Chaitali Sinha ^1* Dyuthi Dinesh ^1* Creighton Koapono Heaukulani ² Ye Sheng Phang ²

• ¹ Wysa, Boston, United States
• ² MOH Office for Healthcare Transformation, Singapore, Singapore

The COVID-19 pandemic in Singapore led to limited access to mental health services, resulting in increased distress among the population. This study explores the potential benefits of offering a digital mental health intervention (Wysa) in the form of a brief and longitudinal intervention, as part of the mindline.sg initiative launched by the MOH Office for Healthcare Transformation in Singapore. This paper aims to: i) Evaluate the engagement and retention of Singaporean users across the brief intervention on the mindline.sg website and the longitudinal app version of Wysa; ii) Examine the types of negative thoughts and challenges managed during the pandemic; iii) Assess the impact of the conversational agent (CA) in supporting cognitive restructuring across attributional styles, and cognitive patterns.A retrospective observational design with a mixed-methods approach was utilized. The sample included website users (N=69,055) and app users (N=4,103) from September 1, 2020, to July 25, 2022. App and website usage data were analyzed to evaluate engagement and retention. T-tests were employed for comparing engagement and retention levels between the app and website. A thematic analysis assessed the types of negative thoughts and the success of cognitive restructuring. Logistic regression was used to estimate the likelihood of restructuring based on negative thought type and attributional style.Those who used the longitudinal intervention after first using a brief intervention demonstrated significantly higher engagement and retention (P<.001). In user ratings received for mindline.sg (n=8,959), 83.03% rated the app 3 or higher (out of 5) on helpfulness. 91.6% of the users (n=862) who attempted cognitive restructuring (n=790) on the app successfully reframed a thought. The logistic regression analysis indicated significance in the ability to restructure future-oriented negative thoughts (P<.001), and internal, stable and global (P<.001) negative thoughts in a single conversation with Wysa, while other attributional styles required more intervention. A qualitative thematic analysis of the negative thoughts mentioned within the CA documented the psychosocial challenges being managed by users during COVID-19. The findings demonstrated that brief interventions can facilitate enhanced engagement with digital mental health interventions and digital interventions can successfully facilitate cognitive restructuring, and improvement of mental health outcomes.