Economic Evaluation of Mindline.sg

The primary hypothesis is:

• Participants in the intervention group using mindline.sg will show significantly greater improvements in mental health outcomes, quality of life, and work productivity at post-intervention (T1) and 3-month follow-up (T2), compared to the control group.

Secondary hypotheses include:

• Intervention participants will demonstrate increased resilience, better emotion regulation, and more positive attitudes and behaviors toward mental health help-seeking compared to the control group.
• Participants in the intervention group will show higher usage and engagement with digital mental health features and report higher perceived helpfulness of tools.
• The mindline.sg intervention will be cost-effective compared to the control condition, considering improvements in mental health and productivity outcomes relative to platform costs.

The study will use a randomized controllled trial design. Participants will be assigned to either: (1) A control group (receiving a mental health information pamphlet), or (2) An intervention group (using mindline.sg). Primary outcomes include mental health status, quality of life, economic and productivity measures, and user engagement metrics.

Trial participation will last 3 months. We aim to screen 5,000 adults from the general population who are aged 21 and above, have lived in Singapore for at least two years, have no psychiatric history, and are not currently receiving mental health treatment.

Participants from screening whose DASS-21 scores are mild to moderate for any one of the following sub scales will be recruited for the subsequent phase of the study.

Participants will be randomly assigned to either the control or intervention group. In the control group, participants will receive mental health literacy materials based on standard materials given out in Singapore (e.g., from the Health Promotion Board). In the intervention group, participants will be encouraged to use Mindline.sg for four weeks.

The intervention includes weekly prompts to engage with different platform features, for example:

• Week 1: Mental health literacy (Self-assessment tools and psychoeducation modules e.g. 'understand stress', 'find perspective')
• Week 2: Positive psychology and meditation exercises through Wysa AI chat (Completion of at least 4 exercises, e.g. 'Feel more control', 'be grateful', 'think motivation', 'identify your strengths', 'be kind to yourself', 'offload your worries', 'talk about your day'). Do note that Wysa's AI materials are carefully assessed for mental health appropriateness. Users can access the Wysa AI chat directly through the mindline platform without any further registration or account creation.
• Week 3: Emotion regulation exercises on mindline.sg platform (eg: tackling emotional burnout, overcoming insecurity, overcoming low mood and regaining motivation)
• Week 4: Help-seeking and personalized toolkit (explore service wayfinding tools for further mental health resources, mindline.sg live chat).

Participants will not be required to download any third party app. They are also not required to disclose any personal data during registration or use of the mindline.sg platform. Weekly activities will likely take between 10 - 30 mins, depending on the activities. Participants can exit and come back to the website later and continue their activities at their own pace. Each week, participants will receive weekly reminders via phone (e.g. messenger app) or email. This will contain infographics explaining the features.

Additionally, to ensure compliance, participants will be given a quiz at the end of each week with reimbursements for quiz completion. At the end of each week, they will also be asked to report on their use of site features (frequency and feature(s) used, and perceived helpfulness of feature), as well as their mood (three visual-analogue scales tracking: overall mood, stress, and ability to cope with challenges during the week). The quizzes will focus on participants' engagement with the platform, user experience, satisfaction, and feedback on specific features-such as what they liked or didn't like, and what worked well or didn't work. There are no "right" or "wrong" answers.

Reimbursement will be based on completeness of the quiz, not correctness-so as long as participants complete all the questions, they will be eligible.

The peer support forum feature (Let's Talk) on the mindline platform will not be part of the package as there is a separate study to evaluate it specifically.

At the end-of-study debrief, control group participants will be directed to the mindline.sg website so they too can benefit from it.

(b) Participants will also complete measures at three time-points: baseline (T0), immediately after the intervention (T1), and 2-months post-intervention. Across the three measurement timepoints, participants will be asked to complete a questionnaire to measure primary and secondary outcomes.

To provide further context, we will analyse aggregated and anonymised administrative data from the platform during the study period, including:

• Referrals: Referrals (self-reported) from mineline.sg to offline mental health services;
• Costs of mindline, including: Development and operational costs.

Please note that this project is a collaborative initiative between the Behavioural and Implementation Sciences Interventions (BISI) at YLLSoM, NUS, the Centre for Evidence and Implementation (CEI), and Ministry of Health Office for Healthcare Transformation (MOHT) formalized through a project contract signed among the three organisations. The project is supported with funding from MOHT.

Inclusion criteria

• Aged at least 21 years or at least 18 years old if National of University student
• Have lived in Singapore for at least 2 years
• Have not received a formal diagnosis of a psychiatric disorder
• Not currently receiving any form of mental health treatment (e.g., counselling)
• Fluent in English
• Participants from screening whose DASS-21 scores are mild or moderate for any one of the sub scales.

Exclusion criteria

• Those who do not meet the inclusion criteria will be screened and excluded.