These preliminary findings were presented at the Anxiety and Depression Association of America Conference on April 2nd, 2016 by Dr. Michelle G. Newman, PhD, Lead Project Investigator, Professor, Penn State University.
The World Health Organization found that 1 in 4 people will suffer from a mental health disorder in their lives. In the U.S., that is estimated around 80 million people. In India, this is roughly 310 million people. However, the number of mental health professionals in the U.S. is roughly 550,000, while it is only 5,000 in India (Fairburn & Patel 2014). Given this significant gap in treatment opportunities and the pressing need for support, an alternative way to deliver mental health care is critical.
April 8th, 2016 — San Francisco, CA — Lantern together with our research partners announce the preliminary results of a randomized controlled trial evaluating the efficacy of Lantern’s Anxiety Program. For the past two years, Lantern has been involved in a research study, Mana Maali (meaning gardener of the mind in Hindi).
Goals of research initiative
The study is designed as a randomized controlled trial (RCT), a research method in which people are randomly assigned to different treatment groups. RCTs are considered the gold standard for clinical trials. The present trial described below is part of an ongoing study aimed to assess the feasibility, acceptability, and efficacy of online, CBT-based guided self-help programs to reduce anxiety among students in Indian Universities.
Why focus on universities in India?
Generalized Anxiety Disorder (GAD) is one of the most common disorders on college campuses and reflects the wide treatment gap between the U.S. and India: 7% GAD prevalence across 26 U.S. college campuses (Eisenberg et al., 2013) and 19% GAD prevalence in male Indian university students (Sahoo and Khess, 2010). In 2012, the Indian government assembled a task force for the Prevention of Suicide and Promotion of Wellness as only 1.6% of all students across 86 institutions (specifically central government funded technical universities) received counseling. A number of factors drives the treatment gap in university settings including stigma, treatment cost, availability of treatment, and confidentiality (research suggests Indian students prefer self-management options).
“One third of the population in India are youth and a quarter among them experience significant mental health problems resulting in distress and dysfunction. However, a very less percentage seek help due to lack of knowledge, stigma, and lack of facilities. As the internet is the most frequently used medium for most of their activities, it offers a safe and potential way of delivering mental health care to this population.” Dr. M. Manjula, Additional Professor, Department of Clinical Psychology, NIMHANS, Bangalore, India (Research collaborator)
The study design and preliminary results
The research team implemented a university-wide, online diagnostic survey across 4 universities to identify interested students that were in need of treatment (both clinical and subclinical Generalized Anxiety Disorder) across four campuses. Thus far, 167 students have been randomized into one of the three following conditions: 1) Lantern Anxiety program 2) Mental Health Online (an un-coached online CBT program) 3) a wait list control group (no treatment). However, randomization to the self-help condition was discontinued after noting a significant lack of student engagement, therefore, that sample is smaller than the others. Outcomes measures include the Generalized Anxiety Disorder Questionnaire for DSM-IV, the Penn State Worry Questionnaire, and a Depression scale, in addition to a number of other measures of anxiety and overall quality of life. Compared to no treatment, both Lantern and Mental Health Online showed a greater reduction in overall GAD symptoms. Based on analysis of the preliminary data, Lantern led to a significant decline in worry (p<.001), GAD (p<.001) and depression symptoms (p<.001). Lantern also had the highest engagement, meaning students were more likely to follow-through with the study from pre-screening to completion of the follow-up survey. Of course, many more factors contribute to the effectiveness of digital health interventions in various populations, such as stakeholder support, user engagement, and such factors should be given similar evaluation when considering the external validity of these findings. Research on these factors is still underway.
What’s the value of this research?
Researchers suggest that online, guided self-help (GSH) programs are less stigmatizing and more acceptable to students and potentially more cost-effective. More specifically, researchers found many potential benefits of the Lantern Anxiety Program approach for students: privacy concerns – students can follow the program and receive mental health coaching anonymously; accessibility in that students can use the tools to reduce anxiety anytime throughout the day; and the emphasis on evidence-based techniques.
“Being a coach has been a tremendously rewarding experience for me. We form a bridge between the student and his mental health. With continued persistence I was able to break the hesitance of the students to open up and make them realise that there is no taboo attached and that anxiety and depression are prevalent amongst students and with help one can conquer it and lead a healthy productive life. We as coaches are able to customise the Lantern anxiety program and provide the necessary help and motivation for the individual needs of the students.” Kumudini Velanand, Mana Maali Lantern Program Coach
As the leader in evidence-based online mental health wellness, these results not only help to support the clinical effectiveness of our programs, but also demonstrate how we think about evidence generation in digital health. “The important thing to us is objectivity. We want to design all evidence to limit conflict of interest” Megan Jones, Chief Science Officer. Through collaboration with academic partners, the recruitment, data management, analysis, and authorship are handled externally to keep evaluations objective.
We’d like to thank all key investigators and collaborators, including BITS Alumni Association International. BITSAA International has supported this project from the beginning.
“Alumni of BITS-Pilani from all corners of the world, represented by BITSAA International, have been enthusiastic supporters of Mana Maali; having recognized the need for a structured mental health support system for students living on campus and going through the rigors of a demanding curriculum. We are delighted to see the positive impact this program has had on the mental well being of our students in all of our campuses.” Jayan Ramankutty, Chairman of BITSAA International
Key Investigators and Collaborators:
This research initiative is led by Dr. C. Barr Taylor, MD, Dr. Michelle G. Newman, PhD, Nitya Kanuri, BA, Dr. Josef Ruzek, PhD, Dr. Eric Kuhn, PhD, Dr. M. Manjula, PhD, Dr. Smita Sharma, PhD, Dr. Megan Jones, PsyD, Dr. Neil Thomas, PhD, and Dr. Jo-Anne Abbott, PhD.
Done in collaboration with researchers at Stanford University, Pennsylvania State University, Birla Institute of Technology and Science Pilani (India), National Institute of Mental Health and Neuro Sciences (India), Palo Alto University, White Swan Foundation (India), Swinburne University of Technology (Australia) and Lantern. The research consortium partnered with BITS Pilani to better understand the prevalence of anxiety and stress among students in Indian universities. Their goal is to make mental health services more widely accessible in universities across India and, in doing so, embody Mana Maali.