Digital mental health intervention by the World Health Organization (WHO) found to lower anxiety and depression, with improvements maintained at 3‑month follow-up

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WHO dig­i­tal men­tal health inter­ven­tion effec­tive in reduc­ing depres­sion among Syr­i­an refugees in Lebanon (press release):

A new dig­i­tal men­tal health inter­ven­tion, Step-by-Step, devel­oped by the World Health Orga­ni­za­tion (WHO) with the Nation­al Men­tal Health Pro­gramme (NMHP) at the Min­istry of Pub­lic Health Lebanon and oth­er part­ners, was effec­tive in reduc­ing depres­sion among Syr­i­an refugees in Lebanon, accord­ing to a study pub­lished in PLOS Medicine.

The study, a ran­dom­ized con­trolled tri­al, sup­port­ed by Elrha’s Research for Health in Human­i­tar­i­an Crises (R2HC), was con­duct­ed among Syr­i­ans suf­fer­ing from depres­sion and impaired func­tion­ing in Lebanon. It found that peo­ple who received the dig­i­tal inter­ven­tion with remote guid­ance from trained non-spe­cial­ist helpers were sig­nif­i­cant­ly less depressed and had sig­nif­i­cant­ly bet­ter func­tion­ing after the inter­ven­tion com­pared with those who received enhanced usu­al care in the con­trol group. Peo­ple who received Step-by-Step also showed improve­ments in symp­toms of anx­i­ety, post-trau­mat­ic stress, well-being and per­son­al prob­lems, with all improve­ments main­tained at 3‑month fol­low-up. This study sup­ports results from a par­al­lel tri­al of Step-by-Step with Lebanese and oth­er pop­u­la­tions liv­ing in Lebanon, which showed sim­i­lar pos­i­tive results … Step-by-Step is a 5‑session WHO dig­i­tal inter­ven­tion designed to treat depres­sion through an inter­net-con­nect­ed device, with week­ly sup­port (e.g. a 15 minute call or mes­sage) from trained non-spe­cial­ist helpers. It pro­vides psy­choe­d­u­ca­tion and train­ing in behav­iour­al acti­va­tion (e.g. doing more pleas­ant activ­i­ties) through an illus­trat­ed nar­ra­tive, with addi­tion­al ther­a­peu­tic tech­niques such as stress man­age­ment, a grat­i­tude exer­cise, pos­i­tive self-talk, strength­en­ing social sup­port, and relapse prevention.

The Study:

Effects of a WHO-guid­ed dig­i­tal health inter­ven­tion for depres­sion in Syr­i­an refugees in Lebanon: A ran­dom­ized con­trolled tri­al (PLOS Med­i­cine). From the Abstract:

  • Back­ground: Most dis­placed peo­ple with men­tal dis­or­ders in low- and mid­dle-income coun­tries do not receive effec­tive care, and their access to care has dete­ri­o­rat­ed dur­ing the Coro­n­avirus Dis­ease 2019 (COVID-19) pan­dem­ic. Dig­i­tal men­tal health inter­ven­tions are scal­able when dig­i­tal access is ade­quate, and they can be safe­ly deliv­ered dur­ing the COVID-19 pan­dem­ic. We exam­ined whether a new WHO-guid­ed dig­i­tal men­tal health inter­ven­tion, Step-by-Step, in which par­tic­i­pants were sup­port­ed by a non­spe­cial­ist helper, was effec­tive in reduc­ing depres­sion among dis­placed peo­ple in Lebanon.
  • Meth­ods and find­ings: We con­duct­ed a sin­gle-blind, 2‑arm prag­mat­ic ran­dom­ized clin­i­cal tri­al, com­par­ing guid­ed Step-by-Step with enhanced care as usu­al (ECAU) among dis­placed Syr­i­ans suf­fer­ing from depres­sion and impaired func­tion­ing in Lebanon. Pri­ma­ry out­comes were depres­sion (Patient Health Ques­tion­naire, PHQ‑9) and impaired func­tion­ing (WHO Dis­abil­i­ty Assess­ment Sched­ule-12, WHODAS) at post­treat­ment. Sec­ondary out­comes includ­ed sub­jec­tive well-being, anx­i­ety, post-trau­mat­ic stress, and self-described prob­lems … Sig­nif­i­cant effects on all out­comes were main­tained at 3 months fol­low-up. Dur­ing the tri­al, one seri­ous adverse event occurred, unre­lat­ed to the inter­ven­tion. The main lim­i­ta­tion of the cur­rent tri­al is the high dropout rate.
  • Con­clu­sions: In this study, we found that a guid­ed, dig­i­tal inter­ven­tion was effec­tive in reduc­ing depres­sion in dis­placed peo­ple in Lebanon. The guid­ed WHO Step-by-Step inter­ven­tion we exam­ined should be made avail­able to com­mu­ni­ties of dis­placed peo­ple that have dig­i­tal access.

The Study in Context: