An RCT to assess whether an online behavioral intervention increases help-seeking behavior initiation for depression

Context: Depression in primary care remains challenging; patients with depression often do not seek help. Interventions to increase help-seeking (HS) behavior have been ineffective or decreased HS. Mental Contrasting and Implementation Intentions (MCII) is a behavioral intervention to create action plan in advance. It has been effective among patients seeking to increase exercise, reduce smoking, and other health behaviors. However, it has not been used for initiating help- seeking for depression. Objective: To assess whether an online MCII training program increases HS or the intention to seek help at 2 weeks post-intervention among those with elevated depressive symptoms, compared to information-only controls (C). Study Design and Analysis: RCT comparing HS and C at 2 weeks using pre-post survey. Analysis using t-test and ANOVA; intention to treat. Setting: MTurk online cloud research toolkit (Feb-March 2020). Population Studied: Adults with Beck Depression Inventory (BDI-II) score of 14 (mild depressive symptoms) or above and who were not seeking professional help at baseline. Intervention: Published online MCII intervention. Outcome Measures: Primary: Self-reported help seeking success (single-item). Secondary: Strength of Implementation Intentions Scale (SIIS), depressive symptoms (BDI-II), current perceived depression (single item). Results: Of the 2134 participants prescreened for depression and HS, 228 met eligibility criteria (37.2 [+ or -] 12.1 yrs, 65% F, 67% white). Demographics and disease severity were similar between groups at baseline. The HS group (n=105) reported greater HS success (p = .013) as well as intention to seek help (p = .001) 2 weeks post intervention compared to C (n=124). Further, perceived HS success was more likely for those who received the HS intervention and either did not perceive themselves as currently depressed at Time 2 (OR = 3.7) or individuals whose actual BDI-II score at follow up was below 14 points (OR = 10.6). Conclusions: Among participants with elevated depression symptoms, an online training in MCII effectively increased help-seeking behavior and intention to seek help compared to information-only control participants 2 weeks after delivery. The intervention is relatively brief and potentially scalable. Further research is warranted to determine clinical utility.