Naturalistic randomized controlled trial demonstrating effectiveness of Text4Hope in supporting male population mental health during the COVID-19 pandemic

Abstract

Background: Mental illness is not uncommon among males. It is estimated that males are more likely to die by suicide, become dependent on alcohol, report frequent drug use, and be dissatisfied with their life, compared to women. In this study, we assessed the potential to offer support to this population using Text4Hope, a texting mental health service.

Methods: The study was a naturalistic randomized controlled trial comparing two populations of Text4Hope male subscribers; an intervention group (IG, Text4Hope subscribers who received once-daily supportive text messages for 6 weeks) and a control group (CG, Text4Hope subscribers who joined the program in the same time frame but were yet to receive text messages). Inferential statistics were used to compare the severity and the prevalence of the likely stress, anxiety, and depression, between the two groups, using the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder 7-item (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9), and defined the Composite Mental Health (CMH) score as the sum of these three. T-test, Chi-squared association, and binary logistic regression analyses were applied.

Results: There were 286 male subscribers to Text4Hope. The majority were above 40 years, white, employed, had postsecondary education, were in a relationship, and owned a home. Mean scores of PSS-10, GAD-7, and PHQ-9 scales and the CMH were significantly higher for the CG compared to the IG, 11.4, 28.8, 25.8, and 18.7%, respectively. Similarly, a statistically significantly lower prevalence in IG, compared to the CG, on likely MDD (58.15 vs. 37.4%) and likely GAD (50 vs. 30.8%), with a small effect size. The IG was a significant predictor for lower odds of both likely MDD and likely GAD while controlling for sociodemographic characteristics.

Conclusions: The Text4Hope service is an effective tool for mental health support for male subscribers during the COVID-19 pandemic. Compared to the males who didn't receive the service, those who received it were in better mental health conditions. Further effort is still needed to encourage males to participate in such online services that can help them receive adequate support, particularly during crisis times.

Keywords: COVID-19; Text4Hope; males; mental health; naturalistic randomized controlled trial; texting services.