A Social Support Just-in-Time Adaptive Intervention for Individuals With Depressive Symptoms: Feasibility Study With a Microrandomized Trial Design.

Background: Just-in-time adaptive interventions (JITAIs) aim to provide psychological support during critical moments in daily life.

Objective: This preregistered study aims to evaluate the feasibility of a social support JITAI for individuals with subclinical and clinical levels of depressive symptoms awaiting psychotherapy. Triggered by ecological momentary assessment (EMA) reports, the intervention encouraged participants to activate their (digital) social support networks.

Methods: A total of 25 participants completed 2689 EMA surveys and received 377 JITAIs over an 18-day intervention period, including a microrandomized trial, to compare 4 strategies to trigger an intervention: fixed cutoff points of distress variables, personalized thresholds (through Shewhart control charts) of distress variables, momentary support need, and no intervention.

Results: The results showed high feasibility, with participants completing 85.37% (2689/3150) of the EMA surveys, exhibiting a low study-related attrition rate (7%; total attrition rate was 17%), and reporting minimal technical issues. Engagement and perceived helpfulness were heterogeneous and moderate, with participants seeking support in one-third of the instances after an intervention was triggered instances. JITAIs triggered by self-reported need for support were rated as more appropriately timed, helpful, and effective for promoting support-seeking behavior compared to those based on distress indicators, despite being triggered less frequently. Barriers, such as time constraints and perceived unavailability of support providers, likely affected support-seeking behavior, as indicated by additional qualitative analyses. Exploratory effectiveness analyses indicated Cohen d effect sizes between 0.06 and 0.14 in reducing distress after JITAIs were received.

Conclusions: The findings of this study demonstrate that a social support JITAI is feasible to implement, with high compliance and minimal technical issues. However, further research is needed to evaluate the JITAI's effectiveness and optimize trigger strategies in addressing individual needs for and barriers to engagement.