Supportive Text Messaging for Mental Health Wellness

(Text4Support Trial)

Overseen By Raquel Luz Dias

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Vincent Agyapong

Disqualifiers: Non-English readers, No mobile phone, No consent

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 7

1500 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if supportive text messages can enhance mental health and well-being for individuals receiving psychiatric care. It compares the effectiveness of daily texts based on cognitive-behavioral therapy (CBT) principles with usual care. Participants are either new to mental health programs or recently discharged from psychiatric units. To join, participants must own a mobile phone capable of receiving texts and be able to read English messages. The study will assess whether these texts improve mental health, increase satisfaction, and affect healthcare use. As an unphased trial, this study provides a unique opportunity to contribute to innovative mental health solutions.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems to focus on adding supportive text messaging to your usual care.

What prior data suggests that this supportive text messaging program is safe for mental health patients?

Research has shown that supportive text messaging programs like Text4Support are generally safe for users. In past studies, participants responded well to these programs. For instance, a study on a similar program called Text4PTSI found that users were satisfied, with no reports of serious problems. These messages are based on cognitive-behavioral therapy (CBT), a common and safe method in mental health care.

Since Text4Support doesn't involve physical procedures, it is less likely to cause side effects compared to medical treatments. Participants usually receive daily automated messages aimed at supporting mental health, and this method has proven safe in other contexts. Overall, evidence suggests that supportive text messaging is a safe way to help improve mental health. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores a novel approach to mental health support using daily automated text messages. Unlike traditional methods such as therapy sessions or medication, this technique leverages technology to provide ongoing, unobtrusive support directly to individuals' phones. This approach offers the potential for continuous engagement and reinforcement of positive mental health practices, making support more accessible and possibly reducing barriers like cost and time. By integrating supportive messages into daily life, it could enhance the overall efficacy of standard care and provide an innovative, scalable solution for mental wellness.

What evidence suggests that this supportive text messaging program is effective for mental health wellness?

Studies have shown that supportive text messaging can improve mental health. In this trial, participants in the Text4Support arm will receive daily messages based on cognitive-behavioral therapy (CBT) techniques, which help reduce stress and anxiety. Research indicates that these messages effectively fill gaps in mental health care by providing ongoing support. For example, one study found that these interventions are affordable and easy to access, making them a practical choice for many people. Initial findings suggest that these messages can also increase patient satisfaction and lessen the need for more intensive therapies. Overall, supportive text messages are a promising tool for improving mental well-being. ^{4 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for new or recently discharged patients from psychiatric care in Nova Scotia who own a mobile device, can read English text messages, and are willing to provide consent. It's not suitable for those unable to read texts in English or without a capable mobile phone.

Inclusion Criteria

Can provide informed written consent

Being a new patient (i.e. first-time user) of the TMHP, DH, RASP or MHCC, OR being a patient discharged from the ED or PIU (i.e. within a week period before discharge date)

Ownership of a mobile device capable of receiving text messages

Exclusion Criteria

I cannot read text messages in English.

Patients who do not own a mobile phone capable of receiving text messages

Patients who are not able/willing to provide consent to take part in the study

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Informed Consent and Randomization

Participants provide informed consent and are randomized into intervention or control groups

1 week

1 visit (in-person or virtual)

Intervention

Participants in the intervention group receive daily supportive text messages for 12 months, while the control group receives usual care

12 months

Daily text messages

Follow-up

Participants complete online questionnaires at 6 weeks, 3, 6, and 12 months to assess mental health outcomes and satisfaction

12 months

4 online questionnaires

Qualitative Sub-study

A sub-sample of participants is invited to participate in individual interviews and focus groups to discuss their experiences

End of Year 2

1-2 visits (in-person or virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Mental health supportive text messages

Trial Overview The study tests if supportive daily text messages based on cognitive-behavioural therapy can improve mental health outcomes compared to usual care alone. Participants will be randomly assigned to receive either the text message program plus usual care or just the usual care.

How Is the Trial Designed?

Group I: Text4Support Arm Experimental Treatment 1 Intervention

Patients in the intervention (Text4Support) arm of the study will receive the usual care (i.e. community care, follow-up appointments), plus daily automated supportive text messages from an online application.

Group II: Care as usual arm Active Control 1 Intervention

Patients in the control arm of the study will receive the usual care, which includes the freely accessible Health Authority approved low-intensity e-mental health services. They will receive a single text message informing and encouraging them to utilize current MHAP resources on the NS Health website. They will not receive automated daily supportive text messages.

Mental health supportive text messages is already approved in Canada for the following indications:

Approved in Canada as Text4Support for:

• Mental health support
• Psychological distress management

Who Is Running the Clinical Trial?

Vincent Agyapong

Lead Sponsor

Trials

1

Recruited

1,500+

Nova Scotia Health Authority

Collaborator

Trials

302

Recruited

95,300+

Dalhousie University

Collaborator

Trials

177

Recruited

402,000+

Published Research Related to This Trial

After 3 months of using the Text4Hope program, participants (n = 373) reported significant reductions in anxiety (22.7%), depressive symptoms (10.3%), and perceived stress (5.7%), indicating its effectiveness in alleviating psychological distress during the pandemic.

The program also led to a notable decrease in the prevalence of moderate to high anxiety symptoms, suggesting that Text4Hope is a convenient and accessible intervention for improving mental health on a population level.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Text4Hope: Receiving Daily Supportive Text Messages for 3 Months During the COVID-19 Pandemic Reduces Stress, Anxiety, and Depression. Agyapong, VIO., Hrabok, M., Shalaby, R., et al.[2022]

SMS (text messaging) is a widely accessible communication tool that can be effectively utilized for health-related messaging, particularly in mental health care.

Technology-delivered interventions like SMS can support mental health patients in their treatment and recovery, providing a valuable resource for both patients and clinicians.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Short message service can be a promising tool for psychiatric patients and clinicians. Vernig, PM., Repique, RJ.[2015]

The Text4Mood program, launched by Alberta Health Services during the COVID-19 pandemic, provided free daily supportive text messages to over 32,000 subscribers within the first week, demonstrating a rapid response to mental health needs.

Crafted by mental health professionals, the program aimed to support individuals during quarantine and isolation, and has garnered interest from other regions looking to implement similar mental health initiatives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coronavirus Disease 2019 Pandemic: Health System and Community Response to a Text Message (Text4Hope) Program Supporting Mental Health in Alberta. Agyapong, VIO.[2021]

The Text4Support service, which provides supportive text messages to patients after discharge from psychiatric care, was well received by 40% of participants who reported high satisfaction with the service's impact on their mental well-being.

Participants suggested that future iterations of the service could benefit from more personalized messages and opportunities for interaction with healthcare personnel, indicating a desire for enhanced engagement in their mental health support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patients' Expectations and Experiences With a Mental Health-Focused Supportive Text Messaging Program: Mixed Methods Evaluation. Shalaby, R., Vuong, W., Eboreime, E., et al.[2022]

The Text4Hope texting service significantly improved mental health outcomes for male subscribers during the COVID-19 pandemic, with lower perceived stress, anxiety, and depression scores in those receiving daily supportive messages compared to those who did not.

Among the 286 male participants, those in the intervention group showed a lower prevalence of likely major depressive disorder (MDD) and generalized anxiety disorder (GAD), indicating that the service effectively supports mental health in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Naturalistic randomized controlled trial demonstrating effectiveness of Text4Hope in supporting male population mental health during the COVID-19 pandemic. Shalaby, R., Agyapong, B., Vuong, W., et al.[2023]

The Text4Support program, a text-messaging intervention based on cognitive behavioral therapy, aims to improve mental well-being for individuals dealing with addiction or mental health issues, and was evaluated over a 6-month period with surveys at baseline, 12 weeks, and 6 months.

Although the study did not have a large enough sample size to achieve statistical significance, it highlights the potential of digital technologies like text messaging to support mental health interventions and suggests areas for future research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Text4Support Mobile-Based Programming for Individuals Accessing Addictions and Mental Health Services-Retroactive Program Analysis at Baseline, 12 Weeks, and 6 Months. Noble, JM., Vuong, W., Surood, S., et al.[2021]

The Text4Hope service, which provided daily mental health text messages for six weeks, significantly reduced levels of moderate/high stress, generalized anxiety disorder (GAD), and major depressive disorder (MDD) among its subscribers compared to those who had not yet received messages.

Participants in the intervention group reported a 20.9% improvement in overall mental health scores, demonstrating that Text4Hope is an effective tool for alleviating mental health issues during the COVID-19 pandemic and suggesting that similar services could be beneficial in future crises.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mental Health Outreach via Supportive Text Messages during the COVID-19 Pandemic: Improved Mental Health and Reduced Suicidal Ideation after Six Weeks in Subscribers of Text4Hope Compared to a Control Population. Agyapong, VIO., Shalaby, R., Hrabok, M., et al.[2021]

Patients often feel vulnerable when accessing community mental health programs, leading to low adherence and dissatisfaction with treatment, which can result in recurrent hospitalizations.

The proposed Text4Support service, based on cognitive-behavioral therapy principles, aims to improve mental health outcomes and patient satisfaction for those attending or discharged from psychiatric care, potentially reducing the burden on the health care system.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Augmenting Mental Health Support for Patients Accessing Different Degrees of Formal Psychiatric Care through a Supportive Text Messaging Program: Protocol for a Randomized Controlled Trial. Dias, RDL., Shalaby, R., Agyapong, B., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12301639/

Impact of a supportive text messaging program ... Text-based interventions are an innovative way to bridge gaps in mental health care. Programs like Text4Support provide accessible, cost-effective mental ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT05411302

Study Details | NCT05411302 | Augmenting Mental Health ... Patients seeking mental health care and those being discharged from psychiatric units frequently express psychological distress. A lack of routine follow-up ...

3. frontiersin.org frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2023.1182267/full

The effectiveness of CBT-based daily supportive text ... The COVID-19 pandemic has significantly exacerbated gender disparities in mental health, particularly impacting women. To address this, Alberta, Canada, ...

4. journals.sagepub.com journals.sagepub.com/doi/abs/10.1177/20552076251361236

Impact of a supportive text messaging program ... Programs like Text4Support provide accessible, cost-effective mental health support using daily messages based on cognitive behavioral ...

5. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40727620/

Impact of a supportive text messaging program ... Affiliations. 1 Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada. 2 Department of Psychiatry, ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10001524/

Text4PTSI: A Promising Supportive Text Messaging ... Text4PTSI is a supportive daily text messaging program based on CBT and trauma therapy principles and aims to provide mental health support for public safety ...

7. formative.jmir.org formative.jmir.org/2023/1/e46431

User Satisfaction With a Daily Supportive Text Message ... Text4PTSI Program and Data Collection. Text4PTSI was launched in July 2021 to support PSP's mental health in Alberta, Canada [ ...

8. journals.sagepub.com journals.sagepub.com/doi/full/10.1177/20552076251361236

Impact of a supportive text messaging program ... This randomized controlled trial assesses the impact of Text4Support, a CBT-based supportive text messaging program, on mental health outcomes, ...

9. researchprotocols.org researchprotocols.org/2024/1/e44368

Psychological Health and Wellness and the Impact of ... Objective: The primary goal of this project is to design, implement, monitor, and evaluate a daily supportive SMS text messaging program ( ...