DIGITAL MENTAL HEALTH: MODERATORS AND MECHANISMS OF AN ONLINE MENTAL HEALTH INTERVENTION
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Date
2024-12-06
Authors
Pettitt, Adam
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Publisher
University of Oregon
Abstract
In the last few decades, digital approaches to mental health treatment has become more prevalent and widespread in an effort to make mental health treatment more accessible to a wider range of individuals. This dissertation aimed to identify and characterize the moderators and mechanisms of a digital mental health intervention (DMHI). Because of the nascent nature of the field, much of the research that has been conducted has focused on if digital mental health interventions are effective. Much of that research has shown it to be on-par with in-person interventions. However, little research has examined the mechanisms by which these interventions are effective. Across five sub-studies, this dissertation sought to elucidate some of the underlying mechanisms for who this DMHI is effective for, how individuals interact with the DMHI, and identify the underlying mechanisms of improvement in symptoms of depression and anxiety. Participants were drawn from a larger sample of individuals who participated in the Meru Health Program, which is a DMHI platform available to the public. Participants underwent an 8-week or 12-week intervention (depending on which version they were given) that focused on therapeutic techniques derived from Cognitive Behavioral Therapy, Mindfulness Based Stress Reduction, and other evidence-based therapies. Participants were administered demographic questions at the beginning of the intervention and administered depression and anxiety questionnaires at enrolment and every 2 weeks until the end of treatment. The analyses used in this dissertation were mixed-methods ranging from mixed-effects modeling to qualitative thematic analyses aimed at understanding the underlying mechanisms for efficacy within the MHP. Results from Chapter 1 Study 1 revealed that across age, gender, and race, the DMHI was effective for all groups, and in particular (from Chapter 1 Study 2) there was a disproportionate drop in suicidality within gender expansive individuals when compared with cis gender individuals. Additionally, results from Chapter 2 study 1 indicate that participants engaged in messaging with their therapist for a wide array of reasons, including rapport building and solving tech difficulties. Further analyses in Chapter 2 Study 2 revealed that, within the first week, days active within the app was the most predictive of completion of the DMHI. Finally, the results from Chapter 3 demonstrated that improvements in HRV across the DMHI are associated with reductions in depressive symptoms. The implications of these findings and proposed areas for ongoing research are discussed.
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Keywords
Anxiety, Depression, Digital Mental Health, heart rate variability, Treatment moderators