Come Get Your Mental Health, at the Screen or on Your Phone!

Aussies love web and phone based interventions for health education and mental health, and are pre-eminent researchers and evaluators of digital services – probably because flesh and blood providers can be hard to come by in the vast, non-urban areas of this very big country that's also a continent.

This Australian study examines whether mental health self-efficacy (MHSE), a construct from Bandura's Social Learning Theory (SLT), influences the positive results of web-based interventions on such conditions as depression and anxiety.

(MHSE is the belief that we have some agency over our fate, and can master a situation and produce a positive outcome with our own efforts. Web-based interventions, of course, put the end-user in the driver's seat - they themselves execute their own results, at their own pace and on their own time.)

So it stands to reason that if you have strong feelings of self-efficacy, you might do well with an online intervention; and in the reverse, that an online intervention might enhance your feelings of self-efficacy.

In particular, the investigators looked at symptom improvement and functional outcomes of a new mobile phone and web-based psychotherapy intervention for people with mild-to-moderate depression, anxiety and stress.

Data from 49 people with symptoms of depression, anxiety and/or stress in the mild-to-moderate range were used to examine the reliability and validity of a new measure of MHSE, the Mental Health Self-efficacy Scale (MHSES).

Then they conducted a secondary analysis of data from a recently completed randomized controlled trial (N = 720) to evaluate whether MHSE effected post-intervention outcomes, as measured by the Depression, Anxiety and Stress Scales (DASS), and the Work and Social Adjustment Scale (WSAS), for people with symptoms in the mild-to-moderate range.

The data from the first study established that the MHSES comprised a unitary factor, with acceptable internal reliability (Cronbach's alpha = .89) and construct validity. In other words, it was a genuinely separate attribute to measure.

In the second study, the intervention group showed significantly greater improvement in MHSE at post-intervention relative to the control conditions (p's < = .000) and investigators determined that MHSE mediated the effects of the intervention on anxiety and stress symptoms.

Furthermore, people with low pre-treatment MHSE reported the greatest post-intervention gains in symptoms of depression, anxiety and overall distress. No effects were found for MHSE on work and social functioning.

The researchers conclude that mental health self-efficacy influences symptom outcomes of a self-guided mobile phone and web-based psychotherapeutic intervention, and may itself be a worthwhile target to increase the effectiveness and efficiency of online treatment programs.

Citation: Clarke J, Proudfoot J, Birch MR, Whitton AE, Parker G, Manicavasagar V, Harrison V, Christensen H, Hadzi-Pavlovic D. Effects of mental health self-efficacy on outcomes of a mobile phone and web intervention for mild-to-moderate depression, anxiety and stress: secondary analysis of a randomised controlled trial. BMC Psychiatry. 2014 Sep 26; 14:272. doi: 10.1186/s12888-014-0272-1.