Please use this identifier to cite or link to this item:
Title: A text messaging intervention (staywell at home) to counteract depression and anxiety during COVID-19 social distancing: Pre-post study
Authors: Aguilera, Adrian
Hernandez-Ramos, Rosa
Haro-Ramos, Alein Y.
Boone, Claire Elizabeth
Luo, Tiffany Christina
Xu, Jing 
Chakraborty, Bibhas 
Karr, Chris
Darrow, Sabrina
Figueroa, Caroline Astrid
Keywords: Anxiety
Cognitive behavioral therapy
Mental health
Microrandomized trials
Mobile health
Text messaging
Issue Date: 7-May-2021
Publisher: JMIR Publications Inc.
Citation: Aguilera, Adrian, Hernandez-Ramos, Rosa, Haro-Ramos, Alein Y., Boone, Claire Elizabeth, Luo, Tiffany Christina, Xu, Jing, Chakraborty, Bibhas, Karr, Chris, Darrow, Sabrina, Figueroa, Caroline Astrid (2021-05-07). A text messaging intervention (staywell at home) to counteract depression and anxiety during COVID-19 social distancing: Pre-post study. JMIR Mental Health 8 (11) : e25298. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Background: Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19–related depression and anxiety symptoms among people who speak English and Spanish in the United States. Objective: This paper describes the changes in StayWell participants’ anxiety and depression levels after 60 days of exposure to skills-based SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. Results: The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of –1.72 (95% CI –2.35 to –1.09) in PHQ-8 scores and –0.48 (95% CI –0.71 to –0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively. Conclusions: StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health. © Adrian Aguilera, Rosa Hernandez-Ramos, Alein Y Haro-Ramos, Claire Elizabeth Boone, Tiffany Christina Luo, Jing Xu, Bibhas Chakraborty, Chris Karr, Sabrina Darrow, Caroline Astrid Figueroa. Originally published in JMIR Mental Health (, 01.11.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License.
Source Title: JMIR Mental Health
ISSN: 2368-7959
DOI: 10.2196/25298
Rights: Attribution 4.0 International
Appears in Collections:Staff Publications

Show full item record
Files in This Item:
File Description SizeFormatAccess SettingsVersion 
10_2196_25298.pdf359.55 kBAdobe PDF



Google ScholarTM



This item is licensed under a Creative Commons License Creative Commons