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Cited by 61Digital Mental Health InterventionsMental Health Treatment and AccessMaternal Mental Health During Pregnancy and Postpartum

Step-by-step: Feasibility randomised controlled trial of a mobile-based intervention for depression among populations affected by adversity in Lebanon

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Heim, Eva, Ramia, Jinane Abi, Hana, Racha Abi, Burchert, Sebastian, Carswell, Kenneth, Cornelisz, Ilja, Cuijpers, Pim, El Chammay, Rabih +5 more·2021·Internet Interventions
DOI 10.1016/j.invent.2021.100380PMC PMC7967003
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Abstract

BACKGROUND: E-mental health interventions may help to bridge the mental health treatment gap. Evidence on their effectiveness is compelling in high-income countries. Not enough evidence has been generated on their use with communities affected by adversity in low- and middle-income countries. The World Health Organization (WHO), the National Mental Health Programme (NMMP) at Ministry of Public Health (MoPH) in Lebanon and other partners have adapted a WHO intervention called Step-by-Step for use with Lebanese and displaced people living in Lebanon. Step-by-Step is a minimally guided, internet-based intervention for adults with depression. In this study, a feasibility randomised controlled trial (RCT) and a qualitative process evaluation were conducted to explore the feasibility and the acceptability of the research methods, and the intervention, in preparation for two fully powered trials to assess the effectiveness and cost-effectiveness of Step-by-Step in Lebanon. METHOD: Participants were recruited through social media. Inclusion criteria were: being able to understand and speak Arabic or English; access to an internet connected device; aged over 18; living in Lebanon; scores above cut-off on the Patient Health Questionnaire and the WHO Disability Assessment Schedule 2.0. Participants were randomly assigned to the intervention or enhanced care as usual. They completed post-assessments eight weeks after baseline, and follow-up assessments another three months later. Primary outcomes were depression and level of functioning, secondary outcomes were anxiety, post-traumatic stress, and well-being. Qualitative interviews were conducted to evaluate the feasibility and acceptability of the research procedures and the intervention. RESULTS: = 138 participants, including 33 Syrians, were recruited and randomised into two equal groups. The dropout rate was higher in the control group (73% post- and 82% follow-up assessment) than in the intervention group (63% post- and 72% follow-up assessment). The intervention was perceived as relevant, acceptable and beneficial to those who completed it. Suggestions were made to further adapt the content and to make the intervention more engaging. Statistical analyses were conducted despite the small sample size. Complete cases analysis showed a statistically significant symptom reduction in depression, anxiety, disability, and post-traumatic stress, and statistically significant improvement in well-being and functioning. Intention-to-treat analysis revealed non-significant effects. CONCLUSION: The research design, methods and procedures are feasible and acceptable in the context of Lebanon and can be applied in the RCTs. Preliminary findings suggest that Step-by-Step may be effective in reducing symptoms of depression and anxiety and improving functioning and well-being.

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  • Initial studies on a guided self-help version of SbS with weekly phone contacts in Lebanon found positive treatment effects on indicators of psychological distress and functioning in Syrian refugees and Lebanese local populations.

    “Initial studies on a guided self-help version of SbS with weekly phone contacts in Lebanon found positive treatment effects on indicators of psychological distress and functioning in Syrian refugees and Lebanese local populations [23,37,38].”

    From Effects of a self-guided digital mental health self-help intervention for Syrian refugees in Egypt: A pragmatic randomized controlled trial (2024) · cites this paper as [38]

    The Results (Primary outcome measures; page unavailable) report improved depression symptoms and functioning in the complete-case analysis, with Syrian and Lebanese participants included. But the Discussion (page unavailable) says the intention-to-treat effects were not significant. The Methods (Intervention; page unavailable) describe weekly guidance by phone or chat, not phone contacts for everyone. (LLM, conf=0.86)

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Authors
Heim, E., Ramia, J. A., Hana, R. A., Burchert, S., Carswell, K., Cornelisz, I., Cuijpers, P., El Chammay, R., Noun, P., van Klaveren, C., van Ommeren, M., Zoghbi, E., & van't Hof, E.
Affiliations
  • University of Zurich (CH)
  • Ministry of Public Health (LB)
  • Freie Universität Berlin (DE)
  • World Health Organization (CH)
  • Vrije Universiteit Amsterdam (NL)
  • Amsterdam Public Health (NL)
Corresponding author
Heim, Eva
ORCID
Venue
Internet Interventions
Publisher
Elsevier BV
Published
2021-04
Volume
24
Pages
100380
ISSN
2214-7829 (ISSN-L)
DOI
10.1016/j.invent.2021.100380
PMC
PMC7967003
OpenAlex
W3134984343
Cited by
61
References
37
Citations by year
2026: 4 · 2025: 9 · 2024: 12 · 2023: 27 · 2022: 8 · 2021: 1
FWCI
10.78
Type
journal article
Language
en
Open access
Licence
Locations
  • Internet Interventions (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • VU Research Portal (publishedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
  • Refubium (Universitätsbibliothek der Freien Universität Berlin) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • SERVAL (Université de Lausanne) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Universitätsbibliothek der FU Berlin Hochschulschriftenstelle u. Dokumentenserver
  • Zurich Open Repository and Archive (University of Zurich)
Funders
  • World Health Organization
  • European Commission
  • Freie Universität Berlin
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords
depression, e-mental health, Syrian refugees, displaced persons, adversity, feasibility and acceptability, depressive symptoms, anxiety, post-traumatic stress, functioning, well-being, disability, Lebanon, dropout, social media recruitment, process evaluation, low- and middle-income countries, mental health treatment gap, cost-effectiveness

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