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Randomized Controlled Trial
. 2024 Aug 30:26:e50071.
doi: 10.2196/50071.

Effectiveness of a Smartphone-Based Stress Management Program for Depression in Hospital Nurses During COVID-19 in Vietnam and Thailand: 2-Arm Parallel-Group Randomized Controlled Trial

Kazuhiro Watanabe  1 , Thuy Thi Thu Tran  2 , Narisara Sripo  3 , Asuka Sakuraya  4 , Kotaro Imamura  4 , Plernpit Boonyamalik  5 , Natsu Sasaki  6 , Thanate Tienthong  3 , Hiroki Asaoka  6 , Mako Iida  6 , Quynh Thuy Nguyen  2 , Nga Thi Nguyen  7 , Son Thai Vu  2 , Thuy Thi Ngo  8 , Tham Thi Luyen  8 , Long Duc Nguyen  9 , Nga Thi Viet Nguyen  9 , Binh Thanh Nguyen  9 , Yutaka Matsuyama  10 , Yukie Takemura  11 , Daisuke Nishi  6 , Akizumi Tsutsumi  1 , Huong Thanh Nguyen  7 , Orawan Kaewboonchoo  5 , Norito Kawakami  4
Affiliations
Randomized Controlled Trial

Effectiveness of a Smartphone-Based Stress Management Program for Depression in Hospital Nurses During COVID-19 in Vietnam and Thailand: 2-Arm Parallel-Group Randomized Controlled Trial

Kazuhiro Watanabe et al. J Med Internet Res. .

Abstract

Background: During the COVID-19 pandemic, health care professionals experienced high levels of depression. However, extant research has not highlighted effective internet-based psychological interventions to improve the mental health in this population during the pandemic. It remains unclear whether self-guided, internet-based cognitive behavioral therapy (iCBT) programs are effective in improving the mental health of health care workers during the COVID-19 pandemic.

Objective: The aim of this study was to evaluate the effectiveness of a smartphone-based iCBT stress management program for reducing the depression experienced by nurses in Vietnam and Thailand.

Methods: From March to April 2022, a 2-arm, parallel-group randomized controlled trial was implemented. One arm offered a 7-week self-guided iCBT program, and the other offered treatment as usual as a control arm. Full-time nurses were recruited from 6 hospitals: 2 hospitals in Vietnam and 4 hospitals in Thailand. The primary outcome of this program was the severity of depression measured by the Depression Anxiety Stress Scale-21 items. Follow-up surveys were conducted to measure the change in depression severity at 3 months (July-August 2022) and at 6 months (October-November 2022) after baseline. Mixed modeling for repeated measures was used to test the effects of the intervention compared with the control for the follow-up.

Results: A total of 1203 nurses were included in this study: 602 in the intervention group and 601 in the control group. The follow-up rate at 3 and 6 months ranged from 85.7% (515/601) to 87.5% (527/602). The completion rate for the program was 68.1% (410/602). The group difference in depression was significant at the 3-month follow-up (coefficient=-0.92, 95% CI -1.66 to -0.18; P=.02) and nonsignificant at the 6-month follow-up (coefficient=-0.33, 95% CI -1.11 to 0.45; P=.41). The estimated effect sizes were -0.15 and -0.06 at the 3- and 6-month follow-ups, respectively.

Conclusions: Our study shows that the smartphone-based iCBT program was effective in reducing depression at the 3-month follow-up among hospital nurses in Vietnam and Thailand during the COVID-19 pandemic. However, the effect size was small, and therefore, these results may not be clinically meaningful.

Trial registration: UMIN Clinical Trials Registry UMIN000044145; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050128.

International registered report identifier (irrid): RR2-10.20944/preprints202303.0450.v1.

Keywords: COVID-19; depression; digital mental health intervention; health care workers; mobile phone; nurses; unguided program; universal prevention.

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Conflict of interest statement

Conflicts of Interest: NK reports personal fees from Junpukai Foundation, Riken Institute, JAXA, Sekisui Chemical Co. Ltd, and SB@Work outside the submitted work. NK, KI, and AS are employed with the Department of Digital Mental Health, an endowment department that is supported by an unrestricted grant from 15 enterprises [40].

Figures

Figure 1
Figure 1
Flowchart of participant recruitment and allocation.
See this image and copyright information in PMC

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