Online peer support in long-term physical health conditions: a feasibility randomised controlled trial

Abstract

Thirty percent of the UK population live with a long-term physical health condition, and many also experience symptoms of low mood. Limited psychosocial support is currently available for people living with long-term physical health conditions and subthreshold depression, who are at risk of developing major depressive disorder. Online peer support offers a low-cost, scalable solution to intervene early and prevent the worsening of depressive symptoms. Partnering with lived experience experts, we co-designed CommonGround, an online peer support platform with embedded psychoeducation. This feasibility randomised controlled trial aimed to assess the usability and acceptability of CommonGround for people with long-term physical health conditions experiencing subthreshold depression and assess the feasibility of a larger confirmatory trial. We conducted a mixed-methods, two-arm, parallel-group, unblinded feasibility randomised controlled trial. We recruited adults living with at least one long-term physical health condition who had access to the internet and subthreshold depression (scoring 5–9 on the Patient Health Questionnaire-8). Participants were randomised to either the CommonGround platform or a control condition where fortnightly emails shared links to the National Health Service mental health webpages. Outcome assessments were administered at baseline (0 weeks), mid-intervention (6 weeks), and post-intervention (12 weeks) timepoints. The primary outcome was the number of participants recruited to the trial. A purposive sample was interviewed to evaluate participant experiences of the CommonGround platform, control condition, and trial procedures. Recruitment targets were met. It was feasible to obtain follow-up questionnaire responses. At screening, 25% were eligible, which was lower than expected (30%), indicating that recruitment/screening processes may need refinement. Qualitative insights highlight the psychosocial benefits from using CommonGround, which felt like a credible, safe space providing transdiagnostic support for mental and physical well-being. However, opinions on anonymity were mixed, and participants felt that a longer intervention period was needed for the sense of community to evolve. There was strong desire for creating a CommonGround smartphone application (‘app’) to improve usability and engagement. People with long-term health conditions found the CommonGround platform usable and acceptable for accessing peer support. With minor modifications to trial design and further platform development, a confirmatory randomised controlled trial to evaluate clinical and cost-effectiveness is feasible and warranted. ClinicalTrials.gov: NCT06222346; https://clinicaltrials.gov/study/NCT06222346 . Protocol version: Version 1.3; 4th September 2024.