Online Mental Health Program for Female College Students
Condition: Post Traumatic Stress Disorder
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Late adolescence and early adulthood are the most exposed to trauma. College students exposed
      to trauma may experience depression, anxiety, stress, and difficulties adapting to college
      life.

      Depression symptoms are the most common reactions that people experience after traumatic
      experiences. Depression also harms college students reactions that people experience after
      traumatic experiences. It is difficult for people who are depressed to meet their social
      function.

      Trauma also has adverse physical effects, including dysfunction of the hypothalamus and
      adrenal axis, lowering blood cortisol levels. As a result, the body's immune system is
      disturbed, leaving people more exposed to diseases and experiencing more pain and fatigue.

      In particular, women are more vulnerable to PTSD than men. Women with post-traumatic stress
      and depression are also more likely to be exposed to several diseases. Moreover, when
      traumatized female college students experience life stress, it worsens their mental health
      and interferes with their studies.

      Cognitive behavioral therapy is the most effective content composition method for trauma
      intervention. CBT should be improved by helping to reduce PTSS and depression and managing
      various aspects of life, such as nutrition, activity, and rest.

      One major advantage of online programs is that they do not face any time or space
      constraints, and they are also less expensive than face-to-face programs. More importantly,
      online programs can reduce psychological barriers to participation. This is especially
      important for women who are more likely to feel shame and stigma about interpersonal traumas,
      such as those arising from relationships and sexual trauma, which are obstacles to their
      access to face-to-face programs. College students can easily access online programs because
      of their familiarity with the Internet, so the programs can be immediately available in
      response to crises without requiring them to expose personal information to unfamiliar
      therapists.

      In this study, the interventions program was based on the Roy Adaptation Model to address
      post-traumatic physical and mental health problems among female college students in Korea.

      Hypothesis

        -  The post-traumatic stress scores, depressive symptom scores of participants who access
           the program will decrease more than those who do not.

        -  The functional health scores, college adaptation scores of participants who access the
           program will increase more than those who do not.
    

Detailed description: 
      1. Study Design This study used a randomized control group pretest-posttest design to
           verify the effectiveness of the proposed program.

        2. Participants & Recruitment Initial participants were recruited from eight universities
           in Korea through advertisements on SNS and bulletin boards at the university. Applicants
           indicated their interest in the study by contacting the research director via SNS,
           email, or SMS. The research director sent a reply message with the research information
           and an initial screening survey link. The applicants were initially screened for
           post-traumatic stress and depression. For inclusion, the participants had to be female
           college students between 19 and 29 years with a traumatic experience and post-traumatic
           stress symptom scores of 22-66, which is a cutoff that can be diagnosed as
           post-traumatic stress disorder; anything above 66 is a severe post-traumatic stress
           disorder condition that cannot be suitably addressed in this study (Eun, 2005; Lee et
           al., 2018).

           The following participants were excluded: those who experienced childhood sexual abuse;
           those who had experienced violent conflict or war, including North Korean defectors; and
           those who had a post-traumatic stress score greater than 66 points. According to a prior
           study, those who experienced childhood sexual abuse, war, or civil war are at a higher
           risk of suicide attempts. Therefore, they were excluded because their profiles did not
           match the purpose of this study (Hirai & Clum, 2005).

           The number of subjects for this study was calculated by G × power using a calculating
           power of 0.8 for the replicate measurement variance analysis, a medium effect size of
           0.25, and a significance level of .05 (Cohen, 1988), resulting in a total of 28 people.
           Fifty-eight people will be recruited, taking into account the dropout rate of 30%.

        3. Procedure The experimental group's pre- and post-outcome measures were collected at
           pre-treatment, post-treatment, and 1-month follow-up. Data were collected from the
           control group three times for three months. After the three surveys, the control group
           was provided the same program as the experimental group if the participants chose to
           join. All questionnaires were conducted using Google Survey.

        4. Interventions The proposed program consisted of eight sessions conducted twice per week,
           consisting of 5 minutes of introductory material, 12-15 minutes of main content, and 5
           minutes of concluding content. The introduction included a brief exercise since
           exercises can relieve post-traumatic stress symptoms by changing the body's cortisol
           concentrations (Kim et al., 2013). The main content intended to improve the control
           processes and each of the four adaptive modes of the Roy Adaptation Model. No session
           lasted longer than 25 min.

           Participants are given homework and feedback through SNSs. The program's sessions were
           accessible through blog entries posted on https://www.tistory.com. Every post in the
           blog required a password. Links and passwords for each session were provided to the
           participants through SNS. The program was accessible from any electronic device with
           Internet access, including computers and smartphones, and was strictly accessible
           through links provided by the researchers.

           The program was partially revised considering the topics' practicality after a
           feasibility study and consultation with experts.

        5. Measurements 1) Trauma experience: Stress Life Events Screening Questionnaire 2)
           Post-traumatic stress symptoms: Impact of Event Scale-Revised 3) Depression: Center for
           Epidemiological Studies Depression Scale 4) Functional health: Functional Health Pattern
           Assessment Screening Tool 5) Adaptation to college life: Students Adjustment to College
           Questionnaire
    

Intervention name(s): Online Mental Health Program
Intervention type(s): Behavioral
Intervention description(s): The proposed program consisted of eight sessions conducted twice per week, consisting of 5 minutes of introductory material, 12-15 minutes of main content, and 5 minutes of concluding content. The main content intended to improve the control processes and each of the four adaptive modes of the RAM. The eight sessions were uploaded on the web. Links and passwords for each session were provided to the participants through SNS. The program was accessible from any electronic device with Internet access
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Stress Disorders, Post-Traumatic; Depression; Internet-Based Intervention; Cognitive Behavioral Therapy