Albertans who signed up to receive daily positive messages from the Text4Hope program reported lower levels of psychological distress after three months, according to newly published research results.
More than 50,000 people subscribed to the daily text service, which was launched in March in response to the COVID-19 pandemic. They received inspiring messages such as, “You are not alone” and, “Practise self-compassion,” along with links to more detailed mental health information.
Researchers analyzed self-reported symptoms of stress, anxiety and depression from 1,079 participants surveyed at the outset, after six weeks and again after three months.
“By three months, we saw statistically significant improvements in all of the measures that we set out to evaluate, which was very exciting,” said Vincent Agyapong, clinical professor of psychiatry and global mental health in the Faculty of Medicine & Dentistry and creator of the text service.
Population-level psychological intervention
When they signed up for the service, almost 85 per cent of respondents reported moderate to high stress, nearly 50 per cent were at risk for an anxiety disorder, and more than 40 per cent were at risk for clinical depression, according to previously published research.
At six weeks, respondents reported reduced stress and anxiety, and by the three-month mark the overall reported rates of mental health distress dropped by 22.7 per cent for anxiety, 10.4 per cent for depression and 5.7 per cent for stress, even for people who initially reported moderate to severe symptoms.
“Text4Hope is an effective, convenient and accessible means of implementing a population-level psychological intervention,” the researchers concluded in their latest paper.
Agyapong pointed out participation in the service and the surveys was voluntary so the results may not be representative of the overall population, but they do fit with previous randomized controlled trials of similar text message services.
“All the numbers seem to be moving on a downward trajectory,” said Agyapong, who is also a member of the U of A’s Neuroscience and Mental Health Institute, as well as clinical section chief for community mental health for the Edmonton Zone of Alberta Health Services.
“Put that in the context that the pandemic is still on, the stress is still here, people’s jobs have not returned,” he said. “We can see that in a real-world situation, this is actually working and making a clinically meaningful impact in people's lives.”
Interrupting negative thoughts
Agyapong said the daily text messages follow the same principle as cognitive behavioural therapy in that they disrupt negative patterns of thinking.
“You may be thinking constantly about job loss, the COVID case numbers going up, the future of the economy, the end of air travel,” he said. “Then a message will come up that reminds you there’s only one day you need to worry about and that’s today. The past is gone and the future will take care of itself.
“A daily dose of positivity coming into your life will help you dwell less on the worry and anxiety.”
Next steps for the Text4Hope project include developing an Arabic-language version with funding from the Royal Bank of Canada, piloting a version of the program for Indigenous communities in British Columbia, tailoring a service to target post-traumatic stress injury for first responders and military veterans, and launching a youth-focused version through the Alberta Integrated Youth Services Initiative. And another study is forthcoming, comparing reported symptoms such as suicidal ideation and interrupted sleep patterns among a smaller group of subscribers against a control group who did not receive texts but were exposed to the same environment in the same time frame, such as COVID-19 news in the media.
Agyapong is also running a clinical trial comparing the effectiveness of text messaging with email messaging, which would be capable of reaching more people around the world.
“If we can reduce the number of people who need that one-to-one therapy, then we can provide more timely and comprehensive care for those who actually need it,” he said.
Text4Hope is provided by Alberta Health Services in partnership with the Mental Health Foundation, Royal Alexandra Hospital Foundation, Alberta Children’s Hospital Foundation, University Hospital Foundation, Calgary Health Trust and Alberta Cancer Foundation.
The research was supported by those organizations as well as the Edmonton Community Foundation, Calgary Foundation and Edmonton Civic Employees Charitable Assistance Fund.
How to sign up for Text4Hope
To subscribe to Text4Hope, text COVID19HOPE to 393939.
The service is not intended to replace one-to-one counselling for those in crisis, available by calling 780-424-2424 for 24/7 access to mental health support in Edmonton or 1-877-303-2642 for the provincewide Mental Health Help Line.
