes variables, provide initial support for the therapeutic potential of MOST+. MOST+ stands as a promising and scalable platform to deliver stand-alone e-mental health services as well as enhance the growing international network of face-to-face youth mental health services. Clinical Trial: ACTRN12617000370303
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