Digital healthcare has grown in popularity in recent years as a scalable solution to address increasing rates of mental illness among employees, but its clinical potential is limited by low engagement and adherence, particularly in open access interventions. Personalized guidance, involving structuring an intervention and tailoring it to the user to increase accountability and social support, is one way to increase engagement with digital health programs. This exploratory retrospective study therefore sought to examine the impact of guidance in the form of personalized prompts from a lay-person (i.e., non-health professional) on user's (N = 88) engagement with a 16-week Behavioral Intervention Technology targeting employee mental health and delivered through a mobile application. Chi-squared tests and Mann-Whitney tests were used to examine differences in retention and engagement between individuals who received personalized prompts throughout their 4-month program and individuals for whom personalized prompts were introduced in the seventh week of their program. There were no significant differences between the groups in the number of weeks they remained active in the app (personalized messages group Mdn = 3.5, IQR = 3; control group Mdn = 2.5, IQR = 4.5; p = 0.472). In the first 3 weeks of the intervention program, the proportion of individuals who explored the educational modules feature and the messaging with health coaches feature was also not significantly associated with group (ps = 1.000). The number of modules completed and number of messages sent to health coaches in the first 3 weeks did not differ significantly between the two groups (ps ≥ 0.311). These results suggest that guidance from a non-health professional is limited in its ability to increase engagement with an open access Behavioral Intervention Technology for employees. Moreover, the findings suggest that the formation of a relationship between the individual and the agent providing the guidance may be necessary in order for personalized guidance to increase engagement.
Mental health has become a growing concern in the wake of the COVID-19 pandemic. We sought to determine the prevalence of mental health symptoms 18 months after the pandemic's declaration. Our cross-sectional study conducted among 18- to 65-year-old adults (N = 33,454) in October 2021 using the Depression, Anxiety and Stress Scales (DASS-21) found a high prevalence of severe to extremely severe anxiety (49%), depression (47%) and stress (36%) symptoms in Malaysia, Indonesia, Thailand, and Singapore. Multiple logistic regression showed that female and non-binary genders were associated with increased odds of severe/extremely severe symptoms of anxiety (female: aOR 1.44 [95% CI 1.37-1.52]; non-binary aOR 1.46 [1.16-1.84]), depression (female: aOR 1.39 [1.32-1.47]; non-binary aOR 1.42 [1.13-1.79]), and stress (female: aOR 1.48 [CI 1.40-1.57]; non-binary aOR 1.42 [1.12-1.78]). In all three symptom domains, the odds of severe/extremely severe symptoms decreased across age groups. Middle- and high-income respondents had lower odds of reporting severe/extremely severe anxiety (middle-income: aOR 0.79 [0.75-0.84]; high-income aOR 0.77 [0.69-0.86]) and depression (middle-income: aOR 0.85 [0.80-0.90]; high-income aOR 0.84 [0.76-0.94]) symptoms compared to low-income respondents, while only middle-income respondents had lower odds of experiencing severe/extremely severe stress symptoms (aOR 0.89 [0.84-0.95]). Compared to residents of Malaysia, residents of Indonesia were more likely to experience severe/extremely severe anxiety symptoms (aOR 1.08 [1.03-1.15]) but less likely to experience depression (aOR 0.69 [0.65-0.73]) or stress symptoms (aOR 0.92 [0.87-0.97]). Respondents living in Singapore had increased odds of reporting severe/extremely severe depression symptoms (aOR 1.33 [1.16-1.52]), while respondents residing in Thailand were more likely to experience severe/extremely severe stress symptoms (aOR 1.46 [1.37-1.55]). This study provides insights into the impacts of the COVID-19 pandemic on the point prevalence of psychological distress in Southeast Asia one and a half years after the beginning of the pandemic.