OPUS (2021) 12:1
heterosexual, and the other half will identify as LGBTQ+. To be eligible, students must be at least 18 years old, have a smartphone or a tablet with internet access, and exhibit at least a mild level of depression, as measured by the 9-item Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001). Individuals who are using SSRI(s) at the time of recruitment will be excluded, as the effects of antidepressants on depression may interfere with the study outcomes. Individuals with suicidal ideations within the month prior to recruitment will also be excluded, due to participant safety and ethical considerations. Instead, they will be directly referred to professional psychological services. Procedure As a first step, participants will complete a demographic survey and a PHQ-9 assessment (Kroenke et al., 2001) to determine their depression level. Those who score 5 or higher, indicating at least a mild level of depression, will be randomly assigned to one of the two groups: (a) doing activities on the SuperBetter app or (b) doing activities on the MoodKit app. The participants will further be separated into heterosexual and LGBTQ+ students, resulting in four groups total. Both apps have demonstrated a significantly positive impact on alleviating depression in randomized controlled trials in a largely heterosexual sample (Bakker et al., 2018; Roepke et al., 2015). Because the two apps have different emphases when approaching depression, including both in this study can help compare results and distinguish between features that contribute to the efficacy of the intervention. SuperBetter is a game-based app that helps build resilience and improve mental health by helping individuals build self-esteem and self-acceptance through activities such as “hugging yourself ” and “writing down things you feel grateful for” (Roepke et al., 2015). Participants assigned to this group will be instructed to complete a To-Do List every day with seven activities of their choice. MoodKit is an app that focuses on mood self-management. It contains four main tools: mood-improving activities, a thought checker, a mood tracker, and a journal (Dahne et al., 2019). Participants assigned to this group will be instructed to record their mood and complete at least three mood-improving activities every day and use the journal and the thought checker as needed. After two months, all participants will be assessed again for depression. Researchers will also assess their depression levels three months after the intervention to see if there is any lasting effect. Measures Demographic form. A demographic form will be administered to collect information on participants’ age, gender, sexual identity, race, academic standing, use of professional mental health services (e.g., therapy or life coaching) and antidepressants, suicide ideations, Internet access, use of electronic devices, and technical difficulties if any. Depression. Depression will be assessed using the PHQ9 (Kroenke & Spitzer, 2001), a self-report scale that measures depression and its severity. The PHQ-9 consists of nine items on 26 | Proposals
a four-point Likert Scale, eight of which measure the frequency of symptoms from not at all to nearly every day, and one of which measures the extent of difficulty these symptoms cause in everyday life, from not difficult at all to extremely difficult. The PHQ-9 has been shown to be a reliable depression assessment tool with a Cronbach’s alpha of approximately 0.86 (Kroenke et al., 2001), and validity has been established, especially in the college student population (Keum et al., 2018; Kroenke & Spitzer, 2001). Data Analysis Plan A repeated measures analysis of co-variance (ANCOVA) will be conducted to help determine if there are significant differences in treatment outcomes between the four groups, using the mean differences in PHQ-9 scores before the intervention, immediately after, and three months later, controlling for covariates (e.g., the use of mental health services). If there are differences, post-hoc tests will be used to determine which group yields the best result. Discussion The proposed study seeks to examine whether there are differences in treatment outcomes of CBT-based mental health apps on depression in LGBTQ+ and heterosexual students. While mental health apps have the potential to improve access to mental health care for LGBTQ+ youth, not much is known about whether they are effective in addressing the needs of this population (Schueller et al., 2019). This study might contribute to a theoretical understanding of whether sexual identity (identifying as a LGBTQ+ or not) moderates the apps’ effects on depression. Given the potential of mobile mental health in increasing LGBTQ+ youth’s service utilization rate (Rozbroj et al., 2015; Schueller et al., 2019), this study might enhance our understanding of the impact of these apps on treating depression in LGBTQ+ college students. It will help elucidate whether there is a need to improve such apps or develop more apps, to better meet their needs. Future research might examine and compare the impact of other types of mental health apps to determine the optimal treatment approach, as well as expand the measures of depression beyond self-report measures, so as to avoid the results may be subject to response bias. Future research might also examine and compare the impact of other types of mental health apps to determine the optimal treatment approach, as well as expand the measures of depression beyond self-report measures, so as to avoid response bias. Moreover, the outcomes of this study can be especially helpful in the context of the current COVID-19 pandemic. As LGBTQ+ youth are experiencing a heavier mental health burden and increased demand for services due to limited resources and support available, CBT-based apps may have potential to serve this population in the aftermath of the pandemic (Moore et al., 2021; Salerno et al., 2020).
