In order to enhance the mental health of university students in Macao, the University of Macau (UM) and New York University Shanghai (NYU Shanghai) have jointly developed a mobile application for mental health named ‘Step by Step’ (SbS). Afterwards, the first randomised controlled trial (RCT) of its effectiveness and implementation was carried out among UM students. The study results were released on 26 March, showing that SbS is effective in alleviating Chinese university students’ depressive symptoms in the short term, and, in the long term, can help students improve their psychological well-being. The outcomes indicate that there is a promising future for digital mental health interventions.
Prior to the trial, the research team spent several months working with focus groups to adapt SbS’s elements (stories, visuals, and language) to a Chinese context. Then a feasibility study was conducted to collect feedback to ensure the seamless implementation of the subsequent large-scale RCT. The RCT lasted for one year, with a total of 371 participants. The whole intervention process took eight weeks, during which the effectiveness of the intervention was evaluated on a weekly basis. Post-intervention assessment and follow-up were conducted at the end of the intervention and three months after the intervention, respectively.
Data from the study showed that participants rated the effectiveness of the intervention in reducing stress at 7 out of 10. The majority of participants reported that the SbS’s content and presentation were better than expected. More than half of the participants felt that they had learnt new knowledge and skills in managing their emotion, making plans, and overcoming negative emotions. This study provides empirical support for the effectiveness of SbS: this application can be used as an evidence-based intervention in university and wider clinical settings to improve the mental health of young people in China. Relevant results were also published in the medical journal Translational Psychiatry.
SbS is a digital mental health treatment application developed by the World Health Organization (WHO). It uses an illustrated story of a person who has learned ways to deal with stress, anxiety, and depression to teach users behavioural activation and stress management strategies. Besides, the users can receive 15 to 20 minutes of guidance per week over the phone or through chat messaging with an online peer supporter, who is a trained and supervised non-specialist. With the strong support of UM, this digital mental health treatment application was introduced to Macao in 2020 and used among different ethnic groups in Macao.
This Chinese university students’ version was jointly sponsored by the Bank of China Macau Branch, the Rotary Club of Macau, the Rotary Club of Amizade, Macao, and the Rotary Club of Penha, Macao. UM’s Centre for Macau Studies recruited university students to join the training programme. UM’s Student Counselling Section, Moon Chun Memorial College, and Shiu Pong College provided training for peer supporters, or e-helpers, in this project.
Group Photo
The report presentation on the latest research results of ‘Step-by-Step’, a mental health intervention application
A group photo of the peer supporters (front row) and the research team