Psychological Health and Wellness and the Impact of a Supportive Text Messaging Program (Wellness4MDs) Among Physicians and Medical Learners in Canada: Protocol for a Longitudinal Study.

BACKGROUND: Burnout, anxiety, and depression continue to affect physicians, postgraduate medical trainees, and medical students globally and in Canada particularly after the COVID-19 pandemic. OBJECTIVE: The primary goal of this project is to design, implement, monitor, and evaluate a daily supportive SMS text messaging program (Wellness4MDs, Global Psychological e-Health Foundation). The program aims to reduce the prevalence and severity of burnout, anxiety, and depression symptoms among physicians, postgraduate medical trainees, and medical students in Canada. METHODS: This longitudinal study represents a multistakeholder, mixed methods, multiyear implementation science project. Project evaluation will be conducted through a quantitative prospective longitudinal approach using a paired sample comparison, a naturalistic cross-sectional controlled design, and satisfaction surveys. Prevalence estimates for psychological problems would be based on baseline data from self-completed validated rating scales. Additional data will be collected at designated time points for paired comparison. Outcome measures will be assessed using standardized rating scales, including the Maslach Burnout Inventory for burnout symptoms, the 9-item Patient Health Questionnaire for depression symptoms, the 7-item Generalized Anxiety Disorder scale for anxiety symptoms, and the World Health Organization-Five Well-Being Index. RESULTS: The project launched in the last quarter of 2023, and program evaluation results will become available within 36 months. The Wellness4MDs program is expected to reduce the prevalence and severity of psychological problems among physicians in Canada and achieve high subscriber satisfaction. CONCLUSIONS: The results from the Wellness4MDs project evaluation will provide key information regarding the effectiveness of daily supportive SMS text messages and links to mental health resources on these mental health parameters in Canadian physicians, postgraduate trainees, and medical students. Information will be useful for informing policy and decision-making concerning psychological interventions for physicians in Canada. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44368.

Comparing Email Versus Text Messaging as Delivery Platforms for Supporting Patients With Major Depressive Disorder: Noninferiority Randomized Controlled Trial.

BACKGROUND: The prevalence of major depressive disorder (MDD) poses significant global health challenges, with available treatments often insufficient in achieving remission for many patients. Digital health technologies, such as SMS text messaging-based cognitive behavioral therapy, offer accessible alternatives but may not reach all individuals. Email communication presents a secure avenue for health communication, yet its effectiveness compared to SMS text messaging in providing mental health support for patients with MDD remains uncertain. OBJECTIVE: This study aims to compare the efficacy of email versus SMS text messaging as delivery platforms for supporting patients with MDD, addressing a critical gap in understanding optimal digital interventions for mental health care. METHODS: A randomized noninferiority pilot trial was conducted, comparing outcomes for patients receiving 6-week daily supportive messages via email with those receiving messages via SMS text message. This duration corresponds to a minimum of 180 days of message delivery. The supportive messages maintained consistent length and structure across both delivery methods. Participants (N=66) were recruited from the Access 24/7 clinic in Edmonton, Alberta, among those who were diagnosed with MDD. The outcomes were measured at baseline and 6 months after enrollment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Well-Being Index (WHO-5). RESULTS: Most of the participants were females (n=43, 65%), aged between 26 and 40 years (n=34, 55%), had high school education (n=35, 58%), employed (n=33, 50%), and single (n=24, 36%). Again, most participants had had no history of any major physical illness (n=56, 85%) and (n=61, 92%) responded "No" to having a history of admission for treatment of mood disorders. There was no statistically significant difference in the mean changes in PHQ-9, GAD-7, and WHO-5 scores between the email and SMS text messaging groups (mean difference, 95% CI: -1.90, 95% CI -6.53 to 2.74; 5.78, 95% CI -1.94 to 13.50; and 11.85, 95% CI -3.81 to 27.51), respectively. Both supportive modalities showed potential in reducing depressive symptoms and improving quality of life. CONCLUSIONS: The study's findings suggest that both email and SMS text messaging interventions have equivalent effectiveness in reducing depression symptoms among individuals with MDD. As digital technology continues to evolve, harnessing the power of multiple digital platforms for mental health interventions can significantly contribute to bridging the existing treatment gaps and improving the overall well-being of individuals with depressive conditions. Further research is needed with a larger sample size to confirm and expand upon these findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT04638231; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/.

Depression, anxiety, and poor well-being at discharge from psychiatric hospitals: prevalence and risk factors.

Background: Being ready for discharge is vital to successful hospital-to-home transitions. For many patients, however, the transition from psychiatric hospital care to outpatient care can be challenging. An in-depth understanding of the mental health conditions of patients at discharge is crucial and instructive for recovery research. Objective: The purpose of this study was to determine the prevalence and risk factors of depression, anxiety, and poor well-being symptoms among patients who are about to be discharged from psychiatric units in Alberta, Canada. Our aim was to help determine the prevalence of anxiety, depression, and overall well-being among the general psychiatric inpatient population in Alberta before discharge and the potential factors which may influence this. Methods: This epidemiological study used a cross-sectional quantitative survey from March 8, 2022, to November 5, 2023, to assess depression, anxiety, and well-being. Participants were invited to complete an online questionnaire that contained demographics, clinical information, and responses to the PHQ-9, GAD-7, and WHO-5 questionnaires. SPSS version 25 was used to analyze the data. Descriptive, univariate, and multivariate regression analyses were employed. Result: The study found that the prevalence of likely depression, anxiety, and poor well-being among patients about to be discharged was 37.1%, 56.4%, and 48.3%, respectively. Based on a logistic regression model, there was a statistically significant association between anxiety, depression, and poor well-being diagnoses and multiple socio-demographic and clinical factors such as ethnicity, primary mental health diagnoses, education level, housing status, depression, anxiety, and well-being at baseline. Conclusion: Mental health assessment at discharge is a critical step in the recovery and transition of care. There is still a need for further research to identify the underlying causes and robust predictors of mental health symptoms in patients about to be discharged and to provide appropriate interventions and supportive resources both before and following discharge. Future research utilizing these findings may help identify key opportunities to improve outcomes for patients after discharge.

2023 Wildfires in Canada: Living in Wildfire Regions in Alberta and Nova Scotia Doubled the Odds for Residents to Experience Likely Generalized Anxiety Disorder Symptoms.

Background: Wildfires have become increasingly prevalent in various regions, resulting in substantial environmental and psychological consequences that have garnered increasing attention. Objective: This study aims to examine the prevalence of likely Generalized Anxiety Disorder (GAD) and explore the determinants of likely GAD during the wildfires in Alberta and Nova Scotia. Methods: Data were collected online through a cross-sectional survey from 14 May-23 June 2023. Alberta and Nova Scotia participants self-subscribed to the program by texting 'HopeAB' or 'HopeNS' to a short code, respectively. The GAD-7-validated tool was used to collect information on likely GAD. Results: This study included 298 respondents while one hundred and twelve respondents lived in a region of Alberta/Nova Scotia affected by the wildfires (37.7%). The prevalence of likely GAD among the respondents was 41.9%. Respondents who lived in a region of Alberta/Nova Scotia recently impacted by the wildfires were twice as likely to experience GAD symptoms (OR = 2.4; 95% C.I. 1.3-4.3). Conclusions: The study's identification of a statistically significant relationship between residing in a wildfire-impacted region and likely GAD shows the association between environmental and psychological well-being. However, the relatively small sample size and self-reported assessment of GAD symptoms may limit the generalizability of the findings. Further research involving a larger sample size delving into potential predictors could facilitate strategies for mitigating the mental health consequences of natural disasters.

Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study.

BACKGROUND: Cancer is the leading cause of death in Canada, and living with cancer generates psychological demands, including depression and anxiety among cancer survivors and caregivers. Text4Hope-Cancer Care SMS text messaging-based service was provided to people with cancer and caregivers during the COVID-19 pandemic to support their mental health. OBJECTIVE: The aim of this study is to examine the clinical effectiveness of and satisfaction with Text4Hope-Cancer Care in addressing mental health conditions among people living with cancer and caregivers. METHODS: The study was conducted in Alberta, Canada. People who were diagnosed or receiving cancer treatment and caregivers self-subscribed to receive 3-months daily supportive cognitive behavioral therapy-based SMS text messages and a web-based survey was sent at designated time points to collect clinical and nonclinical data. The Hospital Anxiety and Depression scale (HADS) was used to examine changes in anxiety and depression symptoms after receiving the service. Satisfaction with the service was assessed using a survey with a Likert scale. Descriptive and inferential statistics were used, and test significance was considered with P≤.05. RESULTS: Overall, 107 individuals subscribed to the service, and 93 completed the program (completion rate 93/107, 86.9%). A significant improvement in the anxiety symptoms (HADS-Anxiety [HADS-A] subscale) was reported after 3 months of Text4Hope-Cancer Care (t11=2.62; P=.02), with medium effect size (Hedges g=0.7), but not depression symptoms (HADS-Depression [HADS-D] subscale). Subscribers expressed high satisfaction and agreed that the service has helped them to cope with mental health symptoms and improve their quality of life. Most subscribers read the SMS text messages more than once (30/30, 100%); took time to reflect or took a beneficial action after reading the messages (27/30, 90%); and highly agreed (27/30, >80%) with the value of the received supportive SMS text messages as being relevant, succinct, affirmative, and positive. All subscribers recommended SMS text messaging for stress, anxiety, and depression and for cancer care support (30/30, 100%). CONCLUSIONS: Text4Hope-Cancer Care was well-perceived and effectively addressed anxiety symptoms among people living with cancer and caregivers during the peak of the COVID-19 pandemic. This study provides evidence-based support and insight for policy and stakeholders to implement similar convenient, economic, and accessible mental health services that support vulnerable populations during crises. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/20240.

Exploring the prevalence and predictors of low resilience and likely PTSD in residents of two provinces in Canada during the 2023 wildfires.

Background: The recent wildfires in Canada serve as a stark example of the substantial and enduring harm they cause to the health of individuals and communities. Assessing the prevalence and correlates of Post-traumatic stress disorder (PTSD) and low resilience is valuable for policymakers in public health. Objectives: The study aimed to assess the prevalence and predictors of low resilience and likely PTSD among subscribers of Text4Hope, an e-mental health program that delivered daily supportive messages to residents of Nova Scotia (NS) and Alberta(AB) during the recent wildfires. Method: Data collection was through a self-administered online survey completed by residents of the affected regions of NS and AB from May 14 to June 23, 2023. Data were analyzed using Statistical Package for the Social Sciences. Results: Out of 298 respondents, the prevalence of low resilience and likely PTSD in our sample were 52.0 and 39.3%, respectively. Unemployed respondents were about 3 times more likely to experience both low resilience and PTSD symptoms compared to those employed. Respondents with a history of mental health diagnosis were about 4 times more likely to experience likely PTSD compared to those with no history of mental health diagnosis. Conclusion: This study established that unemployment and a history of mental health diagnosis predicted likely PTSD, while unemployment was associated with low resilience during the wildfire. These findings offer insights for clinical interventions and the creation of psychosocial support programs for vulnerable populations.

Devastating Wildfires and Mental Health: Major Depressive Disorder Prevalence and Associated Factors among Residents in Alberta and Nova Scotia, Canada.

Background: Since March 2023, hundreds of fires have burned from coast to coast throughout the country, placing Canada on track to have the worst wildfire season ever recorded. From East to West, provinces such as Quebec, Ontario, Nova Scotia, Alberta, and British Columbia have been particularly affected by large and uncontrollable wildfires. Objectives: The objective of this study was to determine the prevalence of depression symptoms and predictors among residents living in extreme climate conditions during the Canadian wildfires of 2023 in Alberta and Nova Scotia and to update the literature with data related to those wildfires. Methods: A cross-sectional quantitative survey was conducted in this study. REDCap was used to administer an online survey between 14 May and 23 June 2023. Through the Text4Hope program, participants subscribe to receive supportive SMS messages daily. As part of the initial welcome message, participants were invited to complete an online questionnaire, containing demographic information, wildfire-related information, and responses to the Patient Health Questionnaire-9 (PHQ-9) for depression assessment. SPSS version 25 was used to analyze the data. Descriptive, univariate, and multivariate regression analyses were employed. Results: A total of 298 respondents completed the survey out of 1802 who self-subscribed to the Text4Hope program in Alberta and Nova Scotia and received a link to the online survey, producing a response rate of 16.54%. Most of the respondents were females (85.2%, 253), below 40 years of age (28.3%, 84), employed (63.6%, 189), and in a relationship (56.4%, 167). A historical depression diagnosis (OR = 3.15; 95% CI: 1.39-7.14) was a significant predictor of moderate to severe MDD in our study. The unemployed individuals were two times more likely to report moderate to severe symptoms of MDD than employed individuals (OR = 2.46; 95% CI: 1.06-5.67). Among the total sample population, the moderate to severe MDD prevalence was 50.4%, whereas it was 56.1% among those living in areas affected by wildfires. Conclusion: Based on our study findings, unemployment and a history of depression diagnosis were independently significant risk factors associated with the developing moderate to severe MDD symptoms during wildfire disasters. Further research is required to identify robust predictors of mental health disorders in disaster survivors and provide appropriate interventions to the most vulnerable communities and individuals.

Effectiveness of Group Physical Exercise in Treating Major Depressive Disorder: An Analysis of Secondary Data from an Aborted Randomized Trial.

BACKGROUND: Depression is highly prevalent and a significant cause of mortality and morbidity across the globe. Although antidepressants and/or psychotherapy are often used to treat depression, some recent studies indicate that exercise may play an important role in lowering depression symptoms among patients meeting the clinical criteria of a depressive episode. OBJECTIVES: This study aimed to evaluate the mental health and wellbeing of adult participants diagnosed with major depressive disorder (MDD) after fourteen weeks of receiving a supervised physical exercise program. METHODS: In a pre-post design, the assessments were performed at baseline, seven weeks and fourteen weeks following the exercise intervention program using facilitated self-reported psychometric scales. The Beck Depression Inventory (BDI-2) and Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) were used to assess depression. The short form of the International Physical Activity Questionnaire (IPAQ) was used for the self-reporting of participants' physical activity. RESULTS: At the beginning of the study, the baseline total mean scores and standard deviations for the BDI-2, CORE-OM, and IPAQ in both genders did not differ significantly (p-value > 0.05). Patients showed significant improvement in all assessment scales after completing fourteen weeks of the physical exercise program. Based on the BDI-2, the baseline score dropped from 31.25 (indicating moderate to severe depression) to 14.25 (indicating mild to minimal depression), with a p-value of <0.001. The CORE-OM total mean score was reduced from 1.91 to 0.98 with a significant p-value < 0.005 indicating effective clinical improvement in depression symptoms. The IPAQ total MET-minutes/week mean score increased from 1713.22 to 4367.62, indicating an improvement in the participants' weekly P.E. intake; however, the change was not statistically significant (p = 0.07). CONCLUSIONS: Exercise treatment is linked with considerable therapeutic improvement in patients with MDD, particularly when exercise is sustained over time. The BDI-2 and CORE-OM total scores significantly decreased after the fourteen-week P.E. programme, indicating a change from moderate and severe depression to minimal and mild depression. Our findings offer insightful information to primary care doctors and psychiatrists, indicating that prescribing exercise to depressed patients may be a helpful adjunctive therapy.

Reducing wait times and avoiding unnecessary use of high-cost mental health services through a Rapid Access and Stabilization Program: protocol for a program evaluation study.

BACKGROUND: Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. In light of this evidence there is a pressing need to provide accessible mental health services in flexible yet cost-effective ways. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative for people in need of mental health care without requiring emergency department visits or hospitalization. This new service is referred to as the Rapid Access and Stabilization Program (RASP). This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners' (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population. METHOD: This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison (pre- and post-evaluation study) will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison (cohort study) will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and health care partners' impressions. DISCUSSION: We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days, in both within-subject and between-subject comparisons. In addition, we anticipate that patients, healthcare providers and healthcare partners would express high levels of satisfaction with the new service. CONCLUSION: This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.

Distributed Medical Education (DME) in psychiatry: perspectives on facilitators, obstacles, and factors affecting psychiatrists' willingness to engage in teaching activities.

BACKGROUND: Distributed Medical Education (DME), a decentralized model focused on smaller cities and communities, has been implemented worldwide to bridge the gap in psychiatric education. Faculty engagement in teaching activities such as clinical teaching, supervision, and examinations is a crucial aspect of DME sites. Implementing or expanding DME sites requires careful consideration to identify enablers that contribute to success and barriers that need to be addressed. This study aims to examine enablers, barriers, and factors influencing psychiatrists' willingness to start or continue participating in teaching activities within Dalhousie University's Faculty of Medicine DME sites in two provinces in Atlantic Canada. METHODOLOGY: This cross-sectional study was conducted as part of an environmental scan of Dalhousie Faculty of Medicine's DME programs in Nova Scotia (NS) and New Brunswick (NB), Canada. In February 2023, psychiatrists from seven administrative health zones in these provinces anonymously participated in an online survey. The survey, created with OPINIO, collected data on sociodemographic factors, practice-related characteristics, medical education, and barriers to teaching activities. Five key outcomes were assessed, which included psychiatrists' willingness to engage in (i) clinical training and supervision, (ii) lectures or skills-based teaching, (iii) skills-based examinations, (iv) training and supervision of Canadian-trained psychiatrists, and (v) training and supervision of internationally trained psychiatrists. The study employed various statistical analyses, including descriptive analysis, chi-square tests, and logistic regression, to identify potential predictors associated with each outcome variable. RESULTS: The study involved 60 psychiatrists, primarily male (69%), practicing in NS (53.3%), with international medical education (69%), mainly working in outpatient services (41%). Notably, 60.3% lacked formal medical education training, yet they did not perceive the lack of training as a significant barrier, but lack of protected time as the main one. Despite this, there was a strong willingness to engage in teaching activities, with an average positive response rate of 81.98%. The lack of protected time for teaching/training was a major barrier reported by study participants. Availability to take the Royal College of Physicians and Surgeons of Canada Competency by Design training was the main factor associated with psychiatrists' willingness to participate in the five teaching activities investigated in this study: willingness to participate in clinical training and supervision of psychiatry residents (p = .01); provision of lectures or skills-based teaching for psychiatry residents (p < .01); skills-based examinations of psychiatry residents (p < .001); training/supervision of Canadian-trained psychiatrists (p < .01); and training and supervision of internationally trained psychiatrists (p < .01). CONCLUSION: The study reveals a nuanced picture regarding psychiatrists' engagement in teaching activities at DME sites. Despite a significant association between interest in formal medical education training and willingness to participate in teaching activities, clinicians do not consider the lack of formal training as a barrier. Addressing this complexity requires thoughtful strategies, potentially involving resource allocation, policy modifications, and adjustments to incentive structures by relevant institutions.

Mitigating Psychological Problems Associated with the 2023 Wildfires in Alberta and Nova Scotia: Six-Week Outcomes from the Text4Hope Program.

Background: In 2023, wildfires led to widespread destruction of property and displacement of residents in Alberta and Nova Scotia, Canada. Previous research suggests that wildfires increase the psychological burden of impacted communities, necessitating population-level interventions. Cognitive Behavioural Therapy (CBT)-based text message interventions, Text4HopeAB and Text4HopeNS, were launched in Alberta and Nova Scotia, respectively, during the 2023 wildfire season to support the mental health of impacted individuals. Objectives: The study examines the effectiveness of Text4HopeNS and Text4HopeAB in alleviating psychological symptoms and improving wellbeing among subscribers. Methods: The study involved longitudinal and naturalistic controlled trial designs. The longitudinal study comprised subscribers who completed program surveys at baseline and six weeks post-enrolment, while the naturalistic controlled study compared psychological symptoms in subscribers who had received daily supportive text messages for six weeks (intervention group) and new subscribers who had enrolled in the program during the same period but had not yet received any text messages (control group). The severity of low resilience, poor mental wellbeing, likely Major Depressive Disorder (MDD), likely Generalized Anxiety Disorder (GAD), likely Post-Traumatic Stress Disorder (PTSD), and suicidal ideation were measured on the Brief Resilience Scale (BRS), the World Health Organization-5 Wellbeing Index (WHO-5), Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) scale, PTSD Checklist-Civilian Version (PCL-C), and the ninth question on the PHQ-9, respectively. The paired and independent sample t-tests were employed in data analysis. Results: The results from the longitudinal study indicated a significant reduction in the mean scores on the PHQ-9 (-12.3%), GAD-7 (-14.8%), and the PCL-C (-5.8%), and an increase in the mean score on the WHO-5, but not on the BRS, from baseline to six weeks. In the naturalistic controlled study, the intervention group had a significantly lower mean score on the PHQ-9 (-30.1%), GAD-7 (-29.4%), PCL-C (-17.5%), and the ninth question on the PHQ-9 (-60.0%) which measures the intensity of suicidal ideation, and an increase in the mean score on the WHO-5 (+24.7%), but not on the BRS, from baseline to six weeks compared to the control group. Conclusions: The results of this study suggests that the Text4Hope program is an effective intervention for mitigating psychological symptoms in subscribers during wildfires. This CBT-based text messaging program can be adapted to provide effective support for individuals' mental health, especially in the context of traumatic events and adverse experiences such as those induced by climate change. Policymakers and mental health professionals should consider these findings when shaping strategies for future disaster response efforts, emphasizing the value of scalable and culturally sensitive mental health interventions.

Subscribers' Perspectives and Satisfaction with the MoreGoodDays Supportive Text Messaging Program and the Impact of the Program on Self-Rated Clinical Measures.

Background: Young adults (18 to 30 years of age) are confronted with numerous challenges, such as academic stressors and peer pressure. The MoreGoodDays program was co-designed with young adults to alleviate psychological issues, improve their mental well-being and provide support for young adults in Alberta during the COVID-19 pandemic and beyond. Objective: The current study aimed to explore subscribers' perspectives and satisfaction with the MoreGoodDays supportive text messaging program and the impact of the program on self-rated clinical measures. Methods: Subscribers of the MoreGoodDays program were invited via a link delivered in a text message to complete online evaluation surveys at six weeks, three months and six months. Program perception and satisfaction questions were adapted from those used to evaluate related programs. Anxiety, depression and PTSD symptoms were respectively assessed using the Generalized Anxiety Disorder-7 scale, the Patient Health Questionnaire-9 scale and the PTSD Civilian Checklist 5, and resilience levels were assessed using the Brief Resilience Scale (BRS). Data were analyzed with SPSS version 26 for Windows utilizing descriptive and inferential statistics. Results: There was a total of 168 respondents across the three follow-up time points (six weeks, three months and six months). The overall mean satisfaction with the MoreGoodDays program was 8.74 (SD = 1.4). A total of 116 (69.1%) respondents agreed or strongly agreed that MoreGoodDays messages helped them cope with stress, and 118 (70.3) agreed the messages helped them cope with loneliness. Similarly, 130 (77.3%) respondents agreed that MoreGoodDays messages made them feel connected to a support system, and 135 (80.4) indicated the program helped to improve their overall mental well-being. In relation to clinical outcomes, the ANOVA test showed no significant differences in mean scores for the PHQ-9, GAD-7 and PCL-C scales and the BRS from baseline to the three follow-up time points. In addition, there was no statistically significant difference in the prevalence of likely GAD, likely MDD, likely PTSD and low resilience at baseline and at six weeks. Conclusions: Notwithstanding the lack of statistically significant clinical improvement in subscribers of the MoreGoodDays program, the high program satisfaction suggests that subscribers accepted the technology-based intervention co-created with young adults, and this offers a vital tool to complement existing programs.

A Scoping Review of Adult Inpatient Satisfaction with Mental Health Services.

Patient satisfaction with hospital services has been increasingly discussed as an important indicator of healthcare quality. It has been demonstrated that improving patient satisfaction is associated with better compliance with treatment plans and a decrease in patient complaints regarding doctors' and nurses' misconduct. This scoping review's objective is to investigate the pertinent literature on the experiences and satisfaction of patients with mental disorders receiving inpatient psychiatric care. Our goals are to highlight important ideas and explore the data that might serve as a guide to enhance the standard of treatment and patient satisfaction in acute mental health environments. This study is a scoping review that was designed in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) statement. A systematic search was conducted in the following databases: PubMed, MEDLINE, PsycINFO, CINAHL, and EMBASE. A comprehensive review was completed, including articles from January 2012 to June 2022. Qualitative and quantitative studies were included in this review based on our eligibility criteria, such as patient satisfaction as a primary outcome, adult psychiatric inpatients, and non-review studies published in the English language. Studies were considered ineligible if they included nonpsychiatric patients or patients with neurocognitive disorders, review studies, or study measure outcomes other than inpatient satisfaction. For the eligible studies, data extraction was conducted, information was summarized, and the findings were reported. A total of 31 studies representing almost all the world's continents were eligible for inclusion in this scoping review. Different assessment tools and instruments were used in the included studies to measure the level of patients' satisfaction. The majority of the studies either utilized a pre-existing or newly created inpatient satisfaction questionnaire that appeared to be reliable and of acceptable quality. This review has identified a variety of possible factors that affect patients' satisfaction and can be used as a guide for service improvement. More than half of the included studies revealed that the following factors were strongly recommended to enhance inpatient satisfaction with care: a clear discharge plan, less coercive treatment during the hospital stay, more individualized, higher quality information and teaching about the mental disorder to patients by staff, better therapeutic relationships with staff, and specific treatment components that patients enjoy, such as physical exercise sessions and music therapy. Patients also value staff who spend more time with them. The scope of patient satisfaction with inpatient mental health services is a growing source of concern. Patient satisfaction is associated with better adherence to treatment regimens and fewer complaints against health care professionals. This scoping review has identified several patient satisfaction research gaps as well as important determinants of satisfaction and how to measure and utilize patient satisfaction as a guide for service quality improvement. It would be useful for future research and reviews to consider broadening their scope to include the satisfaction of psychiatric patients with innovative services, like peer support groups and other technologically based interventions like text for support. Future research also could benefit from utilizing additional technological tools, such as electronic questionnaires.

Status after Hospital Discharge: An Observational Study of the Progression of Patients' Mental Health Symptoms Six Weeks after Hospital Discharge.

(1) Background: Transitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise. We collected data for this study as part of a pragmatic cluster-randomized, longitudinal approach in Alberta. As the first phase of the ongoing innovative supportive program, this paper assessed the progression of mental health symptoms in patients six weeks after hospital discharge. Factors that may contribute to the presence or absence of anxiety and depression symptoms, as well as well-being, following return to the community were investigated. This provides evidence and baseline data for future phases of the project. (2) Methods: An observational study design was adopted for this study. Data on a variety of sociodemographic and clinical factors were collected at discharge and six weeks after via REDCap. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5), respectively. Descriptive, chi-square, independent t-tests, and multivariate regression analyses were conducted. (3) Result: The survey was completed by 88 out of 306 participants (28.8% response rate). The chi-square/Fisher exact test and independent t-test revealed no significant change in the mental health conditions from baseline to six weeks after discharge. It was found that the only significant factor predicting symptoms six weeks after discharge from inpatient treatment was the baseline symptoms in all three logistic regression models. It was four times more likely for those who experienced anxiety and depression at baseline to experience anxiety and depression symptoms six weeks after discharge (OR = 4.27; 95% CI: 1.38-13.20) (OR = 4.04; 95% CI: 1.25-13.05). Those with poor baseline well-being were almost 12 times more likely to experience poor well-being six weeks after discharge (OR = 11.75; 95% CI: 3.21-42.99). (4) Conclusions: Study results found no significant change in mental health conditions in the short term following hospital discharge. It is essential that researchers and policymakers collaborate in order to implement effective interventions to support and maintain the mental health conditions of patients following discharge.

The effectiveness of CBT-based daily supportive text messages in improving female mental health during COVID-19 pandemic: results from the Text4Hope program.

Introduction: The COVID-19 pandemic has significantly exacerbated gender disparities in mental health, particularly impacting women. To address this, Alberta, Canada, launched Text4Hope, a Cognitive Behaviour Therapy-based text messaging intervention, to provide support and resources for psychological challenges during the pandemic. This study aimed to assess the effectiveness of Text4Hope in reducing stress, anxiety, depression, sleeping disturbances, and suicidal ideation among female subscribers during the COVID-19 pandemic. Methods: The study employed both an uncontrolled longitudinal design and a controlled cohort design. The uncontrolled longitudinal study analyzed a one-year dataset (n = 9,545) of clinical outcomes, comparing mean differences in mental health symptoms from baseline to 6 weeks after subscription. The controlled cohort design compared two groups, with (n = 1,763) and without (n = 567) intervention exposure during the same period. Data were collected through self-administered online surveys completed at baseline and six weeks after subscription. Sociodemographic information and validated scales (e.g., 10-item Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire (PHQ-9)) were used to assess mental health outcomes. Results: The results from the longitudinal study indicated a significant reduction in anxiety prevalence and anxiety symptoms, with a 19.63% decrease in GAD-7 mean score and a 32.02% decrease in likely anxiety from baseline to six weeks. Depressive symptoms and perceived stress also showed a significant reduction (p < 0.001), albeit to a lesser extent. In the controlled cohort study, the intervention group had significantly (p < 0.001) lower PHQ-9 [19.5 (SD 7.05)], GAD-7 [7.5 (SD 5.27)], and CMH [35.53 (SD 18.45)] scores. Additionally, the study found substantial differences (p < 0.001) in suicidal ideation (26.1 vs. 15.7) between groups but no significant differences in sleep disruption. Discussion: These findings suggest that Text4Hope could be an effective intervention for reducing stress, depression, suicidal ideation, and particularly anxiety symptoms among women during public emergencies. The study provides valuable insights into the potential benefits of text messaging interventions in supporting mental health during crisis situations.

Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review.

BACKGROUND: The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. OBJECTIVE: This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. METHODS: This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. RESULTS: From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. CONCLUSIONS: In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.

Comparison of Resilience, Personal Recovery, and Quality of Life Measures Pre- and Post-Discharge from Inpatient Mental Health Units in Alberta: Analysis of Control Group Data from a Randomized Trial.

Background: The transition from hospital to community settings for most mental health service users is often hindered by challenges that affect community adjustment and continuity of care. The first few weeks and days after discharge from mental health inpatient units represent a critical phase for many service users. This paper aims to evaluate the changes in the resilience, personal recovery, and quality of life status of individuals with mental health challenges recently discharged from acute mental health care into the community. Methods: Data for this study were collected as part of a pragmatic stepped-wedge cluster-randomized, longitudinal approach in Alberta. A paired sample t-test and Chi-squared/Fisher test were deployed to assess changes from baseline to six weeks in the recovery assessment scale (RAS), brief resilience scale (BRS), and EuroQol-5d (EQ-5D), using an online questionnaire. Results: A total of 306 service users were recruited and 88 completed both baseline and six weeks, giving a response rate of 28.8%. There was no statistically significant change in the level of resilience, recovery and quality of life as measured with the brief resilience scale, recovery assessment scale and EQ-5D from baseline to six weeks (p > 0.05). Conclusions: The study showed that there was neither an improvement nor deterioration in resilience, recovery, or quality of life status of service users six weeks post-discharge from inpatient mental health care. The lack of further progress calls into question whether the support available in the community when patient's leave inpatient care is adequate to promote full recovery. The results justify investigations into the effectiveness of innovative and cost-effective programs such as peer and text-based supportive interventions for service users discharged from inpatient psychiatric care.

Exploring Sociodemographic Characteristics, Adverse Childhood Experience, and Mental Health History as Predictors of Anxiety and Depression among Adolescents and Young Adults: Findings from the MoreGoodDays Support Program in Alberta, Canada.

BACKGROUND: The COVID-19 pandemic has increased psychological disorders among adolescents and young adults. METHODS: This study used a cross-sectional design. An online survey questionnaire was used to collect sociodemographic and clinical information from subscribers of MoreGoodDays program, a daily supportive text message program co-designed with adolescents and young adults for their peers in Alberta. Validated instruments, the Generalized Anxiety Disorder GAD-7 scale and Patient Health Questionnaire-9 PHQ-9 were used to collect information on likely GAD and likely major depressive disorder (MDD). Data was analyzed with SPSS version 25 using chi-squared tests and binary logistic regression analysis. RESULTS: 343 subscribers of MoreGoodDays participated in the survey. Overall, 117 (56.0%) respondents had a likely MDD and 97 (46.6%) had a likely GAD. Participants who would like to receive mental health counselling were 27 times more likely to experience GAD (OR = 27; 95% CI: 3.09-250.00) and 40 times more likely to experience MDD (OR = 40.03; 95% CI: 4.43-361.51) than those who did not. Respondents who had received mental health counselling in the past were 18.5 times more likely to experience MDD compared with those who had not (OR = 18.52; 95% CI: 1.55-200.00). Demographic variables, including age, education, employment, and relationship status, and clinical variables, such as history of anxiety, depression, obsessive-compulsive disorder, ADHD, and adverse childhood experience, did not independently the predict presence of likely GAD or MDD in subscribers of MoreGoodDays. CONCLUSION: The prevalence of anxiety and depression was relatively high among subscribers of MoreGoodDays, indicating the long-term effect of the COVID-19 pandemic. This finding has significant implications in the broader contextof mental health research and emphasizes the need for more research into innovative mental health support for this cohort. The desire to receive counselling was predictive of both anxiety and depression and is a positive sign of the openness of this cohort to receive psychological intervention. Since this group is mostly adapted to mobile text technology, government agencies and policymakers should prioritize and implement readily accessible interventions such as supportive text messages to support their psychological well-being.

User Satisfaction With a Daily Supportive Text Message Program (Text4PTSI) for Public Safety Personnel: Longitudinal Cross-Sectional Study.

BACKGROUND: Public safety personnel (PSP) are exposed to traumatic events due to their work environments, which increases the risk of mental health challenges. Providing effective and evidence-based interventions, such as SMS text messaging programs, can improve PSP's overall mental well-being with high user satisfaction rates. OBJECTIVE: This study aims to evaluate users' satisfaction, receptiveness, and perceptions of a cognitive behavioral therapy (CBT)-based supportive SMS text messaging intervention (Text4PTSI). METHODS: Participants self-subscribed to Text4PTSI and received unidirectional cognitive behavioral-based supportive text messages for 6 months. Participants completed a web-based survey delivered via SMS text message at enrollment, and 6 weeks, 3 months, and 6 months post enrollment. Respondents' perception and receptivity of the program were assessed using a questionnaire measured on a 5-point Likert scale. Data were collected as categorical variables, and overall satisfaction with the Text4PTSI program was measured on a scale from 0 to 100. RESULTS: There were 131 subscribers to the Text4PTSI program; however, only 81 subscribers responded to the survey, producing 100 survey responses across the 3 follow-up time points. The overall mean score of satisfaction was 85.12 (SD 13.35). More than half of the survey responses agreed or strongly agreed that Text4PTSI helped participants cope with anxiety (79/100 responses, 79%), depressive symptoms (72/100 responses, 72%), and loneliness (54/100 responses, 54%). Similarly, most of the survey responses agreed or strongly agreed that the Text4PTSI program made respondents feel connected to a support system, improved their overall mental well-being (84/100 responses, 84%), felt more hopeful about managing concerns about their mental health or substance use (82 out of responses, 82%), and helped enhance their overall quality of life (77/100 responses, 77%). The available survey responses suggest that the majority always read the supportive text messages (84/100 responses, 84%), took time to reflect on each message (75/100 responses, 75%), and returned to read the text messages more than once (76/100 responses, 76%). CONCLUSIONS: PSP who responded to the follow-up surveys reported high user satisfaction and appreciation for receiving the Text4PTSI intervention during the 6-month program. The reported satisfaction with the service provided could pave the way to ensuring a better uptake of the service with potential effectiveness to end users.

Assessing Resilience and Its Correlates among Residents of Fort McMurray during the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic has led to a global health crisis that has affected the psychological well-being of individuals across the world. The persistence of the pandemic and measures to curtail it have tested people's ability to cope successfully and bounce back from the pandemic, otherwise referred to as resilience. The present study examined resilience levels among residents of Fort McMurray and identified the demographic, clinical and social factors associated with resilience. METHODS: The study used a cross-sectional survey design and collected data from 186 participants using online questionnaires. The survey included questions assessing sociodemographic information, mental health history and COVID-19-related variables. The main study outcome was resilience measured using the six-item Brief Resilience Scale (BRS). The data from the survey were analyzed using chi-squared tests and binary logistic regression analyses in the Statistical Package for Social Sciences (SPSS), version 25. RESULTS: The results showed that seven independent variables (age, history of depression, history of anxiety, willingness to receive mental health counselling, support from the government of Alberta and support from employer) were statistically significant within the context of the logistic regression model. A history of an anxiety disorder was demonstrated to best predict low resilience. Participants who had a history of anxiety disorder were five times more likely to show low resilience compared to those without such a history. Participants with a history of depression showed a three-fold likelihood of having low resilience in comparison to those who did not have a history of depression. Individuals who expressed a desire to receive mental health counselling had a four-times likelihood of having low resilience than those who did not express a desire to receive mental health counselling. The results also showed that younger participants were more prone to low resilience compared to older participants. Receiving support from the government and one's employer is a protective factor. CONCLUSIONS: This study highlights the importance of examining resilience and its associated factors during a pandemic such as COVID-19. The results demonstrated that a history of anxiety disorder, depression and being younger were important predictors of low resilience. Responders who reported the desire to receive mental health counselling also reported expressing low resilience. These findings could be used to design and implement interventions aimed at improving the resilience of individuals affected by the COVID-19 pandemic.