Mental health and addiction problems among vulnerable populations and the impact of a supportive text message intervention in one vulnerable group
Creators: Obuobi-Donkor, Gloria
Publisher: name: University of Alberta Library
Year: 2022

<p>Background<br>
Mental health and addiction problems are prevalent among some groups such as the military, firefighters, the elderly, and residents who have experienced multiple disasters. Identifying the prevalence and predictors of mental health and addiction conditions is important for primary prevention and planning treatment programs for these populations. </p>

<p>Objectives<br>
1.To identify the prevalence and correlates of post-traumatic stress disorder (PTSD), depressive disorders and suicidality among the military, firefighters, and the elderly.</p>

<ol>
<li>To identify the prevalence and correlates of likely Major Depressive Disorder (MDD), low resilience and, likely cannabis and alcohol abuse in residents of Fort McMurray following the 2016 wildfires, the COVID-19 pandemic and the 2020 flooding.</li>
<li>To implement and evaluate the impact of supportive texting service (Text4Hope-Addiction) for subscribers experiencing addiction issues in Alberta, Canada during the COVID-19 pandemic.</li>
</ol>

<p>Methods<br>
This thesis includes three separate but related studies which utilizes distinct study designs, including a general and scoping review of literature, cross sectional population level study and a longitudinal cross sectional program evaluation study. <br>
To address objective 1, a general literature review (for the elderly) and scoping literature review (for military and fire fighters) were performed using relevant search terms in MEDLINE, EMBASE, PsycINFO, CINAHL, and PubMed databases. The searches were conducted to describe the existing research literature on the prevalence of depression and correlation of death by suicide among the geriatric population and the prevalence and correlation of PTSD among military personnel and firefighters. The Covidence software was used in the management and screening of the data. <br>
To address objective 2, a cross sectional survey was conducted among residents of Fort McMurray using an online questionnaire. The survey was designed to capture socio-demographic, trauma exposure, and clinical variables. Mental health outcome variables were captured using self-reported standardized assessment scales to assess depression, PTSD, anxiety, suicidality, and resilience. Respondents were also asked to self-report cannabis and alcohol abuse in the last year. Data were analyzed using SPSS version 25 and presented as descriptive statistics, Chi-square/Fisher&#39;s Exact tests, and binary regression analysis.<br>
To address objective 3, a daily supportive text messaging service, Text4Hope-Addiction was implemented for three-month to support subscribers&#39; dealing with mental health and addiction problems during the COVID-19 pandemic. To evaluate the service, online surveys were delivered to subscribers via text messages at baseline, six weeks, and endpoint, 12 weeks and contained validated self-report scales to assess the prevalence and severity of anxiety, depression, and cravings among subscribers. Likert scale satisfaction responses were also used to evaluate various aspects of the Text4Hope-Addiction program. </p>

<p>Results <br>
For the general review, MDD prevalence in the elderly ranges from 5.37% to 56%. Mental illnesses and physical illnesses contributed to suicidality, and depression was found to highly correlate with suicidal behavior among the elderly. <br>
Regarding the scoping review, PTSD prevalence ranges from 1.9% to 57% among the firefighters and 3.72% to 37.8% among military personnel. Demographic factors like age, job factors, physical and psychological factors predicted PTSD among the military and firefighters.<br>
In the population level cross-sectional study, 186 out of 249 individuals who accessed the survey completed it, giving a response rate of 74.7%. Prevalence of likely MDD was 45%, low resilience- 37.4%, cannabis abuse- 14%, and alcohol abuse- 27.4% among Fort McMurray residents. <br>
For the Text4Hope-Addiction support program evaluation, 110 subscribers completed the surveys at least at one time point. After three months of subscription to Text4Hope-Addiction service, the percentage reduction in mean scores on standardized scales from baseline to three-month was 33.4%, 30.2% and 21.2% for craving, depression, and anxiety symptoms, respectively. Subscribers agreed the daily supportive messages helped them cope with stress (89%), anxiety (81%) and depression (69%). </p>

<p>Conclusion <br>
The military personnel, firefighters, the elderly, and people exposed to multiple are susceptible to mental health and addiction problems. Supportive text-based programs are accessible and easily scalable approaches to help close the psychological treatment gap for vulnerable populations.</p>