Supportive Text Messaging and Peer Support for Patients in the 6 Months Following Discharge from a Psychiatric Admission: Mental Health Outcomes from a Cluster-Randomized Controlled Trial

Background/Objective: The transition from psychiatric inpatient care to community settings poses risks of relapse, rehospitalization, and poor well-being. This study examined changes in anxiety, depression, suicidal ideation, sleep issues, and well-being over six months post-discharge and assessed the effectiveness of supportive text messaging (Text4Support) alone and with peer support, compared to treatment as usual (TAU). Methods: A pragmatic stepped-wedge cluster-randomized trial included 1098 participants discharged from psychiatric units across Alberta, Canada. Participants were allocated to the TAU, Supportive Text Messaging (SMS), or SMS plus peer support (SMS+PS) group. Outcomes were measured using GAD-7, PHQ-9, and WHO-5 at baseline and at six weeks, three months, and six months post-discharge. ANCOVA compared outcomes across groups at each time point, controlling for baseline values. Results: Follow-up completion declined (20% at six weeks, 16% at three months, and 15% at six months). No group differences emerged for anxiety, depression, suicidal ideation, or sleep issues at six weeks or three months. Well-being was significantly higher in the SMS group at six weeks (η2 = 0.10). At six months, between-group differences appeared for anxiety and depression, though post hoc tests showed no pairwise differences. Conclusions: Supportive text messaging may improve well-being shortly after discharge and holds promise as a low-intensity transitional care strategy, though findings are limited by low follow-up.