Interest in Mental Health Tools Grows; Challenges Remain

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A Dartmouth study gives clues on how to improve web-based psychological programs.

Isadora Guarino, Jay Buckey, Devin Cowan, Abigail Fellows
Geisel’s Space Medicine Innovations Laboratory, from left: Isadora Guarino, Geisel ’23; Jay Buckey, professor of medicine; Devin Cowan, research programmer (via Zoom); Abigail Fellows, research project manager. (Photos by Robert Gill and Eli Burakian ’00)

Free online mental health tools may be gaining in popularity, but challenges remain to their widespread use, according to a Dartmouth study published in the Journal of Medical Internet Research.

The research shows that PATH—an online resource that addresses stress, depression, and conflict management—surged in popularity among users around the world during the first months of the COVID-19 pandemic, but that the time and effort required to use PATH and similar tools continue to be obstacles for the use of web-based programs.

“Just like dieting and exercise, maintaining the motivation to complete self-driven mental health programs is difficult,” says Jay Buckey, a professor of medicine at the Geisel School of Medicine and senior researcher of the study. “Programs like these need to be used within a supportive environment with a human touch that can provide encouragement and ongoing support.”

The content in PATH was originally developed for NASA as a training and treatment resource to address psychological challenges endured by astronauts on long-duration spaceflights. Buckey, a former astronaut, spent 16 days orbiting Earth aboard the space shuttle Columbia in 1998.

“The demands of living in isolated, confined environments can induce conflict, stress, and depression,” says Buckey, who is also an adjunct professor of engineering at Thayer School of Engineering. “The PATH program was not designed specifically for addressing the social distancing and quarantine measures associated with COVID-19, but the content is very relevant for people during the pandemic.”

According to the study, existing research suggests that as many as 30% of adults in the United States are affected by a mental disorder, with only a quarter of those people receiving clinically recommended treatment. Past studies have shown that online delivery of programs can be as effective as in-person therapy, but dropout rates are high within PATH and similar interventions.

The research team says that the rapid increase in the use of the PATH program allowed them to assess whether such an online tool would be useful as a stand-alone, open-access mental health resource.

“The COVID-19 pandemic provides a unique opportunity to determine the type of problems driving people to self-help tools and to assess the usefulness of these types of resources,” says Isadora Guarino, Geisel ’23, who served as first author of the study. “This strong interest in the PATH tool was due to the psychological challenges that were present during the period of the COVID pandemic studied.”

The analysis of PATH focused on emotional challenges during the April-October 2020 period of the COVID-19 pandemic.

Close to 2,500 individuals registered to use the online program in the time period studied. The study focused on 562 of the registrants that started the program, with responses differing between those who completed multiple sessions and those who only completed a single session.

“The fact that a large number of people registered for the program during COVID-19 indicates that there is a strong interest in self-help tools for behavioral problems. There are also a significant number of people who want to use a computer-based or web-based approach for issues like depression,” says Guarino.

According to the study, while limitations to the online program, such as a high attrition rate, were identified, individuals who completed the modules indicated improvements in stress and depression symptoms. Users found the modules to be effective and rated the program highly for usability and acceptability.

“Despite the high attrition, this study shows that an open-access, online behavioral program aiming to treat depression, stress, and conflict management can be effective and rated highly for users,” says Buckey.

The Dartmouth PATH Program has been freely available in a self-guided format throughout the COVID-19 pandemic. The program has previously been tested in extreme environments, such as the Hawaii Space Exploration Analog and Simulation (HI-SEAS) Mars analog and Australian Antarctic stations.

Geisel’s Space Medicine Innovations Laboratory placed the PATH program online in 2016. Buckey, research programmer Devin Cowan, and research project manager Abigail Fellows have been working to improve it and make it widely available. Cowan and Fellows are also co-authors on the study.

PATH is free and available online to the general public.

David Hirsch