A New Mental Health Mobile App for Well-Being and Stress Reduction in Working Women: Randomized Controlled Trial

Cássia Canha Coelhoso, Patricia Renovato Tobo, Shirley Silva Lacerda, Alex Heitor Lima, Carla Regina Camara Barrichello, Edson Amaro Jr, Elisa Harumi Kozasa, Cássia Canha Coelhoso, Patricia Renovato Tobo, Shirley Silva Lacerda, Alex Heitor Lima, Carla Regina Camara Barrichello, Edson Amaro Jr, Elisa Harumi Kozasa

Abstract

Background: Although the availability and use of mobile mental health apps has grown exponentially in recent years, little data are available regarding their efficacy.

Objective: This study aimed to evaluate the effectiveness of an app developed to promote stress management and well-being among working women compared with a control app.

Methods: Female employees at a private hospital were invited to participate in the study via mailing lists and intranet ads. A total of 653 individuals self-enrolled through the website. Eligible participants were randomized between control (n=240) and intervention (n=250) groups. The well-being mobile app provides an 8-week program with 4 classes per week (including a brief theoretical portion and a 15-min guided practice). The active control app also provided 4 assessments per week that encouraged participants to self-observe how they were feeling for 20 min. We also used the app to conduct Web-based questionnaires (10-item Perceived Stress Scale and 5-item World Health Organization Well-Being Index) and ask specific questions to assess subjective levels of stress and well-being at baseline (t1), midintervention (t4=4 weeks after t1) and postintervention (t8=8 weeks after t1). Both apps were fully automated without any human involvement. Outcomes from the control and intervention conditions at the 3 time points were analyzed using a repeated measures analysis of variance.

Results: Among the randomized participants (n=490), 185 participants were excluded at the 4-week follow-up and another 79 at the 8-week follow-up because of noncompliance with the experimental protocol. Participants who did not complete t4 and t8 assessments were equally distributed between groups (t4: control group=34.6% [83/240] and intervention group=40.8% [102/250]; P=.16; t8: control group=29.9% [47/157] and intervention group=21.6% [32/148]; P=.10). Both groups showed a significant increase in general well-being as a function of time (F2,426=5.27; P=.006), but only the intervention group presented a significant increase in work-related well-being (F2,426=8.92; P<.001), as well as a significant reduction in work-related and overall stress (F2,426=5.50; P=.004 and F2,426=8.59; P<.001, respectively).

Conclusions: The well-being mobile app was effective in reducing employee stress and improving well-being.

Trial registration: Clinicaltrials.gov NCT02637414; https://ichgcp.net/clinical-trials-registry/NCT02637414.

Keywords: behavioral medicine; behavioral symptoms; health promotion; meditation; mental health; mind-body therapies; mobile applications; psychology; stress, psychological; women’s health.

Conflict of interest statement

Conflicts of Interest: None declared.

©Cássia Canha Coelhoso, Patricia Renovato Tobo, Shirley Silva Lacerda, Alex Heitor Lima, Carla Regina Camara Barrichello, Edson Amaro Jr, Elisa Harumi Kozasa. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.11.2019.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials flow diagram. PSS-10: 10-item Perceived Stress Scale; WHO-5: 5-item World Health Organization Well-Being Index.
Figure 2
Figure 2
Baseline outcome score data by experimental group. Scatter plots showing bivariate analyses of 10-item Perceived Stress Scale (t288=0.414; P=.68; d=0.045), 5-item World Health Organization Well-Being Index (U=10461; P=.96; r=−0.002), work-related stress (U=11078; P=.47; r=−0.041), general stress (U=11274; P=.64; r=−0.026), work-related well-being (U=11487; P=.86; r=−0.010), and general well-being (U=11060; P=.45; r=−0.043) for the control and intervention groups. Open circles show data for each participant. Red lines show group medians, except for PSS-10, which shows group means. PSS-10: 10-item Perceived Stress Scale; WHO-5: 5-item World Health Organization Well-Being Index.
Figure 3
Figure 3
Plot means with standard error bars showing all outcome data for the control (dashed black line) and intervention (solid black line) groups at pre intervention and mid intervention. Time × group interaction at 10-item Perceived Stress Scale (F1,208=9.48; P=.002; ηp2=.044), 5-item World Health Organization Well-Being Index (F1,208=8.54; P=.004; ηp2=.168), work-related stress (F1,208=6.34; P=.01; ηp2=.022), work-related well-being (F1,208=12.1; P=.001; ηp2=.041), general stress (F1,208=6.46; P=.01; ηp2=.023), and general well-being (F1,208=1.48; P=.22; ηp2=.005). PSS-10: 10-item Perceived Stress Scale; WHO-5: 5-item World Health Organization Well-Being Index.
Figure 4
Figure 4
Plot means with standard error bars showing all outcome data for the control (dashed black line) and intervention (solid black line) groups at preintervention, midintervention, and postintervention. A time × group interaction was observed at 10-item Perceived Stress Scale (F2,326=7.19; P=.001; ηp2=.042), 5-item World Health Organization Well-Being Index (F2,326=7.97; P<.001; ηp2=.047), work-related stress (F2,426=5.50; P=.004; ηp2=.025), work-related well-being (F2,426=8.92; P<.001; ηp2=.040), general stress (F2,426=8.59; P<.001; ηp2=.039), and general well-being (F2,426=0.74; P=.47; ηp2=.003). PSS-10: 10-item Perceived Stress Scale; WHO-5: 5-item World Health Organization Well-Being Index.

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