Depression Symptoms
Conditions
Keywords
Positive affect, Intervention, Digital intervention, Young adults, Mental health outcomes, Feasibility, Zimbabwe, Randomized controlled trial
Brief summary
This study evaluates the feasibility, acceptability, and preliminary efficacy of a brief email-delivered positive affect intervention for young adults in Zimbabwe. The study uses a randomised controlled trial design with two parallel arms. A total of 100 participants aged 18-25 years will be randomly assigned to two arms: an experimental arm receiving an email-delivered positive affect intervention or a control arm receiving psychoeducational materials. The intervention group will receive guided activities twice weekly over three weeks, focusing on identifying, reflecting on, and engaging in positive experiences. The control group will receive general psychoeducational materials on mental health without structured activities. Assessments will be conducted at baseline and after the intervention. The primary outcome is feasibility( including recruitment, retention, and adherence) and acceptance. Secondary outcomes include changes in positive affect, symptoms of depression and anxiety,self-stigma, and suicidal ideation.
Detailed description
Digital mental health interventions are increasingly recognised as scalable and accessible approaches to supporting psychological well-being, particularly among young adults. These approaches may be especially valuable in low- and middle-income countries, where mental health services are limited and barriers to help-seeking remain substantial. Previous research in Zimbabwe has demonstrated the feasibility and acceptability of digitally delivered mental health interventions (Dambi et al., 2022). However, little is known about the feasibility of self-guided digital interventions designed to enhance positive affect and psychological well-being among young adults. Therefore, the aim of this study is to evaluate the feasibility and acceptability of a brief email-delivered positive affect intervention among young adults in Zimbabwe and to explore its preliminary effects on positive affect, negative affect, symptoms of depression and anxiety, suicidality, and self-stigma associated with seeking psychological help. The primary objective of the study is to evaluate the feasibility, acceptability, usability, and participant engagement of a brief email-based positive affect intervention. The secondary objectives of the study are; To examine changes in positive affect following participation in the intervention. To assess changes in anxiety, depression, suicidality, and negative affect following participation in the intervention. To explore changes in self-stigma associated with seeking psychological help following participation in the intervention. This study is a two-arm, parallel-group randomised controlled feasibility trial. Participants will be randomly allocated in a 1:1 ratio to either a positive affect intervention group or an active psychoeducational control group. The intervention period will last three weeks, with assessments conducted at baseline (T0) and immediately following the intervention (T1). In addition to that, participants will be recruited from a previously established cohort of young adults in Zimbabwe who participated in a cross-sectional mental health survey and consented to future contact. The study aims to recruit 100 participants aged 18-25 years. Ethical approval has been obtained from the Medical Research Council of Zimbabwe and relevant authorities. Participation is voluntary, and informed consent will be obtained before enrolment. Participants may withdraw from the study at any time without penalty. All data will be collected electronically, stored securely, and managed in accordance with data protection and confidentiality requirements.
Interventions
BEHAVIORALEmail-Delivered Positive Affect Intervention
This intervention is a brief email-delivered positive affect program designed specifically for young adults in a low-resource setting and it uses a structured three-step process of remembering, contemplating, and acting on positive experiences to intentionally increase positive affect. Unlike standard psychoeducational or symptom-focused mental health interventions, this program actively guides participants to identify personally meaningful sources of positive emotion and to translate them into daily behavioural activities. The intervention is fully automated and delivered entirely via email, making it highly scalable and accessible without the need for trained clinicians or face-to-face contact.
BEHAVIORALPsychoeducational Control
Participants receive email-based psychoeducational materials about stress, anxiety, depression, and coping strategies over three weeks. No structured behavioural exercises or positive activity tasks are included.
Sponsors
Vilnius University
University of Zimbabwe
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Masking description
No additional parties are masked in this study.
Intervention model description
Participants are randomized in equal proportions to either a three-week email-delivered positive affect intervention or a psychoeducational control condition. The study uses a between-subjects design, with outcomes assessed at baseline and post-intervention.
Eligibility
Sex/Gender
ALL
Age
18 Years to 25 Years
Healthy volunteers
No
Inclusion criteria
Participants must meet all of the following criteria: 1. Aged 18-25 years. 2. Able to understand and read English. 3. Previously participated in Stage 1 of the study and provided consent to be contacted regarding future research opportunities. 4. Have access to a device (for example smartphone, tablet, or computer) and internet connectivity for intervention delivery. 5. Report moderate levels of depression at baseline assessment.
Exclusion criteria
Participants will be excluded if they: 1. Are at high risk of suicide. 2. Are currently experiencing a psychotic episode. 3. Are currently experiencing interpersonal violence.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility and Acceptability | Baseline (Week 0) and post-intervention (Week 3) | Feasibility , usability and acceptability will be assessed using self-reported participation in email activities. Participant feedback on usability, satisfaction, and acceptability of the program will be collected at the post-intervention assessment using self-report questions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes in The Generalized Anxiety Disorder-7 | Baseline (Week 0) and post-intervention (Week 3) | Changes in symptoms of anxiety are measured. The Generalized Anxiety Disorder-7 (GAD-7, Spitzer et al., 2006) is a self-report measure comprising 7 items about symptoms of anxiety. All items are answered on a 4-point Likert scale that ranges from 0 (not at all) to 3 (nearly every day). A higher score indicates more pronounced symptoms. |
| Positive Affect (PANAS Positive Affect Subscale) | Baseline (Week 0) and post-intervention (Week 3) | Changes in positive affect are measured using the Positive and Negative Affect Schedule (PANAS; Watson et al., 1988) positive affect subscale. The PANAS is a self-report measure comprising 20 items, with 10 items assessing positive affect and 10 items assessing negative affect. Items are rated on a 5-point Likert scale ranging from 1 (very slightly or not at all) to 5 (extremely). A higher score on the positive affect subscale indicates greater frequency of positive emotional experiences. |
| Changes in The Patient Health Questionnaire-9 | Baseline (Week 0) and post-intervention (Week 3) | Changes in symptoms of depression are measured. The Patient Health Questionnaire-9 (PHQ-9, Kroenke et al., 2001) is a self-report measure comprising 9 items about symptoms of depression. All items are answered on a 4-point Likert scale that ranges from 0 (not at all) to 3 (nearly every day). A higher score indicates more pronounced symptoms. |
| Changes in the Self-Stigma (SSOSH) | Baseline (Week 0) and post-intervention (Week 3) | Changes in self-stigma associated with seeking psychological help are measured using the Self-Stigma of Seeking Help Scale (SSOSH; Vogel et al., 2006). The SSOSH is a self-report measure comprising 10 items assessing negative beliefs and attitudes about seeking professional psychological help. All items are answered on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). A higher score indicates greater self-stigma associated with seeking psychological help. |
| Changes in The SIDAS | Baseline (Week 0) and post-intervention (Week 3) | Changes in suicidal ideation are measured. The SIDAS (Van Spijker et al., 2014) is a self-report measure comprising 5 questions about suicidal ideation. All items are answered on a 10-point Likert scale that ranges from 0 (never, no control, not close at all, not at all) to 10 (always, full control, made an attempt, extremely). A higher score indicates more pronounced symptoms. |
Countries
Zimbabwe
Contacts
CONTACTFadzai Munyuki, MSc
CONTACTEvaldas Kazlauskas, PhD
PRINCIPAL_INVESTIGATOREvaldas Kazlauskas, PhD
Vilnius University
PRINCIPAL_INVESTIGATORSamson Mhizha, PhD
University of Zimbabwe
Outcome results
None listed