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<p>Depression is a leading cause of disability worldwide. In Thailand, a mental health treatment gap exists due to a shortage of professionals and stigma. Digital mental health interventions, especially culturally tailored ones, offer a scalable solution in low- and middle-income countries. This study assessed the feasibility, acceptability, and preliminary effects of a culturally adapted Thai version of Step-by-Step (SbS), a digital behavioral activation intervention, implemented through a stratified task-shifting model.&#xa0;In a single-arm, mixed-methods study, 113 Thai adults with mild-to-moderate depressive symptoms (9Q score 7–18) were enrolled. Participants were divided into two groups based on baseline symptom severity: those with mild symptoms (<i>n</i> = 58) received self-guided SbS without routine support, while those with moderate symptoms (<i>n</i> = 55) received SbS with weekly support from trained nursing students (e-helpers). Outcomes were measured in terms of depressive symptoms (9Q), psychological distress (DASS-21), and quality of life (SF-12), with assessments conducted at baseline, post-intervention (approximately 6 weeks), and at a 2-week follow-up. Qualitative interviews with 15 participants and 13 e-helpers explored experiences and mechanisms of change.&#xa0;A total of 98 participants (86.7%) completed the intervention. Both groups exhibited significant reductions in depressive symptoms and psychological distress, with the self-led group showing a Cohen’s d of 0.98–1.15 and the e-helper group a Cohen’s d of 1.43–1.66. The e-helper group experienced greater symptom improvement compared to the self-led group (<i>p</i> &lt; .001). Modest improvements were noted in quality of life. Qualitative data highlighted cognitive reframing, emotional regulation, and behavioral activation as key mechanisms of change. E-helpers noted professional development benefits, though they also experienced an emotional burden. The stratified, culturally adapted Thai SbS program demonstrated feasibility and initial success in alleviating depressive symptoms.&#xa0;This model pragmatically aligns the intensity of support with the severity of symptoms. Nonetheless, longer follow-up periods and randomized trials are necessary to confirm its effectiveness.</p>

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Feasibility and Preliminary Effects of a Culturally Adapted Stratified Digital Mental Health Intervention (Step-by-Step) for Depressive Symptoms in Thailand

  • 期刊论文

  • 发表日期：

    2026年6月26日

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  • Kedsaraporn Kenbubpha,
  • Aphichaya Polrak,
  • Chanatip Tongyonk,
  • Wilaiwan Pathike,
  • Dutsadee Juengsiragulwit

摘要

Depression is a leading cause of disability worldwide. In Thailand, a mental health treatment gap exists due to a shortage of professionals and stigma. Digital mental health interventions, especially culturally tailored ones, offer a scalable solution in low- and middle-income countries. This study assessed the feasibility, acceptability, and preliminary effects of a culturally adapted Thai version of Step-by-Step (SbS), a digital behavioral activation intervention, implemented through a stratified task-shifting model. In a single-arm, mixed-methods study, 113 Thai adults with mild-to-moderate depressive symptoms (9Q score 7–18) were enrolled. Participants were divided into two groups based on baseline symptom severity: those with mild symptoms (n = 58) received self-guided SbS without routine support, while those with moderate symptoms (n = 55) received SbS with weekly support from trained nursing students (e-helpers). Outcomes were measured in terms of depressive symptoms (9Q), psychological distress (DASS-21), and quality of life (SF-12), with assessments conducted at baseline, post-intervention (approximately 6 weeks), and at a 2-week follow-up. Qualitative interviews with 15 participants and 13 e-helpers explored experiences and mechanisms of change. A total of 98 participants (86.7%) completed the intervention. Both groups exhibited significant reductions in depressive symptoms and psychological distress, with the self-led group showing a Cohen’s d of 0.98–1.15 and the e-helper group a Cohen’s d of 1.43–1.66. The e-helper group experienced greater symptom improvement compared to the self-led group (p < .001). Modest improvements were noted in quality of life. Qualitative data highlighted cognitive reframing, emotional regulation, and behavioral activation as key mechanisms of change. E-helpers noted professional development benefits, though they also experienced an emotional burden. The stratified, culturally adapted Thai SbS program demonstrated feasibility and initial success in alleviating depressive symptoms. This model pragmatically aligns the intensity of support with the severity of symptoms. Nonetheless, longer follow-up periods and randomized trials are necessary to confirm its effectiveness.