Browsing by Author "Gericke, Franco"

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    Pilot study of an e-intervention for symptoms of depression among university students in South Africa
    (Stellenbosch : Stellenbosch University., 2020-03) Gericke, Franco; Bantjes, Jason; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH ABSTRACT: Background. Major Depressive Disorder (MDD) is associated with a range of adverse outcomes among university students, including academic failure, suicidal thoughts and behaviours, and severe role impairment. Despite the variety of effective treatments available, most university students do not seek or receive help. Evidence suggests that internet-based interventions (e-interventions) might be as effective as existing treatments available to treat MDD. Therefore, e-interventions have been suggested to address the treatment gap among university students. However, e-interventions have not been extensively used or evaluated in low- and middle-income countries (LMIC) like South Africa (SA). Therefore, I set out to pilot the use of an e-intervention, namely iCare, aimed at addressing depressive symptoms among SA university students. Aims. This randomised external pilot study had two primary aims: (1) to assess the key feasibility aspects of iCare, namely (a) recruitment, (b) randomisation, and (c) implementation (utilisation, retention and follow-up rates, and the assessment of the outcome measures); and (2) to investigate students’ experiences of using iCare and to document their suggestions on improving iCare and making it more culturally appropriate for use in the SA context. Methods. All first-year university students (n=5094) were invited to complete a voluntary mental health survey. A total of 138 participants met the inclusion criteria and were randomised (according to a 2:1 ratio) to iCare (n=91) and treatment-as-usual (TAU) (n=47). iCare participants received one-month and three-month post-intervention follow-up assessments to monitor symptom change. Each iCare participant also received an email inviting them to participate in an individual in-depth post-intervention interview. The key feasibility aspects were quantified and assessed using various statistical analyses. A large proportion of the participants did not complete he follow-up assessments. The outcome measures were, therefore, assessed using three iii approaches commonly used to handle missing data in clinical trials: (1) complete case analysis (CCA), (2) intention-to-treat analysis using multiple imputations (ITTA-MI), and (3) per-protocol analysis (PPA). Sample size estimations to scale this study to a randomised control trial were conducted based on the ITTA-MI, using (1) safeguard power analysis, and (2) the minimal clinically significant effect. The interviews were transcribed and analysed through thematic analysis following a data-driven approach. Findings. Only 31.87% (n=29) of participants indicated their willingness to use iCare, of which 24.18% (n=22) started with iCare’s first session. A substantial number (72.73%, n=16) of participants dropped out during treatment. Low follow-up rates were observed at the one-month (65.9%, n=60) and three-month (71.4%, n=65) post-intervention follow-up assessments. However, the ITTA-MI indicated a significant small to moderate decrease in iCare participants’ depressive symptoms at these assessments. The PPA indicated that a large proportion (50%, n=3) of iCare completers achieved a successful treatment outcome. I identified seven superordinate themes and several sub-themes. The majority of participants felt the anonymity and accessibility of iCareen-abled them to overcome the barriers they faced to traditional face-to-face therapy; others found the lack of direct human contact to be problematic, expecting iCare to mimic the responsiveness and reflectiveness of face-to-face therapy. The perceived time-consuming nature of iCare was put forward by some participants for their discontinuation of iCare; while others discontinued due to symptom improvement. The majority of participants indicated the need for more engaging and interactive content and suggested that iCare should be used in addition to, rather than replacing, traditional face-to-face therapy.Conclusion. The findings of this study indicate that there is a proportion of students for whom e-interventions may provide the first step to accessing mental health services, although nota replacement for traditional face-to-face therapy. A randomised control trial is needed to determine the efficacy of iCare. I also offer recommendations for addressing the key feasibility aspects that were identified, and for future research on e-interventions among university students in SA.