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Cited by 10Digital Mental Health InterventionsMental Health Treatment and AccessMobile Health and mHealth Applications

Efficacy of a text-based mental health coaching app in improving the symptoms of stress, anxiety, and depression: randomized controlled trial

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Lim, Yee Siew, Quek, Jia Hui, Ching, Xiu Wei, Lim, Dominic Tao Ran, Lim, Kean Ghee, Thuraisingham, Chandramani, George, Parikial Philip·2023·JMIR Formative Research
DOI 10.2196/46458PMC PMC10559195

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Abstract

BACKGROUND: Stress, anxiety, and depression are major mental health concerns worldwide. A wide variety of digital mental health interventions have demonstrated efficacy in improving one's mental health status, and digital interventions that involve some form of human involvement have been shown to demonstrate greater efficacy than self-guided digital interventions. Studies demonstrating the efficacy of digital mental health interventions within the Asian region are scarce. OBJECTIVE: This study aimed to investigate the potential efficacy of the digital mental health intervention, ThoughtFullChat, which consists of one-on-one, asynchronous, text-based coaching with certified mental health professionals and self-guided tools, in improving self-reported symptoms of depression, anxiety, and stress. The study also aims to examine the potential differences in efficacy among occupational subgroups and between sexes. METHODS: A randomized controlled study was conducted among housemen (trainee physicians), students, faculty members, and corporate staff at International Medical University, Malaysia. A total of 392 participants were enrolled and randomized to the intervention (n=197, 50.3%) and control (n=195, 49.7%) groups. Depression, anxiety, and stress symptoms were measured using the Depression, Anxiety, and Stress Scale-21 items at baseline and after the 3-month intervention period. The Satisfaction with Life Scale and Brief Resilience Scale were also included, along with a questionnaire about demographics. RESULTS: Significant decrease was observed in depression (P=.02) and anxiety (P=.002) scores in the intervention group. A subgroup (corporate staff) also demonstrated significant decrease in stress (P=.005) alongside depression (P=.006) and anxiety (P=.002). Females showed significant improvements in depression (P=.02) and anxiety (P<.001) when compared with males. CONCLUSIONS: This study provides evidence that the ThoughtFullChat app is effective in improving the symptoms of depression, anxiety, and stress in individuals, particularly among corporate staff from the educational field. It also supports the notion that mobile mental health apps that connect users to mental health professionals in a discreet and cost-efficient manner can make important contributions to the improvement of mental health outcomes. The differential improvements among occupational subgroups and between sexes in this study indicate the need for future digital mental health app designs to consider an element of personalization focused on systemic components relating to occupation. TRIAL REGISTRATION: Clinicaltrials.gov NCT04944277; https://classic.clinicaltrials.gov/ct2/show/NCT04944277.

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  • Three blended group studies reported an effect on stress, burnout, and depression and anxiety through the use of the Transition and Adaptation towards Resiliency module, the ThoughFullChat intervention, and the Compassion Cultivating Training.

    “Three studies (79–81) reported an effect on stress (79, 81), burnout (79), and depression and anxiety (79, 80) through the Use of the Transition and Adaptation towards Resiliency module, the ThoughFullChat intervention, and the Compassion Cultivating Training.”

    From Digital resilience interventions for healthcare workers: a systematic review (2025) · cites this paper as [80]

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Research works printed but not linked: 2

  1. [1]National health and morbidity survey 2015-volume II: non-communicable diseases, risk factors & other health problems Ministry of Health Malaysia 2015 01 2020-09-02 https://www.researchgate.net/publication/305213149_National_Health_and_​Morbidity_Survey_2015-VOLUME_II_Non-Communicable_Diseases_Risk_Factors_Other_Health_Problems
  2. [10]Carolan S Increasing adherence to digital mental health interventions delivered in the workplace University of Sussex 2018 10 10 2020-10-15 https://sussex.figshare.com/articles/thesis/Increasing_adherence_to_digital_mental_health_interventions_​delivered_in_the_workplace/23462978

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Authors
Lim, Y. S., Quek, J. H., Ching, X. W., Lim, D. T. R., Lim, K. G., Thuraisingham, C., & George, P. P.
Affiliations
IMU University (MY)
Corresponding author
Lim, Yee Siew
ORCID
Venue
JMIR Formative Research
Publisher
JMIR Publications Inc.
Published
2023-09-22
Volume
7
Pages
e46458
ISSN
2561-326X (ISSN-L)
DOI
10.2196/46458
PMC
PMC10559195
OpenAlex
W4385585801
Cited by
10
References
24
Citations by year
2026: 5 · 2025: 1 · 2024: 4
FWCI
2.58
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Formative Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Greater South Information System
Funders
International Medical University
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
mental health apps, depression, anxiety, stress, digital mental health interventions, occupational differences, sex differences, life satisfaction, resilience, trainee physicians, university students, Malaysia, Asia

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