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The COVID-19 pandemic in Singapore led to limited access to mental health services, resulting in increased distress among the population. This study explores the potential benefits of offering a digital mental health intervention (DMHI), Wysa, as a brief and longitudinal intervention as part of the mindline.sg initiative launched by the MOH Office for Healthcare Transformation in Singapore. The paper aims to (i) Evaluate the engagement and retention of Singaporean users across the brief intervention on the mindline.sg website and the longitudinal app version of Wysa; (ii) Examine the types of negative thoughts and challenges managed during the pandemic; and (iii) Assess the impact of the conversational agent (CA) in supporting cognitive restructuring across attributional styles and cognitive patterns. A retrospective observational design with a mixed-methods approach was utilized. Website users ( N  = 69,055) and app users ( N  = 4,103) from September 1, 2020, to July 25, 2022, were included in the study. Engagement and retention were evaluated through usage data, and T-tests were used to compare engagement and retention between the app and website. A thematic analysis assessed the types of negative thoughts and the success of cognitive restructuring. Logistic regression was used to estimate the likelihood of restructuring based on negative thought type and attributional style. Users who used the longitudinal intervention after first using a brief intervention demonstrated significantly higher engagement and retention ( P  < 0.001). In user ratings received for mindline.sg ( n  = 8,959), 83.03% rated the app 3 or higher (out of 5) on helpfulness. 91.6% of the users ( n  = 862) who attempted cognitive restructuring ( n  = 790) on the app successfully reframed a thought. A single conversation with Wysa was also significantly associated with the ability to restructure future-oriented negative thoughts ( P  < 0.001) and internal, stable and global ( P  < 0.001) negative thoughts, while other attributional styles required more intervention. Psychosocial challenges managed by users during COVID-19 were also documented through negative thoughts mentioned within the CA. The findings demonstrate that brief interventions can facilitate enhanced engagement with DMHIs and that digital interventions can successfully facilitate cognitive restructuring and improve mental health outcomes. The study provides useful inputs to guide the development of DMHIs and improve their effectiveness., Competing Interests: CS and DD are employees of Wysa Inc. and CS owns equity in the company. YP and CH work with the MOH Office for Healthcare Transformation, Singapore, which created mindline.sg., (© 2024 Sinha, Dinesh, Heaukulani and Phang.)

Mental health issues have increased substantially since the onset of the COVID-19 pandemic. However, health policymakers do not have adequate data and tools to predict mental health demand, especially amid a crisis. Using time-series data collected in Singapore, this study examines if and how algorithmically measured emotion indicators from Twitter posts can help forecast emergency mental health needs. We measured the mental health needs during 549 days from 1 July 2020 to 31 December 2021 using the public's daily visits to the emergency room of the country's largest psychiatric hospital and the number of users with "crisis" state assessed through a government-initiated online mental health self-help portal. Pairwise Granger-causality tests covering lag length from 1 day to 5 days indicated that forecast models using Twitter joy, anger and sadness emotions as predictors perform significantly better than baseline models using past mental health needs data alone (e.g., Joy Intensity on IMH Visits, χ2 = 14·9, P < ·001***; Sadness Count on Mindline Crisis, χ2 = 4·6, P = ·031*, with a one-day lag length). The findings highlight the potential of new early indicators for tracking emerging public mental health needs., (© 2024. The Author(s).)

Background: Singapore, like the rest of Asia, faces persistent challenges to mental health promotion, including stigma around unwellness and seeking treatment and a lack of trained mental health personnel. The COVID-19 pandemic, which created a surge in mental health care needs and simultaneously accelerated the adoption of digital health solutions, revealed a new opportunity to quickly scale innovative solutions in the region., Objective: In June 2020, the Singaporean government launched mindline.sg, an anonymous digital mental health resource website that has grown to include >500 curated local mental health resources, a clinically validated self-assessment tool for depression and anxiety, an artificial intelligence (AI) chatbot from Wysa designed to deliver digital therapeutic exercises, and a tailored version of the website for working adults called mindline at work. The goal of the platform is to empower Singapore residents to take charge of their own mental health and to be able to offer basic support to those around them through the ease and convenience of a barrier-free digital solution., Methods: Website use is measured through click-level data analytics captured via Google Analytics and custom application programming interfaces, which in turn drive a customized analytics infrastructure based on the open-source platforms Titanium Database and Metabase. Unique, nonbounced (users that do not immediately navigate away from the site), engaged, and return users are reported., Results: In the 2 years following launch (July 1, 2020, through June 30, 2022), the website received >447,000 visitors (approximately 15% of the target population of 3 million), 62.02% (277,727/447,783) of whom explored the site or engaged with resources (referred to as nonbounced visitors); 10.54% (29,271/277,727) of those nonbounced visitors returned. The most popular features on the platform were the dialogue-based therapeutic exercises delivered by the chatbot and the self-assessment tool, which were used by 25.54% (67,626/264,758) and 11.69% (32,469/277,727) of nonbounced visitors. On mindline at work, the rates of nonbounced visitors who engaged extensively (ie, spent ≥40 seconds exploring resources) and who returned were 51.56% (22,474/43,588) and 13.43% (5,853/43,588) over a year, respectively, compared to 30.9% (42,829/138,626) and 9.97% (13,822/138,626), respectively, on the generic mindline.sg site in the same year., Conclusions: The site has achieved desired reach and has seen a strong growth rate in the number of visitors, which required substantial and sustained digital marketing campaigns and strategic outreach partnerships. The site was careful to preserve anonymity, limiting the detail of analytics. The good levels of overall adoption encourage us to believe that mild to moderate mental health conditions and the social factors that underly them are amenable to digital interventions. While mindline.sg was primarily used in Singapore, we believe that similar solutions with local customization are widely and globally applicable., (©Janice Huiqin Weng, Yanyan Hu, Creighton Heaukulani, Clarence Tan, Julian Kuiyu Chang, Ye Sheng Phang, Priyanka Rajendram, Weng Mooi Tan, Wai Chiong Loke, Robert J T Morris. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 04.06.2024.)

Background: The website mindline.sg is a stress management and coping website that can be accessed anonymously in Singapore for free. Although designed to serve individuals who are well or have mild depression and anxiety symptoms, mindline.sg may potentially be used by clinicians as an adjunct therapeutic aid for patients with clinically diagnosed mental disorders., Objective: This study aims to determine the perceived usability, acceptability, and usefulness of mindline.sg among individuals with diagnosed mental disorders in a clinical setting., Methods: A cross-sectional study with 173 participants was conducted in the waiting room of a psychiatrist's office at the National University Hospital in Singapore. Participants waiting for an appointment were given 30 minutes and a simple set of instructions to use three features of mindline.sg. They subsequently answered a set of web-based survey questions via their smartphones, including a 16-item subset of the Post-Study System Usability Questionnaire (PSSUQ) for usability measurement and 5 questions designed to understand the perceived usefulness and acceptability of mindline.sg. Multiple linear regression is used to determine the associated demographic factors with overall PSSUQ score. A chi-square test is performed to investigate associations of psychiatric condition with users' responses on acceptability and perceived usefulness of mindline.sg. For this study, P<.05 is considered significant., Results: We observed that the overall (mean 2.86, SD 1.46), system usefulness (mean 2.74, SD 1.46), and information quality (mean 2.98, SD 1.33) subscores of the PSSUQ survey are within a 99% CI of a literature-derived norm, which all have the interpretation of having high perceived usability. However, interface quality (mean 2.98, SD 1.33) scored lower than the literature-derived norm, although it is still better than the neutral score of 4. We find participants with lower than a General Certificate of Education O-Level or N-Level education tend to give a lower usability score as compared to others (β=.49; P=.02). Participants who have not been hospitalized previously due to their condition are also more likely to give a lower PSSUQ score as compared to individuals who have been hospitalized (β=.18; P=.03). The platform mindline.sg is also deemed to be generally useful and acceptable with all the survey questions receiving more than a 60% positive response. We found no association between the type(s) of self-reported psychiatric disorder(s) and the perceived usefulness and acceptability of mindline.sg., Conclusions: Our results show that mindline.sg is generally perceived as usable and acceptable by individuals with a diagnosed mental disorder in Singapore. The study suggests improving usability among individuals with lower education levels. Particularly promising is the finding that previously hospitalized individuals have significantly higher perceived usability and satisfaction of the website, suggesting potential impact could be found among a moderately to severely at-risk clinical population. The effectiveness of mindline.sg as an adjunct therapy for individuals with diagnosed mental disorders should therefore be explored in future studies., (©Ye Sheng Phang, Creighton Heaukulani, Wijaya Martanto, Robert Morris, Mian Mian Tong, Roger Ho. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 29.03.2023.)