Research shows that text message reminders help improve the mental health of caregivers

Healthcare workers have reported a spike in feelings of burnout since the start of the COVID-19 pandemic, with nearly half saying the pandemic has taken a toll in 2022, compared to 32% in 2018. But a new survey shows that easy-to-use and accessible platforms can help reverse this trend.

Regular, automated text message reminders that connect staff to a mental health platform called ‘Cobalt’ led to significant improvements in both depression and anxiety scores among employees, according to a new study. JAMA network opened study from the Perelman School of Medicine at the University of Pennsylvania.

“What we found shows that connecting with people, letting them know that help is available and easily accessible, goes a long way to maximizing digital mental health interventions and platforms, leading to important, tangible results,” said the lead author of the study. , Anish Agarwal, MD, MPH, MS, assistant professor of emergency medicine and associate director of the Center for Insights to Outcomes.

“Mental health platforms continue to grow and evolve, but until now not enough research has been done on them and how to optimize their use, especially among healthcare professionals. Work like ours is important as health care systems across the country look to better help their workforce meet the challenges they face.”

COBALT is available as an open-source, web-based platform for any healthcare system and is specifically designed to support healthcare workers seeking mental health care. It includes resources such as podcasts, articles and worksheets, routes for planning one-on-one sessions with therapists, doctors, resilience coaches, and also offers group sessions focused on specific issues, such as mindfulness or anti-racism. The platform also provides access to urgent interventions for people in need of emergency assistance.

Since COBALT launched at Penn Medicine in spring 2020, two other institutions have also adopted the platform. The platform was launched in just two weeks during the first wave of the COVID-19 pandemic. Within 30 days, more than 5,000 people had gained access to the platform. Now a total of more than 100,000 people have access to the platform, spread across the three institutions that use it.

The new research found that users’ self-reported depression symptom scores improved by about 11% six months after workers engaged in COBALT. This was measured with the Patient Health Questionnaire (PHQ-9), in which responses to a survey result in a score used to help assess potential levels of depression. Participating employees included doctors, nurses, technicians, registrars and others.

There were two groups: an intervention group, which received monthly automated reminder text messages about mental health and COBALT availability, and a control group, which only had access to the free platform but no proactive outreach. After nine months, scores improved by just over 22% in both groups.

Although overall scores showed improvement across the board, the effect observed in the intervention group that received text message reminders about the program was noticeably greater. Scores improved by more than 20% six months after these participants first connected to COBALT, and by 30% after nine months. According to the PHQ-9 scale, the latter brought the average score from the lower end of ‘mild depression symptoms’ to just a hair above ‘no symptoms’.

The control group, which received no messages, improved by about 5% after six months and 12% after nine months.

“This study is one of the few evidence-based approaches shown to improve the mental health of healthcare workers post-pandemic,” said the study’s senior author, Raina Merchant, MD, chief of transformation at the University of Pennsylvania Health System and a professor of emergency medicine.

“Our work shows that health care systems have a unique opportunity to provide substantial support to this critical workforce.”

When it came to anxiety – measured similarly to depression with an instrument called the Generalize Anxiety Disorder Assessment (GAD-7) – the control group did not experience a significant improvement in their score after six months (about 4%), but the nine-month assessment showed seeing a significant improvement of 13%.

Again, the intervention arm of the study showed greater improvements in symptom scores at both six and nine months: approximately 17 and 30%, respectively. As with the depression symptom scores, the average anxiety score over nine months fell just short of indicating no symptoms.

“Overall, these numbers clearly indicate that the reception of the digital boost has been very positive and welcome and helped people prioritize their mental health and feel cared for,” said Lisa Bellini, MD, senior vice dean for Academic Affairs and professor of Medicine. at the Perelman School of Medicine.

In the future, the research team hopes to further improve the route to connecting the workforce with COBALT to overcome the barriers for healthcare professionals to connect to mental health care and make the approach easily applicable to other healthcare systems.

“COBALT is a simple, easy-to-use and scalable way to reach our workforce,” said Agarwal. “Mental health is so important, yet many of us don’t take the time to check in with ourselves or remember where to go when we need help. This approach offers insights on ways to reach people and make it even easier to make to connect to worry.”