@Article{info:doi/10.2196/26550,
author="Strudwick, Gillian
and Sockalingam, Sanjeev
and Kassam, Iman
and Sequeira, Lydia
and Bonato, Sarah
and Youssef, Alaa
and Mehta, Rohan
and Green, Nadia
and Agic, Branka
and Soklaridis, Sophie
and Impey, Danielle
and Wiljer, David
and Crawford, Allison",
title="Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review",
journal="JMIR Ment Health",
year="2021",
month="Mar",
day="2",
volume="8",
number="3",
pages="e26550",
keywords="digital health",
keywords="psychiatry",
keywords="mental health",
keywords="informatics",
keywords="pandemic",
keywords="COVID-19",
keywords="telemedicine",
keywords="eHealth",
keywords="public health",
keywords="virtual care",
keywords="mobile apps",
keywords="population health",
abstract="Background: The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22\% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial. Objective: The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention. Methods: This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada's guidance on app assessment and selection. Results: A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity. Conclusions: A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area. ",
doi="10.2196/26550",
url="https://mental.jmir.org/2021/3/e26550",
url="http://www.ncbi.nlm.nih.gov/pubmed/33650985"
}


@Article{info:doi/10.2196/25775,
author="Yunusova, Asal
and Lai, Jocelyn
and Rivera, P. Alexander
and Hu, Sirui
and Labbaf, Sina
and Rahmani, M. Amir
and Dutt, Nikil
and Jain, C. Ramesh
and Borelli, L. Jessica",
title="Assessing the Mental Health of Emerging Adults Through a Mental Health App: Protocol for a Prospective Pilot Study",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="2",
volume="10",
number="3",
pages="e25775",
keywords="ecological momentary assessment",
keywords="stress",
keywords="digital mental health",
keywords="college student",
keywords="mental health",
keywords="protocol",
keywords="prospective",
keywords="feasibility",
keywords="individual",
keywords="factors",
keywords="sleepy",
keywords="physiology",
keywords="activity",
keywords="COVID-19",
abstract="Background: Individuals can experience different manifestations of the same psychological disorder. This underscores the need for a personalized model approach in the study of psychopathology. Emerging adulthood is a developmental phase wherein individuals are especially vulnerable to psychopathology. Given their exposure to repeated stressors and disruptions in routine, the emerging adult population is worthy of investigation. Objective: In our prospective study, we aim to conduct multimodal assessments to determine the feasibility of an individualized approach for understanding the contextual factors of changes in daily affect, sleep, physiology, and activity. In other words, we aim to use event mining to predict changes in mental health. Methods: We expect to have a final sample size of 20 participants. Recruited participants will be monitored for a period of time (ie, between 3 and 12 months). Participants will download the Personicle app on their smartphone to track their activities (eg, home events and cycling). They will also be given wearable sensor devices (ie, devices that monitor sleep, physiology, and physical activity), which are to be worn continuously. Participants will be asked to report on their daily moods and provide open-ended text responses on a weekly basis. Participants will be given a battery of questionnaires every 3 months. Results: Our study has been approved by an institutional review board. The study is currently in the data collection phase. Due to the COVID-19 pandemic, the study was adjusted to allow for remote data collection and COVID-19--related stress assessments. Conclusions: Our study will help advance research on individualized approaches to understanding health and well-being through multimodal systems. Our study will also demonstrate the benefit of using individualized approaches to study interrelations among stress, social relationships, technology, and mental health. International Registered Report Identifier (IRRID): DERR1-10.2196/25775 ",
doi="10.2196/25775",
url="https://www.researchprotocols.org/2021/3/e25775",
url="http://www.ncbi.nlm.nih.gov/pubmed/33513124"
}


@Article{info:doi/10.2196/26559,
author="Jaworski, K. Beth
and Taylor, Katherine
and Ramsey, M. Kelly
and Heinz, Adrienne
and Steinmetz, Sarah
and Pagano, Ian
and Moraja, Giovanni
and Owen, E. Jason",
title="Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="1",
volume="23",
number="3",
pages="e26559",
keywords="COVID-19",
keywords="coronavirus",
keywords="mobile app",
keywords="mHealth",
keywords="digital health",
keywords="mental health",
keywords="public mental health",
keywords="stress",
keywords="coping",
keywords="public health",
keywords="app",
abstract="Background: The COVID-19 pandemic has significantly impacted mental health and well-being. Mobile mental health apps can be scalable and useful tools in large-scale disaster responses and are particularly promising for reaching vulnerable populations. COVID Coach is a free, evidence-informed mobile app designed specifically to provide tools and resources for addressing COVID-19--related stress. Objective: The purpose of this study was to characterize the overall usage of COVID Coach, explore retention and return usage, and assess whether the app was reaching individuals who may benefit from mental health resources. Methods: Anonymous usage data collected from COVID Coach between May 1, 2020, through October 31, 2020, were extracted and analyzed for this study. The sample included 49,287 unique user codes and 3,368,931 in-app events. Results: Usage of interactive tools for coping and stress management comprised the majority of key app events (n=325,691, 70.4\%), and the majority of app users tried a tool for managing stress (n=28,009, 58.8\%). COVID Coach was utilized for ?3 days by 80.9\% (n=34,611) of the sample whose first day of app use occurred within the 6-month observation window. Usage of the key content in COVID Coach predicted returning to the app for a second day. Among those who tried at least one coping tool on their first day of app use, 57.2\% (n=11,444) returned for a second visit; whereas only 46.3\% (n=10,546) of those who did not try a tool returned (P<.001). Symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) were prevalent among app users. For example, among app users who completed an anxiety assessment on their first day of app use (n=4870, 11.4\% of users), 55.1\% (n=2680) reported levels of anxiety that were moderate to severe, and 29.9\% (n=1455) of scores fell into the severe symptom range. On average, those with moderate levels of depression on their first day of app use returned to the app for a greater number of days (mean 3.72 days) than those with minimal symptoms (mean 3.08 days; t1=3.01, P=.003). Individuals with significant PTSD symptoms on their first day of app use utilized the app for a significantly greater number of days (mean 3.79 days) than those with fewer symptoms (mean 3.13 days; t1=2.29, P=.02). Conclusions: As the mental health impacts of the pandemic continue to be widespread and increasing, digital health resources, such as apps like COVID Coach, are a scalable way to provide evidence-informed tools and resources. Future research is needed to better understand for whom and under what conditions the app is most helpful and how to increase and sustain engagement. ",
doi="10.2196/26559",
url="https://www.jmir.org/2021/3/e26559",
url="http://www.ncbi.nlm.nih.gov/pubmed/33606656"
}


@Article{info:doi/10.2196/25834,
author="Ortiz, Robin
and Southwick, Lauren
and Schneider, Rachelle
and Klinger, V. Elissa
and Pelullo, Arthur
and Guntuku, Chandra Sharath
and Merchant, M. Raina
and Agarwal, K. Anish",
title="Improving Mood Through Community Connection and Resources Using an Interactive Digital Platform: Development and Usability Study",
journal="JMIR Ment Health",
year="2021",
month="Feb",
day="26",
volume="8",
number="2",
pages="e25834",
keywords="community",
keywords="COVID-19",
keywords="digital health",
keywords="digital tool",
keywords="mental health",
keywords="mood",
keywords="prospective",
keywords="thematic analysis",
keywords="virtual support",
keywords="well-being",
abstract="Background: COVID-19 continues to disrupt global health and well-being. In April-May 2020, we generated a digital, remote interactive tool to provide health and well-being resources and foster connectivity among community members through a text messaging platform. Objective: This study aimed to prospectively investigate the ability of a health system--based digital, remote, interactive tool to provide health and well-being resources to local community participants and to foster connectivity among them during the early phases of COVID-19. Methods: We performed descriptive and nonparametric longitudinal statistical analyses to describe and compare the participants' mood ratings over time and thematic analysis of their responses to text messages to further assess mood. Results: From among 393 individuals seeking care in an urban emergency department in an academic setting, engaged in a two-way text messaging platform, we recorded 287 mood ratings and 368 qualitative responses. We observed no difference in the initial mood rating by week of enrollment [Kruskal-Wallis chi-square H(5)=1.34; P=.93], and the average mood rating did not change for participants taken together [Friedman chi-square Q(3)=0.32; P=.96]. However, of participants providing mood ratings at baseline, mood improved significantly among participants who reported a low mood rating at baseline [n=25, 14.97\%; Q(3)=20.68; P<.001] but remained stable among those who reported a high mood rating at baseline [n=142, 85.03\%; Q(3)=2.84; P=.42]. Positive mood elaborations most frequently included words related to sentiments of thankfulness and gratitude, mostly for a sense of connection and communication; in contrast, negative mood elaborations most frequently included words related to anxiety. Conclusions: Our findings suggest the feasibility of engaging individuals in a digital community with an emergency department facilitation. Specifically, for those who opt to engage in a text messaging platform during COVID-19, it is feasible to assess and respond to mood-related queries with vetted health and well-being resources. ",
doi="10.2196/25834",
url="https://mental.jmir.org/2021/2/e25834",
url="http://www.ncbi.nlm.nih.gov/pubmed/33635280"
}


@Article{info:doi/10.2196/22705,
author="Yu, Yanqiu
and She, Rui
and Luo, Sitong
and Xin, Meiqi
and Li, Lijuan
and Wang, Suhua
and Ma, Le
and Tao, Fangbiao
and Zhang, Jianxin
and Zhao, Junfeng
and Li, Liping
and Hu, Dongsheng
and Zhang, Guohua
and Gu, Jing
and Lin, Danhua
and Wang, Hongmei
and Cai, Yong
and Wang, Zhaofen
and You, Hua
and Hu, Guoqing
and Lau, Tak-Fai Joseph",
title="Factors Influencing Depression and Mental Distress Related to COVID-19 Among University Students in China: Online Cross-sectional Mediation Study",
journal="JMIR Ment Health",
year="2021",
month="Feb",
day="22",
volume="8",
number="2",
pages="e22705",
keywords="COVID-19",
keywords="depression",
keywords="mental distress",
keywords="psychological responses",
keywords="mediation",
keywords="China",
keywords="online survey",
abstract="Background: The COVID-19 epidemic may elevate mental distress and depressive symptoms in various populations in China. Objective: This study investigates the levels of depression and mental distress due to COVID-19, and the associations between cognitive, behavioral, and psychosocial factors, and depression and mental distress due to COVID-19 among university students in China. Methods: A large-scale online cross-sectional study (16 cities in 13 provinces) was conducted among university students from February 1 to 10, 2020, in China; 23,863 valid questionnaires were returned. The Patient Health Questionnaire-9 was used to assess depression. Structural equation modeling was performed to test mediation and suppression effects. Results: Of the 23,863 participants, 47.1\% (n=11,235) reported high or very high levels of one or more types of mental distress due to COVID-19; 39.1\% (n=9326) showed mild to severe depression. Mental distress due to COVID-19 was positively associated with depression. All but one factor (perceived infection risks, perceived chance of controlling the epidemic, staying at home, contacted people from Wuhan, and perceived discrimination) were significantly associated with mental distress due to COVID-19 and depression. Mental distress due to COVID-19 partially mediated and suppressed the associations between some of the studied factors and depression (effect size of 6.0\%-79.5\%). Conclusions: Both mental distress due to COVID-19 and depression were prevalent among university students in China; the former may have increased the prevalence of the latter. The studied cognitive, behavioral, and psychosocial factors related to COVID-19 may directly or indirectly (via mental distress due to COVID-19) affect depression. Interventions to modify such factors may reduce mental distress and depressive symptoms during the COVID-19 epidemic. ",
doi="10.2196/22705",
url="https://mental.jmir.org/2021/2/e22705",
url="http://www.ncbi.nlm.nih.gov/pubmed/33616541"
}


@Article{info:doi/10.2196/25232,
author="Nishimura, Yoshito
and Ochi, Kanako
and Tokumasu, Kazuki
and Obika, Mikako
and Hagiya, Hideharu
and Kataoka, Hitomi
and Otsuka, Fumio",
title="Impact of the COVID-19 Pandemic on the Psychological Distress of Medical Students in Japan: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="18",
volume="23",
number="2",
pages="e25232",
keywords="COVID-19",
keywords="online education",
keywords="depression",
keywords="pandemic",
keywords="anxiety",
keywords="medical student",
abstract="Background: The COVID-19 pandemic has negatively affected medical education. However, little data are available about medical students' distress during the pandemic. Objective: This study aimed to provide details on how medical students have been affected by the pandemic. Methods: A cross-sectional study was conducted. A total of 717 medical students participated in the web-based survey. The survey included questions about how the participants' mental status had changed from before to after the Japanese nationwide state of emergency (SOE). Results: Out of 717 medical students, 473 (66.0\%) participated in the study. In total, 29.8\% (141/473) of the students reported concerns about the shift toward online education, mostly because they thought online education would be ineffective compared with in-person learning. The participants' subjective mental health status significantly worsened after the SOE was lifted (P<.001). Those who had concerns about a shift toward online education had higher odds of having generalized anxiety and being depressed (odds ratio [OR] 1.97, 95\% CI 1.19-3.28) as did those who said they would request food aid (OR 1.99, 95\% CI 1.16-3.44) and mental health care resources (OR 3.56, 95\% CI 2.07-6.15). Conclusions: Given our findings, the sudden shift to online education might have overwhelmed medical students. Thus, we recommend that educators inform learners that online learning is not inferior to in-person learning, which could attenuate potential depression and anxiety. ",
doi="10.2196/25232",
url="http://www.jmir.org/2021/2/e25232/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33556033"
}


@Article{info:doi/10.2196/26715,
author="Kaveladze, Benjamin
and Chang, Katherine
and Siev, Jedidiah
and Schueller, M. Stephen",
title="Impact of the COVID-19 Pandemic on Online Obsessive-Compulsive Disorder Support Community Members: Survey Study",
journal="JMIR Ment Health",
year="2021",
month="Feb",
day="17",
volume="8",
number="2",
pages="e26715",
keywords="obsessive-compulsive disorder",
keywords="COVID-19 pandemic",
keywords="online support communities",
keywords="mental health",
abstract="Background: People with obsessive-compulsive disorder (OCD) have faced unique challenges during the COVID-19 pandemic. Research from the first two months of the pandemic suggests that a small proportion of people with OCD experienced worsening in their OCD symptoms since the pandemic began, whereas the rest experienced either no change or an improvement in their symptoms. However, as society-level factors relating to the pandemic have evolved, the effects of the pandemic on people with OCD have likely changed as well, in complex and population-specific ways. Therefore, this study contributes to a growing body of knowledge on the impact of the COVID-19 pandemic on people and demonstrates how differences across studies might emerge when studying specific populations at specific timepoints. Objective: This study aimed to assess how members of online OCD support communities felt the COVID-19 pandemic had affected their OCD symptoms, around 3 months after the pandemic began. Methods: We recruited participants from online OCD support communities for our brief survey. Participants indicated how much they felt their OCD symptoms had changed since the pandemic began and how much they felt that having OCD was making it harder to deal with the pandemic. Results: We collected survey data from June through August 2020 and received a total of 196 responses, some of which were partial responses. Among the nonmissing data, 65.9\% (108/164) of the participants were from the United States and 90.5\% (152/168) had been subjected to a stay-at-home order. In all, 92.9\% (182/196) of the participants said they experienced worsening of their OCD symptoms since the pandemic began, although the extent to which their symptoms worsened differed across dimensions of OCD; notably, symmetry and completeness symptoms were less likely to have worsened than others. Moreover, 95.5\% (171/179) of the participants felt that having OCD made it difficult to deal with the pandemic. Conclusions: Our study of online OCD support community members found a much higher rate of OCD symptom worsening than did other studies on people with OCD conducted during the current COVID-19 pandemic. Factors such as quarantine length, location, overlapping society-level challenges, and differing measurement and sampling choices may help to explain this difference across studies. ",
doi="10.2196/26715",
url="http://mental.jmir.org/2021/2/e26715/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33595449"
}


@Article{info:doi/10.2196/25363,
author="Mongkhon, Pajaree
and Ruengorn, Chidchanok
and Awiphan, Ratanaporn
and Thavorn, Kednapa
and Hutton, Brian
and Wongpakaran, Nahathai
and Wongpakaran, Tinakon
and Nochaiwong, Surapon",
title="Exposure to COVID-19-Related Information and its Association With Mental Health Problems in Thailand: Nationwide, Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="12",
volume="23",
number="2",
pages="e25363",
keywords="coronavirus",
keywords="COVID-19",
keywords="insomnia",
keywords="mental health",
keywords="social media",
keywords="depression",
keywords="anxiety",
keywords="stress",
keywords="psychosocial problem",
abstract="Background: The COVID-19 pandemic has had a negative impact on both the physical and mental health of individuals worldwide. Evidence regarding the association between mental health problems and information exposure among Thai citizens during the COVID-19 outbreak is limited. Objective: This study aimed to explore the relationship between information exposure and mental health problems during the COVID-19 pandemic in Thailand. Methods: Between April 21 and May 4, 2020, we conducted a cross-sectional, nationwide online survey of the general population in Thailand. We categorized the duration of exposure to COVID-19-related information as follows: <1 h/day (reference group), 1-2 h/day, and ?3 h/day. Mental health outcomes were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the Perceived Stress Scale-10, and the Insomnia Severity Index for symptoms of depression, anxiety, perceived stress, and insomnia, respectively. Multivariable logistic regression models were used to evaluate the relationship between information exposure and the risk of developing the aforementioned symptoms. An ancillary analysis using multivariable multinomial logistic regression models was also conducted to assess the possible dose-response relationship across the severity strata of mental health problems. Results: Of the 4322 eligible participants, 4004 (92.6\%) completed the online survey. Of them, 1481 (37.0\%), 1644 (41.1\%), and 879 (22.0\%) participants were exposed to COVID-19-related information for less than 1 hour per day, 1 to 2 hours per day, or 3 or more hours per day, respectively. The major source of information related to the COVID-19 pandemic was social media (95.3\%), followed by traditional media (68.7\%) and family members (34.9\%). Those exposed to information for 3 or more hours per day had a higher risk of developing symptoms of depression (adjusted odds ratio [OR] 1.35, 95\% CI 1.03-1.76; P=.03), anxiety (adjusted OR 1.88, 95\% CI 1.43-2.46; P<.001), and insomnia (adjusted OR 1.52, 95\% CI 1.17-1.97; P=.001) than people exposed to information for less than 1 hour per day. Meanwhile, people exposed to information for 1 to 2 hours per day were only at risk of developing symptoms of anxiety (adjusted OR 1.35, 95\% CI 1.08-1.69; P=.008). However, no association was found between information exposure and the risk of perceived stress. In the ancillary analysis, a dose-response relationship was observed between information exposure of 3 or more hours per day and the severity of mental health problems. Conclusions: These findings suggest that social media is the main source of COVID-19-related information. Moreover, people who are exposed to information for 3 or more hours per day are more likely to develop psychological problems, including depression, anxiety, and insomnia. Longitudinal studies investigating the long-term effects of COVID-19-related information exposure on mental health are warranted. ",
doi="10.2196/25363",
url="http://www.jmir.org/2021/2/e25363/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33523828"
}


@Article{info:doi/10.2196/26683,
author="Al-Alawi, Mohammed
and McCall, K. Roopa
and Sultan, Alya
and Al Balushi, Naser
and Al-Mahrouqi, Tamadhir
and Al Ghailani, Abdullah
and Al Sabti, Hilal
and Al-Maniri, Abdullah
and Panchatcharam, M. Sathiya
and Al Sinawi, Hamed",
title="Efficacy of a Six-Week-Long Therapist-Guided Online Therapy Versus Self-help Internet-Based Therapy for COVID-19--Induced Anxiety and Depression: Open-label, Pragmatic, Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2021",
month="Feb",
day="12",
volume="8",
number="2",
pages="e26683",
keywords="COVID-19",
keywords="depression",
keywords="anxiety",
keywords="Oman",
keywords="online therapy",
keywords="randomized controlled trial",
keywords="telehealth",
keywords="therapy",
keywords="mental health",
keywords="e-mental health",
keywords="self-help",
keywords="distress",
abstract="Background: The COVID-19 pandemic has led to a notable increase in psychological distress, globally. Oman is no exception to this, with several studies indicating high levels of anxiety and depression among the Omani public. There is a need for adaptive and effective interventions that aim to improve the elevated levels of psychological distress due to the COVID-19 pandemic. Objective: This study aimed to comparatively assess the efficacy of therapist-guided online therapy with that of self-help, internet-based therapy focusing on COVID-19--induced symptoms of anxiety and depression among individuals living in Oman during the COVID-19 pandemic. Methods: This was a 6-week-long pragmatic randomized controlled trial involving 60 participants who were recruited from a study sample surveyed for symptoms of anxiety or depression among the Omani public amid the COVID-19 pandemic. Participants in the intervention group were allocated to receive 1 online session per week for 6 weeks from certified psychotherapists in Oman; these sessions were conducted in Arabic or English. The psychotherapists utilized cognitive behavioral therapy and acceptance and commitment therapy interventions. Participants in the control group received an automatic weekly newsletter via email containing self-help information and tips to cope with distress associated with COVID-19. The information mainly consisted of behavioral tips revolving around the principles of cognitive behavioral therapy and acceptance and commitment therapy. The primary outcome was measured by comparing the change in the mean scores of Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scale from the baseline to the end of the study (ie, after 6 sessions) between the two groups. The secondary outcome was to compare the proportions of participants with depression and anxiety between the two groups. Results: Data from 46 participants were analyzed (intervention group n=22, control group n=24). There was no statistical difference in the baseline characteristics between both groups. Analysis of covariance indicated a significant reduction in the GAD-7 scores (F1,43=7.307; P=.01) between the two groups after adjusting for baseline scores. GAD-7 scores of participants in the intervention group were considerably more reduced than those of participants in the control group ($\beta$=?3.27; P=.01). Moreover, a greater reduction in mean PHQ-9 scores was observed among participants in the intervention group (F1,43=8.298; P=.006) than those in the control group ($\beta$=?4.311; P=.006). Although the levels of anxiety and depression reduced in both study groups, the reduction was higher in the intervention group (P=.049) than in the control group (P=.02). Conclusions: This study provides preliminary evidence to support the efficacy of online therapy for improving the symptoms of anxiety and depression during the COVID-19 crisis in Oman. Therapist-guided online therapy was found to be superior to self-help, internet-based therapy; however, both therapies could be considered as viable options. Trial Registration: ClinicalTrials.gov NCT04378257; https://clinicaltrials.gov/ct2/show/NCT04378257 ",
doi="10.2196/26683",
url="http://mental.jmir.org/2021/2/e26683/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33512323"
}


@Article{info:doi/10.2196/24162,
author="Wang, Qian
and Song, Bo
and Di, Jiangli
and Yang, Xue
and Wu, Anise
and Lau, Joseph
and Xin, Meiqi
and Wang, Linhong
and Mo, Kit-Han Phoenix",
title="Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study",
journal="JMIR Ment Health",
year="2021",
month="Feb",
day="11",
volume="8",
number="2",
pages="e24162",
keywords="pregnant women",
keywords="COVID-19",
keywords="depression",
keywords="anxiety",
keywords="help-seeking",
keywords="mental health services",
keywords="social support",
keywords="trust",
keywords="intention",
keywords="mental health",
keywords="pregnancy",
keywords="survey",
abstract="Background: Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented. Objective: We aimed to identify factors that are associated with pregnant women's intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China. Methods: A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ?10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ?5 on the 7-item General Anxiety Disorder Scale) was included in our analysis. Results: More than half (3292/6248, 52.7\%) of the participants reported that they did not need mental health services. Furthermore, 28.3\% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19\% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19--related lockdowns in participants' cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants' intentions to seek help from mental health services. Conclusions: Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers. ",
doi="10.2196/24162",
url="http://mental.jmir.org/2021/2/e24162/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33570500"
}


@Article{info:doi/10.2196/23917,
author="Liu, Guihua
and Wang, Shuo
and Liao, Jinhua
and Ou, Ping
and Huang, Longsheng
and Xie, Namei
and He, Yingshuang
and Lin, Jinling
and He, Hong-Gu
and Hu, Rongfang",
title="The Efficacy of WeChat-Based Parenting Training on the Psychological Well-being of Mothers With Children With Autism During the COVID-19 Pandemic: Quasi-Experimental Study",
journal="JMIR Ment Health",
year="2021",
month="Feb",
day="10",
volume="8",
number="2",
pages="e23917",
keywords="coronavirus disease 2019",
keywords="autism spectrum disorder",
keywords="parenting training",
keywords="psychological well-being",
keywords="social media",
keywords="WeChat",
keywords="COVID-19",
keywords="autism",
keywords="parenting",
keywords="mental health",
keywords="well-being",
keywords="anxiety",
keywords="depression",
keywords="stress",
abstract="Background: During the COVID-19 pandemic, special education schools for children in most areas of China were closed between the end of January and the beginning of June in 2020. The sudden interruption in schooling and the pandemic itself caused parents to be anxious and even to panic. Mobile-based parenting skills education has been demonstrated to be an effective method for improving the psychological well-being of mothers with children with autism. However, whether it can improve the psychological states of mothers in the context of the COVID-19 pandemic is a subject that should be urgently investigated. Objective: The aim of this study is to evaluate the efficacy of WeChat-based parenting training on anxiety, depression, parenting stress, and hope in mothers with children with autism, as well as the feasibility of the program during the COVID-19 pandemic. Methods: This was a quasi-experimental trial. A total of 125 mothers with preschool children with autism were recruited in January 2020. The participants were assigned to the control group (n=60), in which they received routine care, or the intervention group (n=65), in which they received the 12-week WeChat-based parenting training plus routine care, according to their preferences. Anxiety, depression, parenting stress, hope, satisfaction, and adherence to the intervention were measured at three timepoints: baseline (T0), postintervention (T1), and a 20-week follow-up (T2). Results: In total, 109 mothers completed the T1 assessment and 104 mothers completed the T2 assessment. The results of the linear mixed model analysis showed statistically significant group {\texttimes} time interaction effects for the intervention on anxiety (F=14.219, P<.001), depression (F=26.563, P<.001), parenting stress (F=68.572, P<.001), and hope (F=197.608, P<.001). Of all mothers in the intervention group, 90.4\% (48.8/54) reported that they were extremely satisfied with the WeChat-based parenting training. In total, 40.0\% (26/65) logged their progress in home training each week and 61.5\% (40/65) logged their progress more than 80\% of the time for all 20 weeks. Conclusions: The WeChat-based parenting training is acceptable and appears to be an effective approach for reducing anxiety, depression, and parenting stress, as well as increasing hope in mothers with children with autism during the global COVID-19 pandemic. Future studies with rigorous designs and longer follow-up periods are needed to further detect the effectiveness of the WeChat-based parenting training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031772; http://www.chictr.org.cn/showproj.aspx?proj=52165 ",
doi="10.2196/23917",
url="https://mental.jmir.org/2021/2/e23917",
url="http://www.ncbi.nlm.nih.gov/pubmed/33481751"
}


@Article{info:doi/10.2196/25118,
author="Lin, Yu-Hsuan
and Chen, Chung-Yen
and Wu, Shiow-Ing",
title="Efficiency and Quality of Data Collection Among Public Mental Health Surveys Conducted During the COVID-19 Pandemic: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="10",
volume="23",
number="2",
pages="e25118",
keywords="COVID-19",
keywords="mental health",
keywords="Newcastle-Ottawa Scale",
keywords="review",
keywords="data collection",
keywords="survey",
keywords="surveillance",
keywords="literature",
keywords="research",
abstract="Background: The World Health Organization has recognized the importance of assessing population-level mental health during the COVID-19 pandemic. During a global crisis such as the COVID-19 pandemic, a timely surveillance method is urgently needed to track the impact on public mental health. Objective: This brief systematic review focused on the efficiency and quality of data collection of studies conducted during the COVID-19 pandemic. Methods: We searched the PubMed database using the following search strings: ((COVID-19) OR (SARS-CoV-2)) AND ((Mental health) OR (psychological) OR (psychiatry)). We screened the titles, abstracts, and texts of the published papers to exclude irrelevant studies. We used the Newcastle-Ottawa Scale to evaluate the quality of each research paper. Results: Our search yielded 37 relevant mental health surveys of the general public that were conducted during the COVID-19 pandemic, as of July 10, 2020. All these public mental health surveys were cross-sectional in design, and the journals efficiently made these articles available online in an average of 18.7 (range 1-64) days from the date they were received. The average duration of recruitment periods was 9.2 (range 2-35) days, and the average sample size was 5137 (range 100-56,679). However, 73\% (27/37) of the selected studies had Newcastle-Ottawa Scale scores of <3 points, which suggests that these studies are of very low quality for inclusion in a meta-analysis. Conclusions: The studies examined in this systematic review used an efficient data collection method, but there was a high risk of bias, in general, among the existing public mental health surveys. Therefore, following recommendations to avoid selection bias, or employing novel methodologies considering both a longitudinal design and high temporal resolution, would help provide a strong basis for the formation of national mental health policies. ",
doi="10.2196/25118",
url="http://www.jmir.org/2021/2/e25118/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33481754"
}


@Article{info:doi/10.2196/26190,
author="Hull, D. Thomas
and Levine, Jacob
and Bantilan, Niels
and Desai, N. Angel
and Majumder, S. Maimuna",
title="Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="9",
volume="5",
number="2",
pages="e26190",
keywords="digital phenotyping",
keywords="COVID-19",
keywords="telehealth",
keywords="digital mental health",
keywords="natural language processing",
keywords="machine learning",
keywords="mental health",
keywords="phenotyping",
keywords="burden",
keywords="treatment",
keywords="symptom",
abstract="Background: The novel COVID-19 disease has negatively impacted mortality, economic conditions, and mental health. These impacts are likely to continue after the COVID-19 pandemic ends. There are no methods for characterizing the mental health burden of the COVID-19 pandemic, and differentiating this burden from that of the prepandemic era. Accurate illness detection methods are critical for facilitating pandemic-related treatment and preventing the worsening of symptoms. Objective: We aimed to identify major themes and symptom clusters in the SMS text messages that patients send to therapists. We assessed patients who were seeking treatment for pandemic-related distress on Talkspace, which is a popular telemental health platform. Methods: We used a machine learning algorithm to identify patients' pandemic-related concerns, based on their SMS text messages in a large, digital mental health service platform (ie, Talkspace). This platform uses natural language processing methods to analyze unstructured therapy transcript data, in parallel with brief clinical assessment methods for analyzing depression and anxiety symptoms. Results: Our results show a significant increase in the incidence of COVID-19--related intake anxiety symptoms (P<.001), but no significant differences in the incidence of intake depression symptoms (P=.79). During our transcript analyses, we identified terms that were related to 24 symptoms outside of those included in the diagnostic criteria for anxiety and depression. Conclusions: Our findings for Talkspace suggest that people who seek treatment during the pandemic experience more severe intake anxiety than they did before the COVID-19 outbreak. It is important to monitor the symptoms that we identified in this study and the symptoms of anxiety and depression, to fully understand the effects of the COVID-19 pandemic on mental health. ",
doi="10.2196/26190",
url="http://formative.jmir.org/2021/2/e26190/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33502999"
}


@Article{info:doi/10.2196/26617,
author="Boucher, M. Eliane
and McNaughton, C. Emily
and Harake, Nicole
and Stafford, L. Julia
and Parks, C. Acacia",
title="The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group",
journal="JMIR Ment Health",
year="2021",
month="Feb",
day="8",
volume="8",
number="2",
pages="e26617",
keywords="loneliness",
keywords="digital interventions",
keywords="COVID-19",
keywords="qualitative research",
keywords="perspective",
keywords="impact",
keywords="intervention",
keywords="lonely",
keywords="mental health",
keywords="e-mental health",
keywords="digital health",
keywords="focus group",
abstract="Background: Loneliness is a growing area of concern, attracting attention as a public health concern due to its association with a variety of psychological and physical health problems. However, interventions targeting loneliness are less common than interventions for other mental health problems, such as depression and anxiety, and existing interventions focus primarily on building social skills and increasing opportunities for social interaction despite research suggesting these techniques are not the most effective. Furthermore, although there is an increasing need for scalable and convenient interventions, digital interventions for loneliness are even less common. Objective: Using a qualitative approach, we explore how adults (18-64 years of age) who express wanting to be more connected to others experience loneliness and react to a digital mental health intervention targeting loneliness. Methods: A total of 11 participants were recruited from a pilot randomized controlled trial exploring the impact of a digital mental health intervention, Happify Health, on loneliness among adults aged 18-64 years who indicated wanting to feel more connected to others when signing up for the platform. Participants were invited to participate in a 3-day asynchronous focus group about their experiences with loneliness, with Happify Health, and with social distancing during the COVID-19 pandemic. All 11 participants completed the focus group in May 2020. Results: Participants' responses were coded using thematic analysis, which led to identifying five themes, each with separate subthemes, that could be applied across the 3-day focus group: loneliness, relationships, social distancing, skill acquisition, and coping. Overall, we observed variability across participants in terms of the source of their loneliness, their perceptions of their social connections, and their motivation to reduce feelings of loneliness; however, participants commonly referred to negative self-perceptions as a cause or consequence of loneliness. Participants also varied in the extent to which they felt social distancing increased or decreased feelings of loneliness. In regard to the intervention, participants showed evidence of adopting skills they used to address their loneliness, particularly mindfulness and gratitude, and then using these skills to shift toward more active coping strategies following the intervention, including during the COVID-19 pandemic. Conclusions: The heterogeneity in participants' experiences with loneliness described during this focus group emphasizes the subjective and complex nature of loneliness. This highlights the importance of developing loneliness interventions that use a variety of strategies, including both direct and indirect strategies for reducing loneliness. However, based on our data, a key component to loneliness interventions is incorporating strategies for addressing underlying negative self-perceptions that stem from, but also contribute to, loneliness. This data also provides preliminary evidence that digital platforms may be an effective tool for disseminating loneliness interventions while providing the added benefit of offering a productive distraction when feeling lonely. ",
doi="10.2196/26617",
url="http://mental.jmir.org/2021/2/e26617/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33498011"
}


@Article{info:doi/10.2196/25835,
author="Molfenter, Todd
and Roget, Nancy
and Chaple, Michael
and Behlman, Stephanie
and Cody, Olivia
and Hartzler, Bryan
and Johnson, Edward
and Nichols, Maureen
and Stilen, Patricia
and Becker, Sara",
title="Use of Telehealth in Substance Use Disorder Services During and After COVID-19: Online Survey Study",
journal="JMIR Ment Health",
year="2021",
month="Feb",
day="8",
volume="8",
number="2",
pages="e25835",
keywords="COVID-19",
keywords="substance use disorders",
keywords="technology acceptance model",
keywords="telehealth",
abstract="Background: Social distancing guidelines for COVID-19 have caused a rapid transition to telephone and video technologies for delivering treatment for substance use disorders (SUDs). Objective: This study examined the adoption of these technologies across the SUD service continuum, acceptance of these technologies among service providers, and intent of providers to use these technologies after the pandemic. Additional analysis using the validated technology acceptance model (TAM) was performed to test the potential applications of these technologies after the pandemic. The study objectives were as follows: (1) to assess the use of telehealth (telephone and video technologies) for different SUD services during COVID-19 in May-June 2020, (2) to assess the intended applications of telehealth for SUD services beyond COVID-19, (3) to evaluate the perceived ease of use and value of telehealth for delivering SUD services, and (4) to assess organizational readiness for the sustained use of telehealth services. Methods: An online survey on the use of telephonic and video services was distributed between May and August 2020 to measure the current use of these services, perceived organizational readiness to use these services, and the intent to use these services after COVID-19. In total, 8 of 10 regional Addiction Technology Transfer Centers representing 43 states distributed the survey. Individual organizations were the unit of analysis. Results: In total, 457 organizations responded to the survey. Overall, the technology was widely used; >70\% (n>335) of organizations reported using telephone or video platforms for most services. The odds of the intent of organizations to use these technologies to deliver services post COVID-19 were significantly greater for all but two services (ie, telephonic residential counseling and buprenorphine therapy; mean odds ratio 3.79, range 1.87-6.98). Clinical users preferred video technologies to telephone technologies for virtually all services. Readiness to use telephone and video technologies was high across numerous factors, though telephonic services were considered more accessible. Consistent with the TAM, perceived usefulness and ease of use influenced the intent to use both telephone and video technologies. Conclusions: The overall perceived ease of use and usefulness of telephonic and video services suggest promising post--COVID-19 applications of these services. Survey participants consistently preferred video services to telephonic services; however, the availability of telephonic services to those lacking easy access to video technology is an important characteristic of these services. Future studies should review the acceptance of telehealth services and their comparative impact on SUD care outcomes. ",
doi="10.2196/25835",
url="http://mental.jmir.org/2021/2/e25835/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33481760"
}


@Article{info:doi/10.2196/21156,
author="Geronikolou, Styliani
and Chrousos, George",
title="COVID-19--Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="3",
volume="5",
number="2",
pages="e21156",
keywords="COVID-19",
keywords="social media",
keywords="misinformation",
keywords="infodemics",
keywords="infodemiology",
keywords="infoveillance",
keywords="fear",
keywords="meta-analysis",
abstract="Background: The World Health Organization named the phenomenon of misinformation spread through social media as an ``infodemic'' and recognized the need to curb it. Misinformation infodemics undermine not only population safety but also compliance to the suggestions and prophylactic measures recommended during pandemics. Objective: The aim of this pilot study is to review the impact of social media on general population fear in ``infoveillance'' studies during the COVID-19 pandemic. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol was followed, and 6 out of 20 studies were retrieved, meta-analyzed, and had their findings presented in the form of a forest plot. Results: The summary random and significant event rate was 0.298 (95\% CI 0.213-0.400), suggesting that social media--circulated misinformation related to COVID-19 triggered public fear and other psychological manifestations. These findings merit special attention by public health authorities. Conclusions: Infodemiology and infoveillance are valid tools in the hands of epidemiologists to help prevent dissemination of false information, which has potentially damaging effects. ",
doi="10.2196/21156",
url="https://formative.jmir.org/2021/2/e21156",
url="http://www.ncbi.nlm.nih.gov/pubmed/33400681"
}


@Article{info:doi/10.2196/23126,
author="Wu, Xiaoyan
and Tao, Shuman
and Zhang, Yi
and Li, Shiyue
and Ma, Le
and Yu, Yizhen
and Sun, Guilong
and Li, Tingting
and Tao, Fangbiao",
title="Geographic Distribution of Mental Health Problems Among Chinese College Students During the COVID-19 Pandemic: Nationwide, Web-Based Survey Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="29",
volume="23",
number="1",
pages="e23126",
keywords="COVID-19 pandemic",
keywords="college students",
keywords="mental health problems",
keywords="geographic location",
abstract="Background: Since the COVID-19 outbreak was first reported, considerable attention has been drawn to mental health problems among college students. Objective: We aimed to estimate the prevalence of anxiety and depressive symptoms among college students in different geographical areas of China during the early stage of the COVID-19 outbreak. Methods: A nationwide cross-sectional survey was conducted among Chinese college students of 16 provinces or municipalities from February 4 to 12, 2020. A web-based survey was adopted to collect information from these college students, including demographics, perceived risk of infection, attitudes toward the epidemic and its control, and mental health status. Anxiety symptoms were assessed using the Generalized Anxiety Disorder scale, and depressive symptoms were assessed using the Patient Health Questionnaire. Chi-square test was used to compare the percentage of perceived risk of infection and attitude toward COVID-19 among college students in different geographic locations. Binary logistic models were used to identify associations between geographic locations and mental health problems after controlling for covariates. Results: A total of 11,787 participants were analyzed in this study (response rate: 79.7\%). The prevalence of anxiety and depressive symptoms among college students was 17.8\% (95\% CI 17.1\%-18.5\%) and 25.9\% (95\% CI 25.1\%-26.7\%), respectively. After controlling for covariates, current residence area in Wuhan city was found to have a positive association with anxiety symptoms (odds ratio [OR] 1.37, 95\% CI 1.11-1.68) and depressive symptoms (OR 1.32, 95\% CI 1.09-1.59). Similarly, college location in Wuhan city was found to have a positive association with anxiety symptoms (OR 1.20, 95\% CI 1.07-1.35) and depressive symptoms (OR 1.22, 95\% CI 1.10-1.36). History of residence in or travel to Wuhan city in the past month was also positively associated with anxiety symptoms (OR 1.62, 95\% CI 1.46-1.80) and depressive symptoms (OR 1.48, 95\% CI 1.35-1.63). Furthermore, the perceived risk of COVID-19 was higher among students whose college location and current residence area were in Wuhan city, and it was positively associated with anxiety and depressive symptoms. Conclusions: During the COVID-19 pandemic, mental health problems among Chinese college students were widespread and geographically diverse. Our study results provide further insight for policymakers to develop targeted intervention strategies. ",
doi="10.2196/23126",
url="http://www.jmir.org/2021/1/e23126/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33439853"
}


@Article{info:doi/10.2196/26011,
author="Nutley, K. Sara
and Falise, M. Alyssa
and Henderson, Rebecca
and Apostolou, Vasiliki
and Mathews, A. Carol
and Striley, W. Catherine",
title="Impact of the COVID-19 Pandemic on Disordered Eating Behavior: Qualitative Analysis of Social Media Posts",
journal="JMIR Ment Health",
year="2021",
month="Jan",
day="27",
volume="8",
number="1",
pages="e26011",
keywords="eating disorders",
keywords="anorexia nervosa",
keywords="binge eating disorder",
keywords="COVID-19",
keywords="coronavirus",
keywords="Reddit",
keywords="social media",
keywords="disorder",
keywords="eating",
keywords="qualitative",
keywords="experience",
keywords="mental health",
keywords="theme",
abstract="Background: A growing body of evidence is suggesting a significant association between the COVID-19 pandemic and population-level mental health. Study findings suggest that individuals with a lifetime history of disordered eating behavior may be negatively affected by COVID-19--related anxiety, and prevention measures may disrupt daily functioning and limit access to treatment. However, data describing the influence of the COVID-19 pandemic on disordered eating behaviors are limited, and most findings focus on individuals in treatment settings. Objective: The aim of this study is to characterize the experiences of Reddit users worldwide who post in eating disorder (ED)--related discussion forums describing the influence of the COVID-19 pandemic on their overall mental health and disordered eating behavior. Methods: Data were collected from popular subreddits acknowledging EDs as their primary discussion topic. Unique discussion posts dated from January 1 to May 31, 2020 that referenced the COVID-19 pandemic were extracted and evaluated using inductive, thematic data analysis. Results: Six primary themes were identified: change in ED symptoms, change in exercise routine, impact of quarantine on daily life, emotional well-being, help-seeking behavior, and associated risks and health outcomes. The majority of users reported that the COVID-19 pandemic and associated public health prevention measures negatively impacted their psychiatric health and contributed to increased disordered eating behaviors. Feelings of isolation, frustration, and anxiety were common. Many individuals used Reddit forums to share personal experiences, seek advice, and offer shared accountability. Conclusions: Reddit discussion forums have provided a therapeutic community for individuals to share experiences and provide support for peers with ED during a period of increased psychiatric distress. Future research is needed to assess the impact of the COVID-19 pandemic on disordered eating behavior and to evaluate the role of social media discussion forums in mental health treatment, especially during periods of limited treatment access. ",
doi="10.2196/26011",
url="http://mental.jmir.org/2021/1/e26011/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33465035"
}


@Article{info:doi/10.2196/25456,
author="Friis-Healy, A. Elsa
and Nagy, A. Gabriela
and Kollins, H. Scott",
title="It Is Time to REACT: Opportunities for Digital Mental Health Apps to Reduce Mental Health Disparities in Racially and Ethnically Minoritized Groups",
journal="JMIR Ment Health",
year="2021",
month="Jan",
day="26",
volume="8",
number="1",
pages="e25456",
keywords="digital health",
keywords="app",
keywords="public mental health",
keywords="health disparities",
keywords="COVID-19",
keywords="pandemic",
keywords="mental health",
keywords="disparity",
keywords="behavior",
doi="10.2196/25456",
url="http://mental.jmir.org/2021/1/e25456/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33406050"
}


@Article{info:doi/10.2196/24495,
author="Yang, Xue
and Song, Bo
and Wu, Anise
and Mo, H. Phoenix K.
and Di, Jiangli
and Wang, Qian
and Lau, F. Joseph T.
and Wang, Linhong",
title="Social, Cognitive, and eHealth Mechanisms of COVID-19--Related Lockdown and Mandatory Quarantine That Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="22",
volume="23",
number="1",
pages="e24495",
keywords="eHealth",
keywords="lockdown",
keywords="quarantine",
keywords="depression",
keywords="anxiety",
keywords="pregnant women",
abstract="Background: Although lockdown and mandatory quarantine measures have played crucial roles in the sharp decrease of the number of newly confirmed/suspected COVID-19 cases, concerns have been raised over the threat that these measures pose to mental health, especially the mental health of vulnerable groups, including pregnant women. Few empirical studies have assessed whether and how these control measures may affect mental health, and no study has investigated the prevalence and impacts of the use of eHealth resources among pregnant women during the COVID-19 outbreak. Objective: This study investigated (1) the effects of lockdown and mandatory quarantine on mental health problems (ie, anxiety and depressive symptoms), (2) the potential mediation effects of perceived social support and maladaptive cognition, and (3) the moderation effects of eHealth-related factors (ie, using social media to obtain health information and using prenatal care services during the COVID-19 pandemic) on pregnant women in China. Methods: An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions from February 25 to March 10, 2020. Results: Of the 19,515 participants, 12,209 (62.6\%) were subjected to lockdown in their areas of residence, 737 (3.8\%) were subjected to mandatory quarantine, 8712 (44.6\%) had probable mild to severe depression, 5696 (29.2\%) had probable mild to severe anxiety, and 1442 (7.4\%) had suicidal ideations. Only 640 (3.3\%) participants reported that they used online prenatal care services during the outbreak. Significant sociodemographic/maternal factors of anxiety/depressive symptoms included age, education, occupation, the area of residence, gestational duration, the number of children born, complication during pregnancy, the means of using prenatal care services, and social media use for obtaining health information. Multiple indicators multiple causes modeling ($\chi$214=495.21; P<.05; comparative fit index=.99; nonnormed fit index=.98; root mean square error of approximation=.04, 90\% CI 0.038-0.045) showed that quarantine was directly and indirectly strongly associated with poor mental health through decreased perceived social support and increased maladaptive cognition (B=.04; $\beta$=.02, 95\% CI 0.01-0.02; P=.001), while lockdown was indirectly associated with mental health through increased social support and maladaptive cognition among pregnant women (B=.03; $\beta$=.03, 95\% CI 0.02-0.03; P=.001). Multigroup analyses revealed that the use of social media for obtaining health information and the means of using prenatal care services were significant moderators of the model paths. Conclusions: Our findings provide epidemiological evidence for the importance of integrating mental health care and eHealth into the planning and implementation of control measure policies. The observed social and cognitive mechanisms and moderators in this study are modifiable, and they can inform the design of evidence-based mental health promotion among pregnant women. ",
doi="10.2196/24495",
url="http://www.jmir.org/2021/1/e24495/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33302251"
}


@Article{info:doi/10.2196/21409,
author="Tai, Yu-Lin
and Chi, Hsin
and Chiu, Nan-Chang
and Tseng, Cheng-Yin
and Huang, Ya-Ning
and Lin, Chien-Yu",
title="The Effect of a Name-Based Mask Rationing Plan in Taiwan on Public Anxiety Regarding a Mask Shortage During the COVID-19 Pandemic: Observational Study",
journal="JMIR Form Res",
year="2021",
month="Jan",
day="22",
volume="5",
number="1",
pages="e21409",
keywords="coronavirus",
keywords="COVID-19",
keywords="novel coronavirus",
keywords="SARS-CoV-2",
keywords="mask",
keywords="rationing",
keywords="Taiwan",
keywords="anxiety",
keywords="mental health",
keywords="observational",
keywords="crisis",
keywords="plan",
abstract="Background: The COVID-19 pandemic is a severe global health crisis. Wearing a mask is a straightforward action that can be taken, but shortage of stock and equity of allocation were important issues in Taiwan. Furthermore, increased anxiety leading to the stockpiling of masks has been common during the pandemic. Objective: We aim to summarize the name-based mask rationing plan implemented in Taiwan and explore the public's perceived anxiety about mask shortages. Methods: The government of Taiwan took action to control the supply and allocation of face masks. We summarize the timeline and important components of the mask rationing plan. A survey that aimed to investigate the overall response to the mask rationing plan was answered by 44 participants. Results: The mask rationing plan was implemented in late January 2020. Daily production capacity was increased from 2 million masks to 16 million masks in April 2020. People could buy 9 masks in 14 days by verification via their National Health Insurance card. Digital face mask availability maps were created. Moreover, the mask plan safeguarded the purchase of masks and resulted in decreased anxiety about a mask shortage (4.05 [SD 1.15] points; 72.7\% [n=32] of participants answered ``agree'' or ``strongly agree''). The majority of people felt that the mask plan was satisfactory (4.2 [SD 0.92] points; 79.5\% [n=35] of participants answered ``agree'' or ``strongly agree''). Conclusions: We found that the unique name-based mask rationing plan allowed for control of the production and supply of masks, and contributed to the appropriate allocation of masks. The mask rationing plan not only provided the public with physical protection, but also resulted in reduced anxiety about mask shortages during the pandemic. ",
doi="10.2196/21409",
url="http://formative.jmir.org/2021/1/e21409/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33400678"
}


@Article{info:doi/10.2196/23125,
author="Ni, Jie
and Wang, Fang
and Liu, Yihai
and Wu, Mingyue
and Jiang, Yan
and Zhou, Yujie
and Sha, Dujuan",
title="Psychological Impact of the COVID-19 Pandemic on Chinese Health Care Workers: Cross-Sectional Survey Study",
journal="JMIR Ment Health",
year="2021",
month="Jan",
day="20",
volume="8",
number="1",
pages="e23125",
keywords="2019-nCoV",
keywords="COVID-19",
keywords="frontline clinician",
keywords="medical students",
keywords="psychology",
abstract="Background: The outbreak of COVID-19 has dominated headlines worldwide. The number of infections has continued to rise and had reached 30,000 worldwide at the time this paper was written. Because of the high risk of nosocomial transmission, medical health care workers may be experiencing substantial psychological stress. This descriptive study aimed to identify psychosocial effects on hospital staff associated with working in a hospital environment during the COVID-19 outbreak. Objective: Our survey participants included 57 frontline clinicians working at Wuhan First Hospital and 157 medical students working at Jiangsu Provincial People's Hospital during the COVID-19 outbreak. The questionnaire we adopted included questions regarding the participants' personal well-being, sociodemographic characteristics, and psychological status. Methods: 57 frontline clinicians working in Wuhan First Hospital and 157 medical training students working in Jiangsu Provincial Peoples Hospital during this outbreak participated in our survey. The questionnaire we adopted included questions regarding the participants' personal well-being, sociodemographic characteristics and the psychological status. Results: The COVID-19 outbreak had psychological impacts both on formal workers and medical students. The psychological effects included sleep disorders, anxiety, and depression. There was no significant difference between the group of formal workers and medical students (P=.85), and more than 50\% (30/54, 56\%, vs. 83/157, 52.9\%) of the respondents reported pandemic-related mental disorders. Conclusions: Our study indicates that the high risk of SARS-CoV-2 exposure caused substantial psychological stress among health care workers. This finding emphasizes the need to promote psychological crisis intervention for medical personnel during this epidemic. ",
doi="10.2196/23125",
url="http://mental.jmir.org/2021/1/e23125/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33341754"
}


@Article{info:doi/10.2196/24298,
author="Pinho, Lucena Rebeca Da N{\'o}brega
and Costa, Ferreira Thais
and Silva, Miranda Nayane
and Barros-Areal, F. Adriana
and Salles, Mattos Andr{\'e} De
and Oliveira, Pedrosa Andrea
and Rassi, Carlos
and Valero, Brero Caroline Elizabeth
and Gomes, Martins Ciro
and Mendon{\c{c}}a-Silva, Dayde
and Oliveira, Fernando
and Jochims, Isadora
and Ranulfo, Ivan
and Neves, Seixas Juliana De Brito
and Oliveira, Lucas
and Dantas, Nogueira Maria
and Rosal, Marta
and Soares, Mayra
and Kurizky, Patr{\'i}cia
and Peterle, Uliana Viviane
and Faro, Furtado Yasmin
and Gomides, Paula Ana
and da Mota, Licia
and Albuquerque, Cleandro
and Simaan, Kozak Cezar
and Amado, M. Veronica",
title="Mental Health and Burnout Syndrome Among Postgraduate Students in Medical and Multidisciplinary Residencies During the COVID-19 Pandemic in Brazil: Protocol for a Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="19",
volume="10",
number="1",
pages="e24298",
keywords="burnout syndrome",
keywords="medical residency",
keywords="multidisciplinary residency",
keywords="COVID-19",
keywords="mental health",
keywords="burnout",
keywords="stress",
keywords="anxiety",
keywords="prospective",
keywords="cohort",
keywords="health care professional",
keywords="medical student",
abstract="Background: The COVID-19 pandemic has led to high levels of physical, psychological, and social stress among health care professionals, including postgraduate students in medical and multidisciplinary residencies. This stress is associated with the intense fear of occupational exposure to SARS-CoV-2, the virus known to cause COVID-19. These professionals are at risk of developing physical and mental illnesses not only due to the infection but also due to prolonged exposure to multidimensional stress and continued work overload. Objective: This study aims to evaluate the prevalence of symptoms suggestive of mental disorders and burnout syndrome and determine the risk factors for burnout among postgraduate students in medical and multidisciplinary residencies in Brazil during the COVID-19 pandemic. Methods: For this prospective cohort study with parallel groups, participants were recruited between July and September 2020 to achieve a sample size of at least 1144 participants. Research instruments such as Depression, Anxiety, and Stress Scale; Patient Health Questionnaire; Brief Resilient Coping Scale; and Oldenburg Burnout Inventory will be used to collect data. Data will be collected in 2 waves: the first wave will include data related to sample characterization and psychosocial evaluation, and the second wave will be launched 12 weeks later and will include an evaluation of the incidence of burnout as well as correlations with the potential predictive factors collected in the first wave. Additionally, we will collect data regarding participants' withdrawal from work. Results: The recruitment took place from July 29 to September 5, 2020. Data analyses for this phase is already in progress. The second phase of the study is also in progress. The final data collection began on December 1, 2020, and it will be completed by December 31, 2020. Conclusions: We believe the findings of this study will help evaluate the impact of the COVID-19 pandemic on the mental health conditions of health professionals in Brazil as well as contribute to the planning and implementation of appropriate measures that can alleviate these mental health challenges. International Registered Report Identifier (IRRID): DERR1-10.2196/24298 ",
doi="10.2196/24298",
url="https://www.researchprotocols.org/2021/1/e24298",
url="http://www.ncbi.nlm.nih.gov/pubmed/33290246"
}


@Article{info:doi/10.2196/24983,
author="Hummel, Svenja
and Oetjen, Neele
and Du, Junfeng
and Posenato, Elisabetta
and Resende de Almeida, Maria Rosa
and Losada, Raquel
and Ribeiro, Oscar
and Frisardi, Vincenza
and Hopper, Louise
and Rashid, Asarnusch
and Nasser, Habib
and K{\"o}nig, Alexandra
and Rudofsky, Gottfried
and Weidt, Steffi
and Zafar, Ali
and Gronewold, Nadine
and Mayer, Gwendolyn
and Schultz, Jobst-Hendrik",
title="Mental Health Among Medical Professionals During the COVID-19 Pandemic in Eight European Countries: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="18",
volume="23",
number="1",
pages="e24983",
keywords="mental health",
keywords="COVID-19",
keywords="Europe",
keywords="medical professionals",
keywords="stress",
keywords="depression",
keywords="anxiety",
keywords="coping",
keywords="stressors",
abstract="Background: The death toll of COVID-19 topped 170,000 in Europe by the end of May 2020. COVID-19 has caused an immense psychological burden on the population, especially among doctors and nurses who are faced with high infection risks and increased workload. Objective: The aim of this study was to compare the mental health of medical professionals with nonmedical professionals in different European countries during the COVID-19 pandemic. We hypothesized that medical professionals, particularly those exposed to COVID-19 at work, would have higher levels of depression, anxiety, and stress. We also aimed to determine their main stressors and most frequently used coping strategies during the crisis. Methods: A cross-sectional online survey was conducted during peak COVID-19 months in 8 European countries. The questionnaire included demographic data and inquired whether the participants were exposed to COVID-19 at work or not. Mental health was assessed via the Depression Anxiety Stress Scales32 (23.53)--21 (DASS-21). A 12-item checklist on preferred coping strategies and another 23-item questionnaire on major stressors were completed by medical professionals. Results: The sample (N=609) consisted of 189 doctors, 165 nurses, and 255 nonmedical professionals. Participants from France and the United Kingdom reported experiencing severe/extremely severe depression, anxiety, and stress more often compared to those from the other countries. Nonmedical professionals had significantly higher scores for depression and anxiety. Among medical professionals, no significant link was reported between direct contact with patients with COVID-19 at work and anxiety, depression, or stress. ``Uncertainty about when the epidemic will be under control'' caused the most amount of stress for health care professionals while ``taking protective measures'' was the most frequently used coping strategy among all participants. Conclusions: COVID-19 poses a major challenge to the mental health of working professionals as a considerable proportion of our participants showed high values for depression, anxiety, and stress. Even though medical professionals exhibited less mental stress than nonmedical professionals, sufficient help should be offered to all occupational groups with an emphasis on effective coping strategies. ",
doi="10.2196/24983",
url="http://www.jmir.org/2021/1/e24983/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33411670"
}


@Article{info:doi/10.2196/18722,
author="Jiang, Hong
and Jin, Longmei
and Qian, Xu
and Xiong, Xu
and La, Xuena
and Chen, Weiyi
and Yang, Xiaoguang
and Yang, Fengyun
and Zhang, Xinwen
and Abudukelimu, Nazhakaiti
and Li, Xingying
and Xie, Zhenyu
and Zhu, Xiaoling
and Zhang, Xiaohua
and Zhang, Lifeng
and Wang, Li
and Li, Lingling
and Li, Mu",
title="Maternal Mental Health Status and Approaches for Accessing Antenatal Care Information During the COVID-19 Epidemic in China: Cross-Sectional Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="18",
volume="23",
number="1",
pages="e18722",
keywords="COVID-19",
keywords="mental health",
keywords="perceived stress",
keywords="anxiety",
keywords="depression",
keywords="antenatal care information",
keywords="social media platform",
keywords="pregnancy",
keywords="women",
abstract="Background: China was the first country in the world to experience a large-scale COVID-19 outbreak. The rapid spread of the disease and enforcement of public health measures has caused distress among vulnerable populations such as pregnant women. With a limited understanding of the novel, emerging infectious disease, pregnant women have sought ways to access timely and trusted health care information. The mental health status of pregnant women during this public health emergency, as well as how they responded to the situation and where and how they obtained antenatal care information, remain to be understood. Objective: This study aimed to evaluate the mental health status of pregnant women during the COVID-19 epidemic in China by measuring their perceived stress, anxiety, and depression levels; explore the approaches used by them to access antenatal health care information; and determine their associations with maternal mental health status. Methods: We conducted a web-based, cross-sectional survey to assess the mental health status of Chinese pregnant women by using the validated, Chinese version of Perceived Stress Scale, Self-Rating Anxiety Scale, and Edinburgh Depression Scale. We also collected information on the various approaches these women used to access antenatal care information during the early stage of the COVID-19 epidemic, from February 5 to 28, 2020. Results: A total of 1873 pregnant women from 22 provinces or regions of China participated in the survey. The prevalence of perceived stress, anxiety, and depression among these participants was 89.1\% (1668/1873; 95\% CI 87.6\%, 90.4\%), 18.1\% (339/1873; 95\% CI 16.4\%, 19.9\%), and 45.9\% (859/1873; 95\% CI 43.6\%, 48.1\%), respectively. Hospitals' official accounts on the Chinese social media platforms WeChat and Weibo were the most popular channels among these pregnant women to obtain antenatal care information during the COVID-19 outbreak. Access to antenatal care information via the hospitals' official social media accounts was found to be associated with a significantly lower risk of perceived stress (adjusted odds ratio [aOR] 0.46, 95\% CI 0.30-0.72; P=.001), anxiety (aOR 0.53, 95\% CI 0.41-0.68; P<.001), and depression (aOR 0.73, 95\% CI 0.59-0.91; P=.005). Access to health care information via hospital hotlines or SMS was found to be significantly associated with a lower risk of anxiety only (OR 0.77, 95\% CI 0.60-0.98; P=.04). Conclusions: During the COVID-19 outbreak in China, pregnant women experienced high levels of perceived stress, anxiety, and depression. During such public health emergencies, mental health care services should be strengthened to reassure and support pregnant women. Specific information targeted at pregnant women, including information on how to cope in an emergency or major disease outbreak, developed and disseminated by health care institutions via social media platforms could be an effective way to mitigate mental health challenges and ensure epidemic preparedness and response in the future. ",
doi="10.2196/18722",
url="http://www.jmir.org/2021/1/e18722/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33347423"
}


@Article{info:doi/10.2196/24069,
author="van Stekelenburg, Aart
and Schaap, Gabi
and Veling, Harm
and Buijzen, Moniek",
title="Investigating and Improving the Accuracy of US Citizens' Beliefs About the COVID-19 Pandemic: Longitudinal Survey Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="12",
volume="23",
number="1",
pages="e24069",
keywords="infodemic",
keywords="infodemiology",
keywords="misinformation",
keywords="COVID-19 pandemic",
keywords="belief accuracy",
keywords="boosting",
keywords="trust in scientists",
keywords="political orientation",
keywords="media use",
abstract="Background: The COVID-19 infodemic, a surge of information and misinformation, has sparked worry about the public's perception of the coronavirus pandemic. Excessive information and misinformation can lead to belief in false information as well as reduce the accurate interpretation of true information. Such incorrect beliefs about the COVID-19 pandemic might lead to behavior that puts people at risk of both contracting and spreading the virus. Objective: The objective of this study was two-fold. First, we attempted to gain insight into public beliefs about the novel coronavirus and COVID-19 in one of the worst hit countries: the United States. Second, we aimed to test whether a short intervention could improve people's belief accuracy by empowering them to consider scientific consensus when evaluating claims related to the pandemic. Methods: We conducted a 4-week longitudinal study among US citizens, starting on April 27, 2020, just after daily COVID-19 deaths in the United States had peaked. Each week, we measured participants' belief accuracy related to the coronavirus and COVID-19 by asking them to indicate to what extent they believed a number of true and false statements (split 50/50). Furthermore, each new survey wave included both the original statements and four new statements: two false and two true statements. Half of the participants were exposed to an intervention aimed at increasing belief accuracy. The intervention consisted of a short infographic that set out three steps to verify information by searching for and verifying a scientific consensus. Results: A total of 1202 US citizens, balanced regarding age, gender, and ethnicity to approximate the US general public, completed the baseline (T0) wave survey. Retention rate for the follow-up waves--- first follow-up wave (T1), second follow-up wave (T2), and final wave (T3)---was high (?85\%). Mean scores of belief accuracy were high for all waves, with scores reflecting low belief in false statements and high belief in true statements; the belief accuracy scale ranged from --1, indicating completely inaccurate beliefs, to 1, indicating completely accurate beliefs (T0 mean 0.75, T1 mean 0.78, T2 mean 0.77, and T3 mean 0.75). Accurate beliefs were correlated with self-reported behavior aimed at preventing the coronavirus from spreading (eg, social distancing) (r at all waves was between 0.26 and 0.29 and all P values were less than .001) and were associated with trust in scientists (ie, higher trust was associated with more accurate beliefs), political orientation (ie, liberal, Democratic participants held more accurate beliefs than conservative, Republican participants), and the primary news source (ie, participants reporting CNN or Fox News as the main news source held less accurate beliefs than others). The intervention did not significantly improve belief accuracy. Conclusions: The supposed infodemic was not reflected in US citizens' beliefs about the COVID-19 pandemic. Most people were quite able to figure out the facts in these relatively early days of the crisis, calling into question the prevalence of misinformation and the public's susceptibility to misinformation. ",
doi="10.2196/24069",
url="http://www.jmir.org/2021/1/e24069/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33351776"
}


@Article{info:doi/10.2196/23699,
author="Kawakami, Norito
and Sasaki, Natsu
and Kuroda, Reiko
and Tsuno, Kanami
and Imamura, Kotaro",
title="The Effects of Downloading a Government-Issued COVID-19 Contact Tracing App on Psychological Distress During the Pandemic Among Employed Adults: Prospective Study",
journal="JMIR Ment Health",
year="2021",
month="Jan",
day="12",
volume="8",
number="1",
pages="e23699",
keywords="coronavirus disease",
keywords="digital contact tracing",
keywords="mental health",
keywords="working population",
keywords="longitudinal study",
keywords="COVID-19",
keywords="contact tracing",
keywords="surveillance",
keywords="tracking",
keywords="anxiety",
keywords="distress",
abstract="Background: Downloading a COVID-19 contact tracing app may be effective in reducing users' worry about COVID-19 and psychological distress. Objective: This 2.5-month prospective study aimed to investigate the association of downloading a COVID-19 contact tracing app, the COVID-19 Contact Confirming Application (COCOA), released by the Japanese government, with worry about COVID-19 and psychological distress in a sample of employed adults in Japan. Methods: A total of 996 full-time employed respondents to an online survey conducted May 22-26, 2020 (baseline), were invited to participate in a follow-up survey August 7-12, 2020 (follow-up). A high level of worrying about COVID-19 and high psychological distress were defined by baseline and follow-up scores on a single-item scale and the Kessler 6 (K6) scale, respectively. The app was released between the two surveys, on June 17. Participants were asked at follow-up if they downloaded the app. Results: A total of 902 (90.6\%) of 996 baseline participants responded to the follow-up survey. Among them, 184 (20.4\%) reported that they downloaded the app. Downloading of the contact tracing app was significantly negatively associated with psychological distress at follow-up after controlling for baseline variables, but not with worry about COVID-19. Conclusions: This study provides the first evidence that using a government-issued COVID-19 contact tracing app may be beneficial for the mental health of employed adults during the COVID-19 pandemic. ",
doi="10.2196/23699",
url="http://mental.jmir.org/2021/1/e23699/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33347424"
}


@Article{info:doi/10.2196/25372,
author="Sturgill, Ronda
and Martinasek, Mary
and Schmidt, Trine
and Goyal, Raj",
title="A Novel Artificial Intelligence-Powered Emotional Intelligence and Mindfulness App (Ajivar) for the College Student Population During the COVID-19 Pandemic: Quantitative Questionnaire Study",
journal="JMIR Form Res",
year="2021",
month="Jan",
day="5",
volume="5",
number="1",
pages="e25372",
keywords="mindfulness",
keywords="COVID-19",
keywords="college students",
keywords="emotional intelligence",
abstract="Background: Emotional intelligence (EI) and mindfulness can impact the level of anxiety and depression that an individual experiences. These symptoms have been exacerbated among college students during the COVID-19 pandemic. Ajivar is an app that utilizes artificial intelligence (AI) and machine learning to deliver personalized mindfulness and EI training. Objective: The main objective of this research study was to determine the effectiveness of delivering an EI curriculum and mindfulness techniques using an AI conversation platform, Ajivar, to improve symptoms of anxiety and depression during this pandemic. Methods: A total of 99 subjects, aged 18 to 29 years, were recruited from a second-semester group of freshmen students. All participants completed the online TestWell Wellness Inventory at the start and end of the 14-week semester. The comparison group members (49/99, 49\%) were given routine mental wellness instruction. The intervention group members (50/99, 51\%) were required to complete Ajivar activities in addition to routine mental wellness instruction during the semester, which coincided with the onset of the COVID-19 pandemic. This group also completed assessments to evaluate for anxiety, using the 7-item Generalized Anxiety Disorder (GAD-7) scale, and depression, using the 9-item Patient Health Questionnaire (PHQ-9). Results: Study participants reported a mean age of 19.9 (SD 1.94) years; 27\% (27/99) of the group were male and 60\% (59/99) identified as Caucasian. No significant demographic differences existed between the comparison and intervention groups. Subjects in the intervention group interacted with Ajivar for a mean time of 1424 (SD 1168) minutes. There was a significant decrease in anxiety, as measured by the GAD-7: the mean score was 11.47 (SD 1.85) at the start of the study compared to 6.27 (SD 1.44) at the end (P<.001). There was a significant reduction in the symptoms of depression measured by the PHQ-9: the mean score was 10.69 (SD 2.04) at the start of the study compared to 6.69 (SD 2.41) at the end (P=.001). Both the intervention and comparison groups independently had significant improvements in the TestWell Wellness Inventory from pretest to posttest. The subgroups in the social awareness and spirituality inventories showed significant improvement in the intervention group. In a subgroup of participants (11/49, 22\%) where the GAD-7 was available during the onset of the COVID-19 pandemic, there was an increase in anxiety from the start of the study (mean score 11.63, SD 2.16) to mid-March (ie, onset of the pandemic) (mean score 13.03, SD 1.48; P=.23), followed by a significant decrease at the end of the study period (mean score 5.9, SD 1.44; P=.001). Conclusions: It is possible to deliver EI and mindfulness training in a scalable way using the Ajivar app during the COVID-19 pandemic, resulting in improvements in anxiety, depression, and EI in the college student population. ",
doi="10.2196/25372",
url="http://formative.jmir.org/2021/1/e25372/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33320822"
}


@Article{info:doi/10.2196/23696,
author="Zhong, Bu
and Jiang, Zhibin
and Xie, Wenjing
and Qin, Xuebing",
title="Association of Social Media Use With Mental Health Conditions of Nonpatients During the COVID-19 Outbreak: Insights from a National Survey Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="31",
volume="22",
number="12",
pages="e23696",
keywords="COVID-19",
keywords="mental health",
keywords="social media",
keywords="health information support",
keywords="secondary traumatic stress",
keywords="vicarious trauma",
keywords="social support",
abstract="Background: Considerable research has been devoted to examining the mental health conditions of patients with COVID-19 and medical staff attending to these patients during the COVID-19 pandemic. However, there are few insights concerning how the pandemic may take a toll on the mental health of the general population, and especially of nonpatients (ie, individuals who have not contracted COVID-19). Objective: This study aimed to investigate the association between social media use and mental health conditions in the general population based on a national representative sample during the peak of the COVID-19 outbreak in China. Methods: We formed a national representative sample (N=2185) comprising participants from 30 provinces across China, who were the first to experience the COVID-19 outbreak in the world. We administered a web-based survey to these participants to analyze social media use, health information support received via social media, and possible psychiatric disorders, including secondary traumatic stress (STS) and vicarious trauma (VT). Results: Social media use did not cause mental health issues, but it mediated the levels of traumatic emotions among nonpatients. Participants received health information support via social media, but excessive social media use led to elevated levels of stress ($\beta$=.175; P<.001), anxiety ($\beta$=.224; P<.001), depression ($\beta$=.201; P<.001), STS ($\beta$=.307; P<.001), and VT ($\beta$=.688; P<.001). Geographic location (or geolocation) and lockdown conditions also contributed to more instances of traumatic disorders. Participants living in big cities were more stressed than those living in rural areas (P=.02). Furthermore, participants from small cities or towns were more anxious (P=.01), stressed (P<.001), and depressed (P=.008) than those from rural areas. Obtaining more informational support ($\beta$=.165; P<.001) and emotional support ($\beta$=.144; P<.001) via social media increased their VT levels. Peer support received via social media increased both VT ($\beta$=.332; P<.001) and STS ($\beta$=.130; P<.001) levels. Moreover, geolocation moderated the relationships between emotional support on social media and VT (F2=3.549; P=.029) and the association between peer support and STS (F2=5.059; P=.006). Geolocation also interacted with health information support in predicting STS (F2=5.093; P=.006). Conclusions: COVID-19 has taken a severe toll on the mental health of the general population, including individuals who have no history of psychiatric disorders or coronavirus infection. This study contributes to the literature by establishing the association between social media use and psychiatric disorders among the general public during the COVID-19 outbreak. The study findings suggest that the causes of such psychiatric disorders are complex and multifactorial, and social media use is a potential factor. The findings also highlight the experiences of people in China and can help global citizens and health policymakers to mitigate the effects of psychiatric disorders during this and other public health crises, which should be regarded as a key component of a global pandemic response. ",
doi="10.2196/23696",
url="https://www.jmir.org/2020/12/e23696",
url="http://www.ncbi.nlm.nih.gov/pubmed/33302256"
}


@Article{info:doi/10.2196/24868,
author="Richardson, G. Chris
and Slemon, Allie
and Gadermann, Anne
and McAuliffe, Corey
and Thomson, Kimberly
and Daly, Zachary
and Salway, Travis
and Currie, M. Leanne
and David, Anita
and Jenkins, Emily",
title="Use of Asynchronous Virtual Mental Health Resources for COVID-19 Pandemic--Related Stress Among the General Population in Canada: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="30",
volume="22",
number="12",
pages="e24868",
keywords="virtual health",
keywords="digital health",
keywords="virtual mental health",
keywords="mental health",
keywords="public health",
keywords="COVID-19",
keywords="coping",
keywords="stress",
keywords="implementation",
keywords="utilization",
abstract="Background: The COVID-19 pandemic has resulted in profound mental health impacts among the general population worldwide. As many in-person mental health support services have been suspended or transitioned online to facilitate physical distancing, there have been numerous calls for the rapid expansion of asynchronous virtual mental health (AVMH) resources. These AVMH resources have great potential to provide support for people coping with negative mental health impacts associated with the pandemic; however, literature examining use prior to COVID-19 illustrates that the uptake of these resources is consistently low. Objective: The aim of this paper is to examine the use of AVMH resources in Canada during the COVID-19 pandemic among the general population and among a participant subgroup classified as experiencing?an?adverse mental health impact related to the pandemic. Methods: Data from this study were drawn from the first wave of a large multiwave cross-sectional monitoring survey, distributed from May 14 to 29, 2020. Participants (N=3000) were adults living in Canada. Descriptive statistics were used to characterize the sample, and bivariate?cross-tabulations were used to examine the relationships between the use of AVMH resources and self-reported indicators of mental health that included a range of emotional and coping-related responses to the pandemic. Univariate and fully adjusted multivariate logistic regression models were used to examine associations between sociodemographic and health-related characteristics?and use of?AVMH resources in the subgroup of participants who reported experiencing one or more adverse mental health impacts identified in the set of self-reported mental health indicators. Results: Among the total sample, 2.0\% (n=59) of participants reported accessing AVMH resources in the prior 2 weeks to cope with stress related to the COVID-19 pandemic, with the highest rates of use among individuals who reported self-harm (n=5, 10.4\%) and those who reported coping ``not well'' with COVID-19--related stress (n=22, 5.5\%). Within the subgroup of 1954 participants (65.1\% of the total sample) who reported an adverse mental health impact related to COVID-19, 54 (2.8\%) reported use of AVMH resources. Individuals were more likely to have used AVMH resources if they had reported receiving in-person mental health supports, were connecting virtually with a mental health worker or counselor, or belonged to a visible minority group. Conclusions: Despite substantial government investment into AVMH resources, uptake is low among both the general population and individuals who may benefit from the use of these resources as a means of coping with the adverse mental health impacts of the COVID-19 pandemic. Further research is needed to improve our understanding of the barriers to use. ",
doi="10.2196/24868",
url="http://www.jmir.org/2020/12/e24868/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33315583"
}


@Article{info:doi/10.2196/24694,
author="Burnett, Dayle
and Eapen, Valsamma
and Lin, Ping-I",
title="Time Trends of the Public's Attention Toward Suicide During the COVID-19 Pandemic: Retrospective, Longitudinal Time-Series Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Dec",
day="30",
volume="6",
number="4",
pages="e24694",
keywords="COVID-19",
keywords="suicide",
keywords="infodemiology",
keywords="infoveillance",
keywords="Google Trends",
keywords="time trend",
keywords="school closure",
keywords="attention",
keywords="mental health",
keywords="crisis",
keywords="time series",
abstract="Background: The COVID-19 pandemic has overwhelmed health care systems around the world. Emerging evidence has suggested that substantially few patients seek help for suicidality at clinical settings during the COVID-19 pandemic, which has elicited concerns of an imminent mental health crisis as the course of the pandemic continues to unfold. Clarifying the relationship between the public's attention to knowledge about suicide and the public's attention to knowledge about the COVID-19 pandemic may provide insight into developing prevention strategies for a putative surge of suicide in relation to the impact of the COVID-19 pandemic. Objective: The goal of this retrospective, longitudinal time-series study is to understand the relationship between temporal trends of interest for the search term ``suicide'' and those of COVID-19--related terms, such as ``social distancing,'' ``school closure,'' and ``lockdown.'' Methods: We used the Google Trends platform to collect data on daily interest levels for search terms related to suicide, several other mental health-related issues, and COVID-19 over the period between February 14, 2020 and May 13, 2020. A correlational analysis was performed to determine the association between the search term ``suicide'' and COVID-19--related search terms in 16 countries. The Mann-Kendall test was used to examine significant differences between interest levels for the search term ``suicide'' before and after school closure. Results: We found that interest levels for the search term ``suicide'' statistically significantly inversely correlated with interest levels for the search terms ``COVID-19'' or ``coronavirus'' in nearly all countries between February 14, 2020 and May 13, 2020. Additionally, search interest for the term ``suicide'' significantly and negatively correlated with that of many COVID-19--related search terms, and search interest varied between countries. The Mann-Kendall test was used to examine significant differences between search interest levels for the term ``suicide'' before and after school closure. The Netherlands (P=.19), New Zealand (P=.003), the United Kingdom (P=.006), and the United States (P=.049) showed significant negative trends in interest levels for suicide in the 2-week period preceding school closures. In contrast, interest levels for suicide had a significant positive trend in Canada (P<.001) and the United States (P=.002) after school closures. Conclusions: The public's attention to suicide might inversely correlate with the public's attention to COVID-19--related issues. Additionally, several anticontagion policies, such as school closure, might have led to a turning point for mental health crises, because the attention to suicidality increased after restrictions were implemented. Our results suggest that an increased risk of suicidal ideation may ensue due to the ongoing anticontagion policies. Timely intervention strategies for suicides should therefore be an integral part of efforts to flatten the epidemic curve. ",
doi="10.2196/24694",
url="http://publichealth.jmir.org/2020/4/e24694/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33326407"
}


@Article{info:doi/10.2196/24487,
author="Pramukti, Iqbal
and Strong, Carol
and Sitthimongkol, Yajai
and Setiawan, Agus
and Pandin, Rumambo Moses Glorino
and Yen, Cheng-Fang
and Lin, Chung-Ying
and Griffiths, D. Mark
and Ko, Nai-Ying",
title="Anxiety and Suicidal Thoughts During the COVID-19 Pandemic: Cross-Country Comparative Study Among Indonesian, Taiwanese, and Thai University Students",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="24",
volume="22",
number="12",
pages="e24487",
keywords="anxiety",
keywords="COVID-19",
keywords="cross-country",
keywords="suicidal thoughts",
keywords="university students",
abstract="Background: The COVID-19 pandemic has negatively affected the mental health of university students. Objective: This study examined the psychological responses toward COVID-19 among university students from 3 countries---Indonesia, Taiwan, and Thailand. Methods: We used a web-based, cross-sectional survey to recruit 1985 university students from 5 public universities (2 in Indonesia, 1 in Thailand, and 1 in Taiwan) via popular social media platforms such as Facebook, LINE, WhatsApp, and broadcast. All students (n=938 in Indonesia, n=734 in Thailand, and n=313 in Taiwan) answered questions concerning their anxiety, suicidal thoughts (or sadness), confidence in pandemic control, risk perception of susceptibility to infection, perceived support, resources for fighting infection, and sources of information in the context of the COVID-19 pandemic. Results: Among the 3 student groups, Thai students had the highest levels of anxiety but the lowest levels of confidence in pandemic control and available resources for fighting COVID-19. Factors associated with higher anxiety differed across countries. Less perceived satisfactory support was associated with more suicidal thoughts among Indonesian students. On the other hand, Taiwanese students were more negatively affected by information gathered from the internet and from medical staff than were Indonesian or Thai students. Conclusions: Our findings suggest that health care providers in Thailand may need to pay special attention to Thai university students given that high levels of anxiety were observed in this study population. In addition, health care providers should establish a good support system for university students, as the results of this study indicate a negative association between support and suicidal thoughts. ",
doi="10.2196/24487",
url="http://www.jmir.org/2020/12/e24487/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33296867"
}


@Article{info:doi/10.2196/22740,
author="Cheng, Cecilia
and Lau, Yan-Ching
and Luk, W. Jeremy",
title="Social Capital--Accrual, Escape-From-Self, and Time-Displacement Effects of Internet Use During the COVID-19 Stay-at-Home Period: Prospective, Quantitative Survey Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="24",
volume="22",
number="12",
pages="e22740",
keywords="coping",
keywords="coronavirus",
keywords="COVID-19",
keywords="cyberaggression",
keywords="cybervictimization",
keywords="epidemic",
keywords="gaming",
keywords="mental health",
keywords="psychological well-being",
keywords="social networking",
keywords="social support",
abstract="Background: COVID-19 has spread like wildfire across the globe, prompting many governments to impose unprecedented stay-at-home orders to limit its transmission. During an extended stay-at-home period, individuals may engage in more online leisure activities. Internet use is a double-edged sword that may have both desirable and undesirable effects on psychological well-being, and this study sought to disentangle adaptive from maladaptive internet use amidst this unusual health crisis. Objective: The objectives of this study were to assess the prevalence of probable depression during the COVID-19 stay-at-home period and to test three hypothesized risk reduction or risk elevation mechanisms, namely social capital--accrual, escape-from-self, and time-displacement effects. Methods: This study took place from March to May 2020 at the early stage of the pandemic. The study adopted a prospective design, with an online survey administered to 573 UK and 474 US adult residents at two assessment points 2 months apart. Results: The prevalence of moderate to severe depression was 36\% (bootstrap bias-corrected and accelerated [BCa] 95\% CI 33\%-39\%) at Time 1 (ie, initial time point) and 27\% (bootstrap BCa 95\% CI 25\%-30\%) at Time 2 (ie, follow-up time point). The results supported the social capital--accrual hypothesis by showing that the approach coping style was inversely associated with Time 2 depression through its positive associations with both social networking and perceived family support. The results also supported the escape-from-self hypothesis by revealing that the avoidant coping style was positively associated with Time 2 depression through its positive associations with both gaming and cyberbullying victimization, but the serial mediation model was no longer significant after Time 1 depression and some demographic risk factors had been controlled for. Finally, the results supported the time-displacement hypothesis by showing that gaming was positively associated with Time 2 depression through its inverse associations with social networking and perceived family support. Conclusions: During the extended stay-at-home period in the early stages of the COVID-19 pandemic, the prevalence of probable depression during the 2-month study period was high among the UK and US residents. Individuals with distinct coping styles may engage in different types of online leisure activities and perceive varying levels of social support, which are associated with risks of probable depression. ",
doi="10.2196/22740",
url="http://www.jmir.org/2020/12/e22740/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33320824"
}


@Article{info:doi/10.2196/24761,
author="Guinart, Daniel
and Marcy, Patricia
and Hauser, Marta
and Dwyer, Michael
and Kane, M. John",
title="Patient Attitudes Toward Telepsychiatry During the COVID-19 Pandemic: A Nationwide, Multisite Survey",
journal="JMIR Ment Health",
year="2020",
month="Dec",
day="22",
volume="7",
number="12",
pages="e24761",
keywords="telehealth",
keywords="telepsychiatry",
keywords="telemedicine",
keywords="attitude",
keywords="patients",
keywords="survey",
keywords="COVID-19",
keywords="mental health",
abstract="Background: The COVID-19 pandemic and its associated movement restrictions forced a rapid and massive transition to telepsychiatry to successfully maintain care continuity. Objective: The aim of this study is to examine a large number of patients' experiences of, use of, and attitudes toward telepsychiatry. Methods: An anonymous 11-question survey was delivered electronically to 14,000 patients receiving telepsychiatry care at 18 participating centers across 11 US states between the months of April and June 2020, including questions about their age and length of service use, as well as experience and satisfaction with telepsychiatry on a 5-point Likert scale. Descriptive statistics were used to analyze and report data. Results: In total, 3070 patients with different age ranges participated. The overall experience using telepsychiatry was either excellent or good for 1189 (82.2\%) participants using video and 2312 (81.5\%) using telephone. In addition, 1922 (63.6\%) patients either agreed or strongly agreed that remote treatment sessions (telephone or video) have been just as helpful as in-person treatment. Lack of commute (n=1406, 46.1\%) and flexible scheduling/rescheduling (n=1389, 45.5\%) were frequently reported advantages of telepsychiatry, whereas missing the clinic/hospital (n=936, 30.7\%) and not feeling as connected to their doctor/nurse/therapist (n=752, 24.6\%) were the most frequently reported challenges. After the current pandemic resolves, 1937 (64.2\%) respondents either agreed or strongly agreed that they would consider using remote treatment sessions in the future. Conclusions: Telepsychiatry is very well perceived among a large sample of patients. After the current pandemic resolves, some patients may benefit from continued telepsychiatry, but longitudinal studies are needed to assess impact on clinical outcomes and determine whether patients' perceptions change over time. ",
doi="10.2196/24761",
url="http://mental.jmir.org/2020/12/e24761/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33302254"
}


@Article{info:doi/10.2196/23776,
author="Martinez-Martin, Nicole
and Dasgupta, Ishan
and Carter, Adrian
and Chandler, A. Jennifer
and Kellmeyer, Philipp
and Kreitmair, Karola
and Weiss, Anthony
and Cabrera, Y. Laura",
title="Ethics of Digital Mental Health During COVID-19: Crisis and Opportunities",
journal="JMIR Ment Health",
year="2020",
month="Dec",
day="22",
volume="7",
number="12",
pages="e23776",
keywords="ethics",
keywords="digital mental health",
keywords="neuroethics",
keywords="mental health",
keywords="COVID-19",
keywords="crisis",
keywords="opportunity",
keywords="implementation",
keywords="online tool",
keywords="telehealth",
doi="10.2196/23776",
url="https://mental.jmir.org/2020/12/e23776",
url="http://www.ncbi.nlm.nih.gov/pubmed/33156811"
}


@Article{info:doi/10.2196/25469,
author="Severe, Jennifer
and Tang, Ruiqi
and Horbatch, Faith
and Onishchenko, Regina
and Naini, Vidisha
and Blazek, Carol Mary",
title="Factors Influencing Patients' Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="22",
volume="4",
number="12",
pages="e25469",
keywords="telepsychiatry",
keywords="COVID-19",
keywords="video visit",
keywords="telephone visit",
keywords="telehealth",
keywords="mental health",
keywords="United States",
keywords="decision making",
keywords="virtual care",
abstract="Background: Telepsychiatry enables patients to establish or maintain psychiatric care during the COVID-19 pandemic. Little is known about the factors influencing patients' initial decisions to participate in telepsychiatry in the midst of a public health crisis. Objective: This paper seeks to examine factors influencing patients' initial decisions to accept or decline telepsychiatry immediately after the stay-at-home order in Michigan, their initial choice of virtual care modality (video or telephone), and their anticipated participation in telepsychiatry once clinics reopen for in-person visits. Methods: Between June and August 2020, we conducted a telephone-based survey using a questionnaire comprising 14 quantitative and two qualitative items as part of a quality improvement initiative. We targeted patients who had an in-person appointment date that fell in the first few weeks following the Michigan governor's stay-at-home order, necessitating conversion to virtual visits or deferment of in-person care. We used descriptive statistics to report individual survey responses and assess the association between chosen visit type and patient characteristics and future participation in telepsychiatry using multivariable logistic regression. Results: A total of 244 patients whose original in-person appointments were scheduled within the first 3 weeks of the stay-at-home order in Michigan completed the telephone survey. The majority of the 244 respondents (n=202, 82.8\%) initially chose to receive psychiatric care through video visits, while 13.5\% (n=33) chose telephone visits and 1.2\% (n=3) decided to postpone care until in-person visit availability. Patient age correlated with chosen visit type (P<.001; 95\% CI 0.02-0.06). Patients aged ?44 years were more likely than patients aged 0-44 years to opt for telephone visits (relative risk reduction [RRR] 1.2; 95\% CI 1.06-1.35). Patient sex (P=.99), race (P=.06), type of insurance (P=.08), and number of previous visits to the clinic (P=.63) were not statistically relevant. Half of the respondents (132/244, 54.1\%) stated theywere likely to continue with telepsychiatry even after in-person visits were made available. Telephone visit users were less likely than video visit users to anticipate future participation in telepsychiatry (RRR 1.08; 95\% CI 0.97-1.2). Overall, virtual visits met or exceeded expectations for the majority of users. Conclusions: In this cohort, patient age correlates with the choice of virtual visit type, with older adults more likely to choose telephone visits over video visits. Understanding challenges to patient-facing technologies can help advance health equity and guide best practices for engaging patients and families through telehealth. ",
doi="10.2196/25469",
url="https://formative.jmir.org/2020/12/e25469",
url="http://www.ncbi.nlm.nih.gov/pubmed/33320823"
}


@Article{info:doi/10.2196/22423,
author="Agyapong, Ouoku Vincent Israel
and Hrabok, Marianne
and Vuong, Wesley
and Shalaby, Reham
and Noble, Marie Jasmine
and Gusnowski, April
and Mrklas, J. Kelly
and Li, Daniel
and Urichuk, Liana
and Snaterse, Mark
and Surood, Shireen
and Cao, Bo
and Li, Xin-Min
and Greiner, Russell
and Greenshaw, James Andrew",
title="Changes in Stress, Anxiety, and Depression Levels of Subscribers to a Daily Supportive Text Message Program (Text4Hope) During the COVID-19 Pandemic: Cross-Sectional Survey Study",
journal="JMIR Ment Health",
year="2020",
month="Dec",
day="18",
volume="7",
number="12",
pages="e22423",
keywords="COVID-19",
keywords="mobile technology",
keywords="text",
keywords="anxiety",
keywords="depression",
keywords="stress",
keywords="outbreak",
keywords="pandemic",
keywords="mental health",
keywords="outreach",
abstract="Background: In addition to the obvious physical medical impact of COVID-19, the disease poses evident threats to people's mental health, psychological safety, and well-being. Provision of support for these challenges is complicated by the high number of people requiring support and the need to maintain physical distancing. Text4Hope, a daily supportive SMS text messaging program, was launched in Canada to mitigate the negative mental health impacts of the pandemic among Canadians. Objective: This paper describes the changes in the stress, anxiety, and depression levels of subscribers to the Text4Hope program after 6 weeks of exposure to daily supportive SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of Text4Hope subscribers. Perceived stress, anxiety, and depression were measured with the 10-Item Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder--7 (GAD-7) scale, and the Patient Health Questionnaire--9 (PHQ-9) scale at baseline and sixth week time points. Moderate or high perceived stress, likely generalized anxiety disorder, and likely major depressive disorder were assessed using cutoff scores of ?14 for the PSS-10, ?10 for the GAD-7, and ?10 for the PHQ-9, respectively. At 6 weeks into the program, 766 participants had completed the questionnaires at both time points. Results: At the 6-week time point, there were statistically significant reductions in mean scores on the PSS-10 and GAD-7 scales but not on the PHQ-9 scale. Effect sizes were small overall. There were statistically significant reductions in the prevalence rates of moderate or high stress and likely generalized anxiety disorder but not likely major depressive disorder for the group that completed both the baseline and 6-week assessments. The largest reductions in mean scores and prevalence rates were for anxiety (18.7\% and 13.5\%, respectively). Conclusions: Text4Hope is a convenient, cost-effective, and accessible means of implementing a population-level psychological intervention. This service demonstrated significant reductions in anxiety and stress levels during the COVID-19 pandemic and could be used as a population-level mental health intervention during natural disasters and other emergencies. International Registered Report Identifier (IRRID): RR2-10.2196/19292 ",
doi="10.2196/22423",
url="http://mental.jmir.org/2020/12/e22423/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33296330"
}


@Article{info:doi/10.2196/24913,
author="Alavi, Nazanin
and Yang, Megan
and Stephenson, Callum
and Nikjoo, Niloofar
and Malakouti, Niloufar
and Layzell, Gina
and Jagayat, Jasleen
and Shirazi, Amirhossein
and Groll, Dianne
and Omrani, Mohsen
and O'Riordan, Anne
and Khalid-Khan, Sarosh
and Freire, Rafael
and Brietzke, Elisa
and Gomes, Alves Fabiano
and Milev, Roumen
and Soares, N. Claudio",
title="Using the Online Psychotherapy Tool to Address Mental Health Problems in the Context of the COVID-19 Pandemic: Protocol for an Electronically Delivered Cognitive Behavioral Therapy Program",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="18",
volume="9",
number="12",
pages="e24913",
keywords="mental health",
keywords="COVID-19",
keywords="depression",
keywords="anxiety",
keywords="psychotherapy",
keywords="cognitive behavioural therapy",
keywords="online",
keywords="internet",
keywords="electronic",
keywords="mental health care",
abstract="Background: The considerable rise of mental health challenges during the COVID-19 pandemic has had detrimental effects on the public health sector and economy. To meet the overwhelming and growing demand for mental health care, innovative approaches must be employed to significantly expand mental health care delivery capacity. Although it is not feasible to increase the number of mental health care providers or hours they work in the short term, improving their time efficiency may be a viable solution. Virtually and digitally delivering psychotherapy, which has been shown to be efficient and clinically effective, might be a good method for addressing this growing demand. Objective: This research protocol aims to evaluate the feasibility and efficacy of using an online, digital, asynchronous care model to treat mental health issues that are started or aggravated by stressors associated with the COVID-19 pandemic. Methods: This nonrandomized controlled trial intervention will be delivered through the Online Psychotherapy Tool, a secure, cloud-based, digital mental health platform. Participants will be offered a 9-week electronically delivered cognitive behavioral therapy program that is tailored to address mental health problems in the context of the COVID-19 pandemic. This program will involve weekly self-guided educational material that provides an overview of behavioral skills and weekly homework. Participants (N=80) will receive personalized feedback from and weekly interaction with a therapist throughout the course of the program. The efficacy of the program will be evaluated using clinically validated symptomology questionnaires, which are to be completed by participants at baseline, week 5, and posttreatment. Inclusion criteria includes the capacity to consent; a primary diagnosis of generalized anxiety disorder or major depressive disorder, with symptoms that started or worsened during the COVID-19 pandemic; the ability to speak and read English; and consistent and reliable access to the internet. Exclusion criteria includes active psychosis, acute mania, severe alcohol or substance use disorder, and active suicidal or homicidal ideation. Results: This study received funding in May 2020. Ethics approval was received in June 2020. The recruitment of participants began in June 2020. Participant recruitment is being conducted via social media, web-based communities, and physician referrals. To date, 58 participants have been recruited (intervention group: n=35; control group: n=23). Data collection is expected to conclude by the end of 2020. Analyses (ie, linear regression analysis for continuous outcomes and binomial regression analysis for categorical outcomes) are expected to be completed by February 2021. Conclusions: If proven feasible, this care delivery method could increase care capacity by up to fourfold. The findings from this study can potentially influence clinical practices and policies and increase accessibility to care during the COVID-19 pandemic, without sacrificing the quality of care. Trial Registration: ClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/ct2/show/NCT04476667 International Registered Report Identifier (IRRID): DERR1-10.2196/24913 ",
doi="10.2196/24913",
url="http://www.researchprotocols.org/2020/12/e24913/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33290245"
}


@Article{info:doi/10.2196/22500,
author="Pelletier, Jean-Francois
and Houle, Janie
and Goulet, Marie-H{\'e}l{\`e}ne
and Juster, Robert-Paul
and Gigu{\`e}re, Charles-{\'E}douard
and Bordet, Jonathan
and H{\'e}nault, Isabelle
and Lesage, Alain
and De Benedictis, Luigi
and Denis, Fr{\'e}d{\'e}ric
and Ng, Roger",
title="Online and Recovery-Oriented Support Groups Facilitated by Peer Support Workers in Times of COVID-19: Protocol for a Feasibility Pre-Post Study",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="18",
volume="9",
number="12",
pages="e22500",
keywords="peer support workers",
keywords="internet-based peer support groups",
keywords="personal-civic recovery",
keywords="clinical recovery",
keywords="COVID-19 Stress Scales",
keywords="peer support",
keywords="feasibility",
keywords="mental health",
keywords="COVID-19",
keywords="intervention",
keywords="recovery",
abstract="Background: In times of pandemics, social distancing, isolation, and quarantine have precipitated depression, anxiety, and substance misuse. Scientific literature suggests that patients living with mental health problems or illnesses (MHPIs) who interact with peer support workers (PSWs) experience not only the empathy and connectedness that comes from similar life experiences but also feel hope in the possibility of recovery. So far, it is the effect of mental health teams or programs with PSWs that has been evaluated. Objective: This paper presents the protocol for a web-based intervention facilitated by PSWs. The five principal research questions are whether this intervention will have an impact in terms of (Q1) personal-civic recovery and (Q2) clinical recovery, (Q3) how these recovery potentials can be impacted by the COVID-19 pandemic, (Q4) how the lived experience of persons in recovery can be mobilized to cope with such a situation, and (Q5) how sex and gender considerations can be taken into account for the pairing of PSWs with service users beyond considerations based solely on psychiatric diagnoses or specific MHPIs. This will help us assess the impact of PSWs in this setting. Methods: PSWs will lead a typical informal peer support group within the larger context of online peer support groups, focusing on personal-civic recovery. They will be scripted with a fixed, predetermined duration (a series of 10 weekly 90-minute online workshops). There will be 2 experimental subgroups---patients diagnosed with (1) psychotic disorders (n=10) and (2) anxiety or mood disorders (n=10)---compared to a control group (n=10). Random assignment to the intervention and control arms will be conducted using a 2:1 ratio. Several instruments will be used to assess clinical recovery (eg, the Recovery Assessment Scale, the Citizenship Measure questionnaire). The COVID-19 Stress Scales will be used to assess effects in terms of clinical recovery and stress- or anxiety-related responses to COVID-19. Changes will be compared between groups from baseline to endpoint in the intervention and control groups using the Student paired sample t test. Results: This pilot study was funded in March 2020. The protocol was approved on June 16, 2020, by the Research Ethics Committees of the Montreal Mental Health University Institute. Recruitment took place during the months of July and August, and results are expected in December 2020. Conclusions: Study results will provide reliable evidence on the effectiveness of a web-based intervention provided by PSWs. The investigators, alongside key decision makers and patient partners, will ensure knowledge translation throughout, and our massive open online course (MOOC), The Fundamentals of Recovery, will be updated with the evidence and new knowledge generated by this feasibility study. Trial Registration: ClinicalTrials.gov NCT04445324; https://clinicaltrials.gov/ct2/show/NCT04445324 International Registered Report Identifier (IRRID): PRR1-10.2196/22500 ",
doi="10.2196/22500",
url="http://www.researchprotocols.org/2020/12/e22500/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33259326"
}


@Article{info:doi/10.2196/24775,
author="Wang, Yilin
and Wu, Peijing
and Liu, Xiaoqian
and Li, Sijia
and Zhu, Tingshao
and Zhao, Nan",
title="Subjective Well-Being of Chinese Sina Weibo Users in Residential Lockdown During the COVID-19 Pandemic: Machine Learning Analysis",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="17",
volume="22",
number="12",
pages="e24775",
keywords="COVID-19",
keywords="residential lockdown",
keywords="subjective well-being",
keywords="online ecological recognition",
abstract="Background: During the COVID-19 pandemic, residential lockdowns were implemented in numerous cities in China to contain the rapid spread of the disease. Although these stringent regulations effectively slowed the spread of COVID-19, they may have posed challenges to the well-being of residents. Objective: This study aims to explore the effects of residential lockdown on the subjective well-being (SWB) of individuals in China during the COVID-19 pandemic. Methods: The sample consisted of 1790 Sina Weibo users who were residents of cities that imposed residential lockdowns, of which 1310 users (73.18\%) were female, and 3580 users who were residents of cities that were not locked down (gender-matched with the 1790 lockdown residents). In both the lockdown and nonlockdown groups, we calculated SWB indicators during the 2 weeks before and after the enforcement date of the residential lockdown using individuals' original posts on Sina Weibo. SWB was calculated via online ecological recognition, which is based on established machine learning predictive models. Results: The interactions of time (before the residential lockdown or after the residential lockdown) {\texttimes} area (lockdown or nonlockdown) in the integral analysis (N=5370) showed that after the residential lockdown, compared with the nonlockdown group, the lockdown group scored lower in some negative SWB indicators, including somatization (F1,5368=13.593, P<.001) and paranoid ideation (F1,5368=14.333, P<.001). The interactions of time (before the residential lockdown or after the residential lockdown) {\texttimes} area (developed or underdeveloped) in the comparison of residential lockdown areas with different levels of economic development (N=1790) indicated that the SWB of residents in underdeveloped areas showed no significant change after the residential lockdown (P>.05), while that of residents in developed areas changed. Conclusions: These findings increase our understanding of the psychological impact and cost of residential lockdown during an epidemic. The more negative changes in the SWB of residents in developed areas imply a greater need for psychological intervention under residential lockdown in such areas. ",
doi="10.2196/24775",
url="http://www.jmir.org/2020/12/e24775/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33290247"
}


@Article{info:doi/10.2196/24815,
author="Kleiman, M. Evan
and Yeager, L. April
and Grove, L. Jeremy
and Kellerman, K. John
and Kim, S. Joanne",
title="Real-time Mental Health Impact of the COVID-19 Pandemic on College Students: Ecological Momentary Assessment Study",
journal="JMIR Ment Health",
year="2020",
month="Dec",
day="15",
volume="7",
number="12",
pages="e24815",
keywords="ecological momentary assessment",
keywords="college students",
keywords="COVID-19, anxiety",
keywords="real-time",
keywords="mental health",
keywords="impact",
keywords="student",
abstract="Background: College students' mental health may be disproportionally affected by the COVID-19 pandemic because of the abrupt shift off campus and subsequent loss of a social network and potential long-term impact on job prospects. Objective: We sought to assess the nature of COVID-19's mental health impact among a sample of undergraduates who were experiencing the pandemic as it occurred in real time. Methods: In total, 140 college students completed smartphone-based ecological momentary assessments of anxiety and optimism related to COVID-19 and other generic mental health variables 6 times daily. Results: Participants completed >23,750 surveys. Overall, >75\% of these surveys indicated at least some level of anxiety about COVID-19. On average, the proportion of responses each day at the highest levels of anxiety about COVID-19 was 7 times greater than the proportion of responses at the highest levels of non--COVID-19--specific anxiety. Structural change analyses indicated a significant downward trend in COVID-19 anxiety after the first week of June, but even at the lowest point, >15\% of the participants in the sample still reported high levels of COVID-19 anxiety each day. Participants felt more anxious about COVID-19 on days when the number of new cases and deaths due to COVID-19 were higher. When participants felt anxious about COVID-19, they also felt sad, anxious (in general), and had a greater desire to drink and use drugs. Participants felt more optimistic about COVID-19 when they received more support from others and from their university. Conclusions: This study demonstrated the widespread mental health impact that COVID-19 has had on college students. ",
doi="10.2196/24815",
url="http://mental.jmir.org/2020/12/e24815/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33207308"
}


@Article{info:doi/10.2196/24776,
author="Ngoc Cong Duong, Khanh
and Nguyen Le Bao, Tien
and Thi Lan Nguyen, Phuong
and Vo Van, Thanh
and Phung Lam, Toi
and Pham Gia, Anh
and Anuratpanich, Luerat
and Vo Van, Bay",
title="Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="15",
volume="4",
number="12",
pages="e24776",
keywords="COVID-19",
keywords="mental health",
keywords="psychological distress",
keywords="depression",
keywords="anxiety",
keywords="Vietnam",
keywords="psychology",
keywords="distress",
keywords="lockdown",
keywords="survey",
abstract="Background: The first nationwide lockdown due to the COVID-19 pandemic was implemented in Vietnam from April 1 to 15, 2020. Nevertheless, there has been limited information on the impact of COVID-19 on the psychological health of the public. Objective: This study aimed to estimate the prevalence of psychological issues and identify the factors associated with the psychological impact of COVID-19 during the first nationwide lockdown among the general population in Vietnam. Methods: We employed a cross-sectional study design with convenience sampling. A self-administered, online survey was used to collect data and assess psychological distress, depression, anxiety, and stress of participants from April 10 to 15, 2020. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were utilized to assess psychological distress, depression, anxiety, and stress of participants during social distancing due to COVID-19. Associations across factors were explored using regression analysis. Results: A total of 1385 respondents completed the survey. Of this, 35.9\% (n=497) experienced psychological distress, as well as depression (n=325, 23.5\%), anxiety (n=195, 14.1\%), and stress (n=309, 22.3\%). Respondents who evaluated their physical health as average had a higher IES-R score (beta coefficient [B]=9.16, 95\% CI 6.43 to 11.89), as well as higher depression (B=5.85, 95\% CI 4.49 to 7.21), anxiety (B=3.64, 95\% CI 2.64 to 4.63), and stress (B=5.19, 95\% CI 3.83 to 6.56) scores for DASS-21 than those who rated their health as good or very good. Those who self-reported their health as bad or very bad experienced more severe depression (B=9.57, 95\% CI 4.54 to 14.59), anxiety (B=7.24, 95\% CI 3.55 to 10.9), and stress (B=10.60, 95\% CI 5.56 to 15.65). Unemployment was more likely to be associated with depression (B=3.34, 95\% CI 1.68 to 5.01) and stress (B=2.34, 95\% CI 0.84 to 3.85). Regarding worries about COVID-19, more than half (n=755, 54.5\%) expressed concern for their children aged <18 years, which increased their IES-R score (B=7.81, 95\% CI 4.98 to 10.64) and DASS-21 stress score (B=1.75, 95\% CI 0.27 to 3.24). The majority of respondents (n=1335, 96.4\%) were confident about their doctor's expertise in terms of COVID-19 diagnosis and treatment, which was positively associated with less distress caused by the outbreak (B=--7.84, 95\% CI --14.58 to --1.11). Conclusions: The findings highlight the effect of COVID-19 on mental health during the nationwide lockdown among the general population in Vietnam. The study provides useful evidence for policy decision makers to develop and implement interventions to mitigate these impacts. ",
doi="10.2196/24776",
url="http://formative.jmir.org/2020/12/e24776/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33284778"
}


@Article{info:doi/10.2196/24430,
author="Adamou, Marios
and Fullen, Tim
and Galab, Nazmeen
and Mackintosh, Isobel
and Abbott, Karl
and Lowe, Deborah
and Smith, Claire",
title="Psychological Effects of the COVID-19 Imposed Lockdown on Adults with Attention Deficit/Hyperactivity Disorder: Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="15",
volume="4",
number="12",
pages="e24430",
keywords="adult ADHD",
keywords="pandemic",
keywords="lockdown",
keywords="COVID-19",
keywords="well-being",
keywords="psychological",
keywords="intervention",
keywords="ADHD",
abstract="Background: The psychological effects of the COVID-19 government-imposed lockdown have been studied in several populations. These effects however have not been studied in adult populations with attention deficit/hyperactivity disorder (ADHD). Objective: We wanted to investigate the psychological effects of the COVID-19 imposed lockdown on an adult population with ADHD. Methods: We conducted a cross-sectional survey by administering the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Brief Adjustment Scale-6, Perceived Stress Scale, and Multidimensional Scale of Perceived Social Support to a pragmatic sample of adults with ADHD. Results: In total, 24 individuals (male: n=18, 75\%; female: n=6, 25\%; age: mean 21.75 years, SD 1.85 years) were included in this study. The adults with ADHD we surveyed had significant levels of emotional distress during the COVID-19 pandemic period. However, there was no evidence of significant deterioration to the mental health of our sample during the COVID-19 pandemic. Conclusions: When treatment for ADHD is maintained, the effects of the COVID-19 pandemic on the mental health of adults with ADHD are mild. Targeted psychological interventions may be useful in such circumstances. ",
doi="10.2196/24430",
url="https://formative.jmir.org/2020/12/e24430",
url="http://www.ncbi.nlm.nih.gov/pubmed/33108312"
}


@Article{info:doi/10.2196/24578,
author="Davenport, A. Tracey
and Cheng, Sze Vanessa Wan
and Iorfino, Frank
and Hamilton, Blake
and Castaldi, Eva
and Burton, Amy
and Scott, M. Elizabeth
and Hickie, B. Ian",
title="Flip the Clinic: A Digital Health Approach to Youth Mental Health Service Delivery During the COVID-19 Pandemic and Beyond",
journal="JMIR Ment Health",
year="2020",
month="Dec",
day="15",
volume="7",
number="12",
pages="e24578",
keywords="health information technologies",
keywords="clinical staging",
keywords="youth",
keywords="mental health",
keywords="transdiagnostic",
keywords="eHealth",
keywords="routine outcome monitoring",
keywords="adolescent",
keywords="mental health services",
keywords="health services",
keywords="telemedicine",
keywords="monitoring",
keywords="outcome",
keywords="young adult",
keywords="COVID-19",
doi="10.2196/24578",
url="http://mental.jmir.org/2020/12/e24578/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33206051"
}


@Article{info:doi/10.2196/21418,
author="Valdez, Danny
and ten Thij, Marijn
and Bathina, Krishna
and Rutter, A. Lauren
and Bollen, Johan",
title="Social Media Insights Into US Mental Health During the COVID-19 Pandemic: Longitudinal Analysis of Twitter Data",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="14",
volume="22",
number="12",
pages="e21418",
keywords="social media",
keywords="analytics",
keywords="infodemiology",
keywords="infoveillance",
keywords="COVID-19",
keywords="United States",
keywords="mental health",
keywords="informatics",
keywords="sentiment analysis",
keywords="Twitter",
abstract="Background: The COVID-19 pandemic led to unprecedented mitigation efforts that disrupted the daily lives of millions. Beyond the general health repercussions of the pandemic itself, these measures also present a challenge to the world's mental health and health care systems. Considering that traditional survey methods are time-consuming and expensive, we need timely and proactive data sources to respond to the rapidly evolving effects of health policy on our population's mental health. Many people in the United States now use social media platforms such as Twitter to express the most minute details of their daily lives and social relations. This behavior is expected to increase during the COVID-19 pandemic, rendering social media data a rich field to understand personal well-being. Objective: This study aims to answer three research questions: (1) What themes emerge from a corpus of US tweets about COVID-19? (2) To what extent did social media use increase during the onset of the COVID-19 pandemic? and (3) Does sentiment change in response to the COVID-19 pandemic? Methods: We analyzed 86,581,237 public domain English language US tweets collected from an open-access public repository in three steps. First, we characterized the evolution of hashtags over time using latent Dirichlet allocation (LDA) topic modeling. Second, we increased the granularity of this analysis by downloading Twitter timelines of a large cohort of individuals (n=354,738) in 20 major US cities to assess changes in social media use. Finally, using this timeline data, we examined collective shifts in public mood in relation to evolving pandemic news cycles by analyzing the average daily sentiment of all timeline tweets with the Valence Aware Dictionary and Sentiment Reasoner (VADER) tool. Results: LDA topics generated in the early months of the data set corresponded to major COVID-19--specific events. However, as state and municipal governments began issuing stay-at-home orders, latent themes shifted toward US-related lifestyle changes rather than global pandemic-related events. Social media volume also increased significantly, peaking during stay-at-home mandates. Finally, VADER sentiment analysis scores of user timelines were initially high and stable but decreased significantly, and continuously, by late March. Conclusions: Our findings underscore the negative effects of the pandemic on overall population sentiment. Increased use rates suggest that, for some, social media may be a coping mechanism to combat feelings of isolation related to long-term social distancing. However, in light of the documented negative effect of heavy social media use on mental health, social media may further exacerbate negative feelings in the long-term for many individuals. Thus, considering the overburdened US mental health care structure, these findings have important implications for ongoing mitigation efforts. ",
doi="10.2196/21418",
url="http://www.jmir.org/2020/12/e21418/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33284783"
}


@Article{info:doi/10.2196/22755,
author="Balcombe, Luke
and De Leo, Diego",
title="Psychological Screening and Tracking of Athletes and Digital Mental Health Solutions in a Hybrid Model of Care: Mini Review",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="14",
volume="4",
number="12",
pages="e22755",
keywords="athletes",
keywords="screening",
keywords="tracking",
keywords="engagement",
keywords="well-being",
keywords="stress",
keywords="adjustment",
keywords="COVID-19",
keywords="hybrid model of care",
keywords="digital mental health",
keywords="machine learning",
keywords="artificial intelligence",
abstract="Background: There is a persistent need for mental ill-health prevention and intervention among at-risk and vulnerable subpopulations. Major disruptions to life, such as the COVID-19 pandemic, present an opportunity for a better understanding of the experience of stressors and vulnerability. Faster and better ways of psychological screening and tracking are more generally required in response to the increased demand upon mental health care services. The argument that mental and physical health should be considered together as part of a biopsychosocial approach is garnering acceptance in elite athlete literature. However, the sporting population are unique in that there is an existing stigma of mental health, an underrecognition of mental ill-health, and engagement difficulties that have hindered research, prevention, and intervention efforts. Objective: The aims of this paper are to summarize and evaluate the literature on athletes' increased vulnerability to mental ill-health and digital mental health solutions as a complement to prevention and intervention, and to show relationships between athlete mental health problems and resilience as well as digital mental health screening and tracking, and faster and better treatment algorithms. Methods: This mini review shapes literature in the fields of athlete mental health and digital mental health by summarizing and evaluating journal and review articles drawn from PubMed Central and the Directory of Open Access Journals. Results: Consensus statements and systematic reviews indicated that elite athletes have comparable rates of mental ill-health prevalence to the general population. However, peculiar subgroups require disentangling. Innovative expansion of data collection and analytics is required to respond to engagement issues and advance research and treatment programs in the process. Digital platforms, machine learning, deep learning, and artificial intelligence are useful for mental health screening and tracking in various subpopulations. It is necessary to determine appropriate conditions for algorithms for use in recommendations. Partnered with real-time automation and machine learning models, valid and reliable behavior sensing, digital mental health screening, and tracking tools have the potential to drive a consolidated, measurable, and balanced risk assessment and management strategy for the prevention and intervention of the sequelae of mental ill-health. Conclusions: Athletes are an at-risk subpopulation for mental health problems. However, a subgroup of high-level athletes displayed a resilience that helped them to positively adjust after a period of overwhelming stress. Further consideration of stress and adjustments in brief screening tools is recommended to validate this finding. There is an unrealized potential for broadening the scope of mental health, especially symptom and disorder interpretation. Digital platforms for psychological screening and tracking have been widely used among general populations, but there is yet to be an eminent athlete version. Sports in combination with mental health education should address the barriers to help-seeking by increasing awareness, from mental ill-health to positive functioning. A hybrid model of care is recommended, combining traditional face-to-face approaches along with innovative and evaluated digital technologies, that may be used in prevention and early intervention strategies. ",
doi="10.2196/22755",
url="http://formative.jmir.org/2020/12/e22755/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33271497"
}


@Article{info:doi/10.2196/24021,
author="Chiauzzi, Emil
and Clayton, Ashley
and Huh-Yoo, Jina",
title="Videoconferencing-Based Telemental Health: Important Questions for the COVID-19 Era From Clinical and Patient-Centered Perspectives",
journal="JMIR Ment Health",
year="2020",
month="Dec",
day="8",
volume="7",
number="12",
pages="e24021",
keywords="telehealth",
keywords="telemental health",
keywords="COVID-19",
keywords="videoconferencing",
keywords="ethics",
keywords="privacy",
keywords="mental health",
keywords="psychotherapy",
keywords="patient-centered",
keywords="lived experience",
doi="10.2196/24021",
url="http://mental.jmir.org/2020/12/e24021/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33180739"
}


@Article{info:doi/10.2196/24507,
author="Kubb, Christian
and Foran, M. Heather",
title="Measuring COVID-19 Related Anxiety in Parents: Psychometric Comparison of Four Different Inventories",
journal="JMIR Ment Health",
year="2020",
month="Dec",
day="3",
volume="7",
number="12",
pages="e24507",
keywords="COVID-19",
keywords="coronavirus",
keywords="anxiety",
keywords="parents",
keywords="parenting",
keywords="scale",
keywords="inventory",
keywords="well-being",
keywords="mental health",
keywords="stress",
abstract="Background: The COVID-19 outbreak and the measures to contain the global pandemic can have an impact on the well-being and mental health status of individuals. Parents of young children are particularly at risk for high levels of parental stress due to the current public health crisis, which can impact parenting behaviors and children's well-being. Although different initial scales have been developed to measure COVID-19--related anxiety, they have not yet been tested sufficiently in parent samples. A brief measure of COVID-19--related anxiety is necessary for both quick assessment in practice and in larger epidemiological studies of parents. Objective: The purpose of this study is to compare the distributions, validities, and reliabilities of four different COVID-19 anxiety scales: Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Pandemic Anxiety Scale, and one subscale of the COVID Stress Scales. Based on the psychometric properties of these scales, we aim to provide recommendations for a brief unidimensional inventory to assess COVID-19--related anxiety among parents. Methods: A cross-sectional web-based survey of 515 German-speaking parents (465 mothers, 90.3\%) with at least one child aged 0-6 years was conducted during a 6-week period (June 29 to August 9, 2020). Half of the parents were recruited via Facebook parenting groups, while the other half were recruited through childcare centers. We psychometrically tested 25 items on COVID-19--related anxiety using the framework of classical test theory, including item analysis, correlational analysis of family variables, and exploratory factor analysis. Moreover, an item response theory approach was applied to estimate item discriminations and item difficulties. Results: Based on the psychometric properties, three items of the Pandemic Anxiety Scale were identified as a single unidimensional factor. The adapted scale demonstrated acceptable internal consistency ($\alpha$=.79), moderate to high item discrimination, strong positive intercorrelation with two other COVID-19 anxiety scales, and a small positive association with parenting stress. Mothers and fathers did not differ in total scores (t513=?0.79, P=.42). Conclusions: Factor analysis suggests that existing COVID-19--related anxiety scales measure different latent constructs of anxiety. Furthermore, all scales showed only small to moderate correlations with trait health anxiety, suggesting that COVID-19--related anxiety is distinct from general health anxiety. The adapted ``disease anxiety'' subscale of the Pandemic Anxiety Scale is an economical measure for assessing COVID-19--related anxiety in parents. Directions for future research are outlined. ",
doi="10.2196/24507",
url="https://mental.jmir.org/2020/12/e24507",
url="http://www.ncbi.nlm.nih.gov/pubmed/33197233"
}


@Article{info:doi/10.2196/22757,
author="Pizzoli, Maria Silvia Francesca
and Marzorati, Chiara
and Mazzoni, Davide
and Pravettoni, Gabriella",
title="Web-Based Relaxation Intervention for Stress During Social Isolation: Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2020",
month="Dec",
day="3",
volume="7",
number="12",
pages="e22757",
keywords="relaxation",
keywords="guided meditation",
keywords="web-based intervention",
keywords="social isolation",
keywords="intervention",
keywords="COVID-19",
keywords="anxiety",
keywords="stress",
keywords="internet",
abstract="Background: Relaxation practices might be helpful exercises for coping with anxiety and stressful sensations. They may be of particular utility when used in web-based interventions during periods of social isolation. Objective: This randomized study aimed to test whether web-based relaxation practices like natural sounds, deep respiration, and body scans can promote relaxation and a positive emotional state, and reduce psychomotor activation and preoccupation related to the COVID-19 pandemic. Methods: Participants were randomly assigned to one of three experimental conditions. Each condition was characterized by a single online session of a guided square breathing exercise, a guided body scan exercise, or natural sounds. The participants listened to one of the fully automated audio clips for 7 minutes and pre-post completed self-assessed scales on perceived relaxation, psychomotor activation, level of preoccupation associated with COVID-19, and emotional state. At the end of the session, qualitative reports on subjective experience were also collected. Results: Overall, 294 participants completed 75\% of the survey and 240 completed the entire survey as well as one of three randomly assigned interventions. Perceived relaxation, psychomotor activation/stress, and preoccupation related to COVID-19 showed a positive improvement after participants listened to the audio clips. The same pattern was observed for the valence and perceived dominance of the emotional state. The square breathing and body scan exercises yielded superior results compared to natural sounds in lowering perceived stress. Conclusions: This study provides a novel insight that can guide the development of future low-cost web-based interventions to reduce preoccupation and stress in the general population. International Registered Report Identifier (IRRID): RR2-10.2196/19236 ",
doi="10.2196/22757",
url="https://mental.jmir.org/2020/12/e22757",
url="http://www.ncbi.nlm.nih.gov/pubmed/33200990"
}


@Article{info:doi/10.2196/24240,
author="Du, Junfeng
and Mayer, Gwendolyn
and Hummel, Svenja
and Oetjen, Neele
and Gronewold, Nadine
and Zafar, Ali
and Schultz, Jobst-Hendrik",
title="Mental Health Burden in Different Professions During the Final Stage of the COVID-19 Lockdown in China: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="2",
volume="22",
number="12",
pages="e24240",
keywords="mental health",
keywords="COVID-19",
keywords="China",
keywords="depression",
keywords="anxiety",
keywords="lockdown",
keywords="coping strategies",
keywords="stressors",
keywords="stress",
keywords="doctors",
keywords="nurses",
keywords="students",
keywords="media consumption",
keywords="WeChat",
abstract="Background: COVID-19 resulted in considerable mental health burden in the Chinese general population and among health care workers at the beginning and peak of the pandemic. However, little is known about potentially vulnerable groups during the final stage of the lockdown. Objective: The aim of this survey study was to assess the mental health burden of different professions in China in order to find vulnerable groups, possible influencing factors, and successful ways of coping during the last 4 weeks of the lockdown in Hubei Province. Methods: A cross-sectional online survey asked participants about current residence, daily working hours, exposure to COVID-19 at work, and media preferences. We used a shortened version of the Depression, Anxiety and Stress Scale (DASS-21) to assess mental health. Further assessments included perceived stress (Simplified Chinese version of the 14-item Perceived Stress Scale), coping strategies for all participants, and specific stressors for health care workers. We followed the reporting guidelines of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies. Results: The sample (N=687) consisted of 158 doctors, 221 nurses, 24 other medical staff, 43 students, 60 teachers/government staff, 135 economy staff, 26 workers/farmers, and 20 professions designated under the ``other'' category. We found increased depression (n=123, 17.9\%), anxiety (n=208, 30.3\%), and stress (n=94, 13.7\%) in our sample. Professions that were vulnerable to depression were other medical staff and students. Doctors, nurses, and students were vulnerable to anxiety; and other medical staff, students, and economy staff were vulnerable to stress. Coping strategies were reduced to three factors: active, mental, and emotional. Being female and emotional coping were independently associated with depression, anxiety, or stress. Applying active coping strategies showed lower odds for anxiety while mental coping strategies showed lower odds for depression, anxiety, and stress. Age, being inside a lockdown area, exposure to COVID-19 at work, and having a high workload (8-12 hours per day) were not associated with depression, anxiety, or stress. WeChat was the preferred way of staying informed across all groups. Conclusions: By the end of the lockdown, a considerable part of the Chinese population showed increased levels of depression and anxiety. Students and other medical staff were the most affected, while economy staff were highly stressed. Doctors and nurses need support regarding potential anxiety disorders. Future work should focus on longitudinal results of the pandemic and develop targeted preventive measures. ",
doi="10.2196/24240",
url="https://www.jmir.org/2020/12/e24240",
url="http://www.ncbi.nlm.nih.gov/pubmed/33197231"
}


@Article{info:doi/10.2196/21886,
author="Sobowale, Kunmi
and Hilliard, Heather
and Ignaszewski, J. Martha
and Chokroverty, Linda",
title="Real-Time Communication: Creating a Path to COVID-19 Public Health Activism in Adolescents Using Social Media",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="1",
volume="22",
number="12",
pages="e21886",
keywords="social media",
keywords="digital health",
keywords="COVID-19",
keywords="adolescent",
keywords="public health",
keywords="disaster",
keywords="communication",
keywords="affordances",
doi="10.2196/21886",
url="https://www.jmir.org/2020/12/e21886",
url="http://www.ncbi.nlm.nih.gov/pubmed/33226956"
}


@Article{info:doi/10.2196/20246,
author="Humer, Elke
and Stippl, Peter
and Pieh, Christoph
and Pryss, R{\"u}diger
and Probst, Thomas",
title="Experiences of Psychotherapists With Remote Psychotherapy During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="27",
volume="22",
number="11",
pages="e20246",
keywords="psychotherapists",
keywords="remote psychotherapy",
keywords="telephone",
keywords="internet",
keywords="experiences",
keywords="expectations",
keywords="COVID-19",
keywords="telehealth",
keywords="therapy",
keywords="psychology",
abstract="Background: The current situation around the COVID-19 pandemic and the measures necessary to fight it are creating challenges for psychotherapists, who usually treat patients face-to-face with personal contact. The pandemic is accelerating the use of remote psychotherapy (ie, psychotherapy provided via telephone or the internet). However, some psychotherapists have expressed reservations regarding remote psychotherapy. As psychotherapists are the individuals who determine the frequency of use of remote psychotherapy, the potential of enabling mental health care during the COVID-19 pandemic in line with the protective measures to fight COVID-19 can be realized only if psychotherapists are willing to use remote psychotherapy. Objective: This study aimed to investigate the experiences of psychotherapists with remote psychotherapy in the first weeks of the COVID-19 lockdown in Austria (between March 24 and April 1, 2020). Methods: Austrian psychotherapists were invited to take part in a web-based survey. The therapeutic orientations of the psychotherapists (behavioral, humanistic, psychodynamic, or systemic), their rating of the comparability of remote psychotherapy (web- or telephone-based) with face-to-face psychotherapy involving personal contact, and potential discrepancies between their actual experiences and previous expectations with remote psychotherapy were assessed. Data from 1162 psychotherapists practicing before and during the COVID-19 lockdown were analyzed. Results: Psychotherapy conducted via telephone or the internet was reported to not be totally comparable to psychotherapy with personal contact (P<.001). Psychodynamic (P=.001) and humanistic (P=.005) therapists reported a higher comparability of telephone-based psychotherapy to in-person psychotherapy than behavioral therapists. Experiences with remote therapy (both web- and telephone-based) were more positive than previously expected (P<.001). Psychodynamic therapists reported more positive experiences with telephone-based psychotherapy than expected compared to behavioral (P=.03) and systemic (P=.002) therapists. In general, web-based psychotherapy was rated more positively (regarding comparability to psychotherapy with personal contact and experiences vs expectations) than telephone-based psychotherapy (P<.001); however, psychodynamic therapists reported their previous expectations to be equal to their actual experiences for both telephone- and web-based psychotherapy. Conclusions: Psychotherapists found their experiences with remote psychotherapy (ie, web- or telephone-based psychotherapy) to be better than expected but found that this mode was not totally comparable to face-to-face psychotherapy with personal contact. Especially, behavioral therapists were found to rate telephone-based psychotherapy less favorably than therapists with other theoretical backgrounds. ",
doi="10.2196/20246",
url="http://www.jmir.org/2020/11/e20246/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33151896"
}


@Article{info:doi/10.2196/23748,
author="BinDhim, F. Nasser
and Althumiri, A. Nora
and Basyouni, H. Mada
and Alageel, A. Asem
and Alghnam, Suliman
and Al-Qunaibet, M. Ada
and Almubark, A. Rasha
and Aldhukair, Shahla
and Ad-Dab'bagh, Yasser",
title="A Mental Health Surveillance System for the General Population During the COVID-19 Pandemic: Protocol for a Multiwave Cross-sectional Survey Study",
journal="JMIR Res Protoc",
year="2020",
month="Nov",
day="26",
volume="9",
number="11",
pages="e23748",
keywords="mental health",
keywords="depression",
keywords="anxiety",
keywords="screening",
keywords="surveillance",
keywords="COVID-19",
abstract="Background: The COVID-19 outbreak can potentially be categorized as a traumatic event. Public health surveillance is one of the cornerstones of public health practice, and it empowers decision makers to lead and manage public health crises and programs more effectively by providing timely and useful evidence. Objective: This paper presents the protocol for a study that aims to identify, track, and monitor trends in the population in Saudi Arabia at risk of major depressive disorders and anxiety during the COVID-19 pandemic. Methods: This study utilizes continuous, cross-sectional, national-level mental health screening via computer-assisted phone interviews, conducted in four waves on a monthly basis (between May and August 2020). Arabic-speaking adults, aged ?18 years, and living in Saudi Arabia were recruited via a random phone list. This surveillance system used the proportional quota sampling technique to achieve an equal distribution of participants, stratified by age and gender, and region, within and across the 13 administrative regions of Saudi Arabia. A sample size of 4056 participants per wave was calculated to achieve enough power to detect changes in mental health status. The questionnaire includes the Arabic version of the Patient Health Questionnaire-9 (PHQ-9) to measure depressive symptoms and the General Anxiety Disorder-7 (GAD-7) to measure anxiety. In addition, it will collect data on sociodemographic variables and potential risk factors. Results: Study recruitment began in May 2020. The data analysis was completed in October 2020, and the final report is expected to be published by the end of December 2020. Conclusions: Monitoring the population's mental health status during the COVID-19 pandemic will inform decision makers of any potential deterioration in mental health on a national level and among subgroups, including across regions, age groups, and gender groups. It will allow decision makers to recognize issues and intervene sooner. It will also provide valuable scientific data to help understand the effects of epidemics and pandemics on mental health. As far as we know, this is the only study that attempts to monitor the mental health status of the general population on a monthly basis. International Registered Report Identifier (IRRID): DERR1-10.2196/23748 ",
doi="10.2196/23748",
url="http://www.researchprotocols.org/2020/11/e23748/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33156802"
}


@Article{info:doi/10.2196/22600,
author="Saha, Koustuv
and Torous, John
and Caine, D. Eric
and De Choudhury, Munmun",
title="Psychosocial Effects of the COVID-19 Pandemic: Large-scale Quasi-Experimental Study on Social Media",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="24",
volume="22",
number="11",
pages="e22600",
keywords="social media",
keywords="Twitter",
keywords="language",
keywords="psychosocial effects",
keywords="mental health",
keywords="transfer learning",
keywords="depression",
keywords="anxiety",
keywords="stress",
keywords="social support",
keywords="emotions",
keywords="COVID-19",
keywords="coronavirus",
keywords="crisis",
abstract="Background: The COVID-19 pandemic has caused several disruptions in personal and collective lives worldwide. The uncertainties surrounding the pandemic have also led to multifaceted mental health concerns, which can be exacerbated with precautionary measures such as social distancing and self-quarantining, as well as societal impacts such as economic downturn and job loss. Despite noting this as a ``mental health tsunami'', the psychological effects of the COVID-19 crisis remain unexplored at scale. Consequently, public health stakeholders are currently limited in identifying ways to provide timely and tailored support during these circumstances. Objective: Our study aims to provide insights regarding people's psychosocial concerns during the COVID-19 pandemic by leveraging social media data. We aim to study the temporal and linguistic changes in symptomatic mental health and support expressions in the pandemic context. Methods: We obtained about 60 million Twitter streaming posts originating from the United States from March 24 to May 24, 2020, and compared these with about 40 million posts from a comparable period in 2019 to attribute the effect of COVID-19 on people's social media self-disclosure. Using these data sets, we studied people's self-disclosure on social media in terms of symptomatic mental health concerns and expressions of support. We employed transfer learning classifiers that identified the social media language indicative of mental health outcomes (anxiety, depression, stress, and suicidal ideation) and support (emotional and informational support). We then examined the changes in psychosocial expressions over time and language, comparing the 2020 and 2019 data sets. Results: We found that all of the examined psychosocial expressions have significantly increased during the COVID-19 crisis---mental health symptomatic expressions have increased by about 14\%, and support expressions have increased by about 5\%, both thematically related to COVID-19. We also observed a steady decline and eventual plateauing in these expressions during the COVID-19 pandemic, which may have been due to habituation or due to supportive policy measures enacted during this period. Our language analyses highlighted that people express concerns that are specific to and contextually related to the COVID-19 crisis. Conclusions: We studied the psychosocial effects of the COVID-19 crisis by using social media data from 2020, finding that people's mental health symptomatic and support expressions significantly increased during the COVID-19 period as compared to similar data from 2019. However, this effect gradually lessened over time, suggesting that people adapted to the circumstances and their ``new normal.'' Our linguistic analyses revealed that people expressed mental health concerns regarding personal and professional challenges, health care and precautionary measures, and pandemic-related awareness. This study shows the potential to provide insights to mental health care and stakeholders and policy makers in planning and implementing measures to mitigate mental health risks amid the health crisis. ",
doi="10.2196/22600",
url="http://www.jmir.org/2020/11/e22600/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33156805"
}


@Article{info:doi/10.2196/24012,
author="Zhang, Boyu
and Zaman, Anis
and Silenzio, Vincent
and Kautz, Henry
and Hoque, Ehsan",
title="The Relationships of Deteriorating Depression and Anxiety With Longitudinal Behavioral Changes in Google and YouTube Use During COVID-19: Observational Study",
journal="JMIR Ment Health",
year="2020",
month="Nov",
day="23",
volume="7",
number="11",
pages="e24012",
keywords="mental health",
keywords="anxiety",
keywords="depression",
keywords="Google Search",
keywords="YouTube",
keywords="pandemic",
keywords="COVID-19",
abstract="Background: Depression and anxiety disorders among the global population have worsened during the COVID-19 pandemic. Yet, current methods for screening these two issues rely on in-person interviews, which can be expensive, time-consuming, and blocked by social stigma and quarantines. Meanwhile, how individuals engage with online platforms such as Google Search and YouTube has undergone drastic shifts due to COVID-19 and subsequent lockdowns. Such ubiquitous daily behaviors on online platforms have the potential to capture and correlate with clinically alarming deteriorations in depression and anxiety profiles of users in a noninvasive manner. Objective: The goal of this study is to examine, among college students in the United States, the relationships of deteriorating depression and anxiety conditions with the changes in user behaviors when engaging with Google Search and YouTube during COVID-19. Methods: This study recruited a cohort of undergraduate students (N=49) from a US college campus during January 2020 (prior to the pandemic) and measured the anxiety and depression levels of each participant. The anxiety level was assessed via the General Anxiety Disorder-7 (GAD-7). The depression level was assessed via the Patient Health Questionnaire-9 (PHQ-9). This study followed up with the same cohort during May 2020 (during the pandemic), and the anxiety and depression levels were assessed again. The longitudinal Google Search and YouTube history data of all participants were anonymized and collected. From individual-level Google Search and YouTube histories, we developed 5 features that can quantify shifts in online behaviors during the pandemic. We then assessed the correlations of deteriorating depression and anxiety profiles with each of these features. We finally demonstrated the feasibility of using the proposed features to build predictive machine learning models. Results: Of the 49 participants, 49\% (n=24) of them reported an increase in the PHQ-9 depression scores; 53\% (n=26) of them reported an increase in the GAD-7 anxiety scores. The results showed that a number of online behavior features were significantly correlated with deteriorations in the PHQ-9 scores (r ranging between --0.37 and 0.75, all P values less than or equal to .03) and the GAD-7 scores (r ranging between --0.47 and 0.74, all P values less than or equal to .03). Simple machine learning models were shown to be useful in predicting the change in anxiety and depression scores (mean squared error ranging between 2.37 and 4.22, R2 ranging between 0.68 and 0.84) with the proposed features. Conclusions: The results suggested that deteriorating depression and anxiety conditions have strong correlations with behavioral changes in Google Search and YouTube use during the COVID-19 pandemic. Though further studies are required, our results demonstrate the feasibility of using pervasive online data to establish noninvasive surveillance systems for mental health conditions that bypasses many disadvantages of existing screening methods. ",
doi="10.2196/24012",
url="http://mental.jmir.org/2020/11/e24012/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33180743"
}


@Article{info:doi/10.2196/20656,
author="Li, Mengyao
and Liu, Li
and Yang, Yilong
and Wang, Yang
and Yang, Xiaoshi
and Wu, Hui",
title="Psychological Impact of Health Risk Communication and Social Media on College Students During the COVID-19 Pandemic: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="18",
volume="22",
number="11",
pages="e20656",
keywords="COVID-19",
keywords="anxiety",
keywords="panic",
keywords="health risk",
keywords="communication",
keywords="social media",
abstract="Background: The outbreak of COVID-19 began in 2019 and is expected to impact the psychological health of college students. Few studies have investigated the associations among health risk communication, social media, and psychological symptoms during a major pandemic. Objective: The aim of this research was to assess the prevalence of psychological symptoms among college students and explore their associations with health risk communication and social media. Methods: A web-based survey was distributed through the Wenjuanxing platform among Chinese college students from March 3-15, 2020. In addition to demographics, information on health risk communication and social media was collected, and the Symptom Checklist 90 Phobia and Health Anxiety Inventory subscale was used to assess psychological symptoms among 1676 college students in China. Multivariable logistic regression was performed to examine these independent risk factors. Results: The prevalence of panic and health anxiety was 17.2\% (288/1676) and 24.3\% (408/1676), respectively. Regarding risk communication, understanding the risk of COVID-19 (odds ratio [OR] 0.480, 95\% CI 0.367-0.627) was a protective factor against panic. Knowledge of prognosis (OR 0.708, 95\% CI 0.551-0.910), preventive measures (OR 0.380, 95\% CI 0.195-0.742), and wearing face masks (OR 0.445, 95\% CI 0.230-0.862) were shown to be protective factors in predicting health anxiety. Perceived lethality (OR 1.860, 95\% CI 1.408-2.459), being affected by the global spread (OR 1.936, 95\% CI 1.405-2.669), and impact on social contacts (OR 1.420, 95\% CI 1.118-1.802) were identified as significant risk factors associated with health anxiety. In terms of social media, trust in mainstream media (OR 0.613, 95\% CI 0.461-0.816) was considered to be a protective factor against health anxiety. Conclusions: There was a high prevalence of psychological symptoms among college students. Health risk communication and social media use were important in predicting psychological symptoms, especially health anxiety. Scientific and evidence-based information should be reported by social media platforms. Web-based consultation and intervention measures should be the focus of future studies. ",
doi="10.2196/20656",
url="http://www.jmir.org/2020/11/e20656/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33108308"
}


@Article{info:doi/10.2196/24136,
author="Zhang, Lunbo
and Yan, Ming
and Takashima, Kaito
and Guo, Wenru
and Yamada, Yuki",
title="The Effect of the COVID-19 Pandemic on Health Care Workers' Anxiety Levels: Protocol for a Meta-Analysis",
journal="JMIR Res Protoc",
year="2020",
month="Nov",
day="18",
volume="9",
number="11",
pages="e24136",
keywords="COVID-19",
keywords="health care worker",
keywords="anxiety",
keywords="meta-analysis",
keywords="review",
keywords="protocol",
keywords="mental health",
keywords="literature",
keywords="bias",
abstract="Background: The COVID-19 pandemic has been declared a public health emergency of international concern; this has caused excessive anxiety among health care workers. In addition, publication bias and low-quality publications have become widespread, which can result in the dissemination of unreliable findings. Objective: This paper presents the protocol for a meta-analysis with the following two aims: (1) to examine the prevalence of anxiety among health care workers and determine whether it has increased due to the COVID-19 pandemic, and (2) to investigate whether there has been an increase in publication bias. Methods: All related studies that were published/released from 2015 to 2020 will be searched in electronic databases (Web of Science, PubMed, PsyArXiv, and medRxiv). The risk of bias in individual studies will be assessed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. The heterogeneity of the studies will be assessed using the I2 statistic. The effect size (prevalence rates of anxiety) and a 95\% CI for each paper will also be calculated. We will use a moderator analysis to test for the effect of COVID-19 on health care workers' anxiety levels and detect publication bias in COVID-19 studies. We will also assess publication bias using the funnel plot and Egger regression. In case of publication bias, if studies have no homogeneity, the trim-and-fill procedure will be applied to adjust for missing studies. Results: Database searches will commence in November 2020. The meta-analysis will be completed within 2 months of the start date. Conclusions: This meta-analysis aims to provide comprehensive evidence about whether COVID-19 increases the prevalence of anxiety among health care workers and whether there has been an increase in publication bias and a deterioration in the quality of publications due to the pandemic. The results of this meta-analysis can provide evidence to help health managers to make informed decisions related to anxiety prevention in health care workers. International Registered Report Identifier (IRRID): PRR1-10.2196/24136 ",
doi="10.2196/24136",
url="http://www.researchprotocols.org/2020/11/e24136/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33170800"
}


@Article{info:doi/10.2196/23117,
author="Dominguez-Rodriguez, Alejandro
and De La Rosa-G{\'o}mez, Anabel
and Hern{\'a}ndez Jim{\'e}nez, Jes{\'u}s M.
and Arenas-Landgrave, Paulina
and Mart{\'i}nez-Luna, Cristina Sof{\'i}a
and Alvarez Silva, Joabian
and Garc{\'i}a Hern{\'a}ndez, Ernesto Jos{\'e}
and Arzola-S{\'a}nchez, Carlos
and Acosta Guzm{\'a}n, Victoria",
title="A Self-Administered Multicomponent Web-Based Mental Health Intervention for the Mexican Population During the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Nov",
day="16",
volume="9",
number="11",
pages="e23117",
keywords="e-health",
keywords="positive psychology",
keywords="cognitive behavioral therapy, behavioral activation therapy, COVID-19",
keywords="internet",
keywords="intervention",
keywords="telepsychology, Mexican sample",
abstract="Background: The COVID-19 pandemic has become a public health emergency of international concern; it has not only threatened people's physical health but has also affected their mental health and psychological well-being. It is necessary to develop and offer strategies to reduce the psychological impact of the outbreak and promote adaptive coping. Objective: This study protocol aims to describe a self-administered web-based intervention (Mental Health COVID-19) based on the principles of positive psychology supported by elements of cognitive behavioral therapy and behavioral activation therapy to reduce the symptoms of anxiety and depression and increase positive emotions and sleep quality during and after the COVID-19 outbreak through a telepsychology system. Methods: A randomized controlled clinical superiority trial with two independent groups will be performed, with intrasubject measures at four evaluation periods: pretest, posttest, 3-month follow-up, and 6-month follow-up. Participants will be randomly assigned to one of two groups: self-administered intervention with assistance via chat or self-administered intervention without assistance via chat. The total required sample size will be 166 participants (83 per group). Results: The clinical trial is ongoing. This protocol was approved by the Research Ethics Board of the Free School of Psychology-University of Behavioral Sciences (Escuela libre de Psicolog{\'i}a-Universidad de Ciencias del Comportamiento). The aim is to publish the preliminary results in December 2020. A conservative approach will be adopted, and the size effect will be estimated using the Cohen d index with a significance level ($\alpha$) of .05 (95\% reliability) and a conventional 80\% power statistic. Conclusions: The central mechanism of action will be to investigate the effectiveness of an intervention based on positive psychology through a web platform that can be delivered through computers and tablets, with content that has been rigorously contextualized to the Mexican culture to provide functional strategies to help the target users cope with the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/ct2/show/NCT04468893 International Registered Report Identifier (IRRID): DERR1-10.2196/23117 ",
doi="10.2196/23117",
url="http://www.researchprotocols.org/2020/11/e23117/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33196449"
}


@Article{info:doi/10.2196/22984,
author="Turkington, Robin
and Mulvenna, Maurice
and Bond, Raymond
and Ennis, Edel
and Potts, Courtney
and Moore, Ciaran
and Hamra, Louise
and Morrissey, Jacqui
and Isaksen, Mette
and Scowcroft, Elizabeth
and O'Neill, Siobhan",
title="Behavior of Callers to a Crisis Helpline Before and During the COVID-19 Pandemic: Quantitative Data Analysis",
journal="JMIR Ment Health",
year="2020",
month="Nov",
day="6",
volume="7",
number="11",
pages="e22984",
keywords="COVID-19",
keywords="coronavirus",
keywords="pandemic",
keywords="mental health",
keywords="crisis helplines",
keywords="machine learning",
keywords="clustering",
keywords="caller behavior",
abstract="Background: The World Health Organization declared the outbreak of COVID-19 to be an international pandemic in March 2020. While numbers of new confirmed cases of the disease and death tolls are rising at an alarming rate on a daily basis, there is concern that the pandemic and the measures taken to counteract it could cause an increase in distress among the public. Hence, there could be an increase in need for emotional support within the population, which is complicated further by the reduction of existing face-to-face mental health services as a result of measures taken to limit the spread of the virus. Objective: The objective of this study was to determine whether the COVID-19 pandemic has had any influence on the calls made to Samaritans Ireland, a national crisis helpline within the Republic of Ireland. Methods: This study presents an analysis of calls made to Samaritans Ireland in a four-week period before the first confirmed case of COVID-19 (calls=41,648, callers=3752) and calls made to the service within a four-week period after a restrictive lockdown was imposed by the government of the Republic of Ireland (calls=46,043, callers=3147). Statistical analysis was conducted to explore any differences between the duration of calls in the two periods at a global level and at an hourly level. We performed k-means clustering to determine the types of callers who used the helpline based on their helpline call usage behavior and to assess the impact of the pandemic on the caller type usage patterns. Results: The analysis revealed that calls were of a longer duration in the postlockdown period in comparison with the pre--COVID-19 period. There were changes in the behavior of individuals in the cluster types defined by caller behavior, where some caller types tended to make longer calls to the service in the postlockdown period. There were also changes in caller behavior patterns with regard to the time of day of the call; variations were observed in the duration of calls at particular times of day, where average call durations increased in the early hours of the morning. Conclusions: The results of this study highlight the impact of COVID-19 on a national crisis helpline service. Statistical differences were observed in caller behavior between the prelockdown and active lockdown periods. The findings suggest that service users relied on crisis helpline services more during the lockdown period due to an increased sense of isolation, worsening of underlying mental illness due to the pandemic, and reduction or overall removal of access to other support resources. Practical implications and limitations are discussed. ",
doi="10.2196/22984",
url="http://mental.jmir.org/2020/11/e22984/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33112759"
}


@Article{info:doi/10.2196/24361,
author="Xue, Jia
and Chen, Junxiang
and Chen, Chen
and Hu, Ran
and Zhu, Tingshao",
title="The Hidden Pandemic of Family Violence During COVID-19: Unsupervised Learning of Tweets",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="6",
volume="22",
number="11",
pages="e24361",
keywords="Twitter",
keywords="family violence",
keywords="COVID-19",
keywords="machine learning",
keywords="big data",
keywords="infodemiology",
keywords="infoveillance",
abstract="Background: Family violence (including intimate partner violence/domestic violence, child abuse, and elder abuse) is a hidden pandemic happening alongside COVID-19. The rates of family violence are rising fast, and women and children are disproportionately affected and vulnerable during this time. Objective: This study aims to provide a large-scale analysis of public discourse on family violence and the COVID-19 pandemic on Twitter. Methods: We analyzed over 1 million tweets related to family violence and COVID-19 from April 12 to July 16, 2020. We used the machine learning approach Latent Dirichlet Allocation and identified salient themes, topics, and representative tweets. Results: We extracted 9 themes from 1,015,874 tweets on family violence and the COVID-19 pandemic: (1) increased vulnerability: COVID-19 and family violence (eg, rising rates, increases in hotline calls, homicide); (2) types of family violence (eg, child abuse, domestic violence, sexual abuse); (3) forms of family violence (eg, physical aggression, coercive control); (4) risk factors linked to family violence (eg, alcohol abuse, financial constraints, guns, quarantine); (5) victims of family violence (eg, the LGBTQ [lesbian, gay, bisexual, transgender, and queer or questioning] community, women, women of color, children); (6) social services for family violence (eg, hotlines, social workers, confidential services, shelters, funding); (7) law enforcement response (eg, 911 calls, police arrest, protective orders, abuse reports); (8) social movements and awareness (eg, support victims, raise awareness); and (9) domestic violence--related news (eg, Tara Reade, Melissa DeRosa). Conclusions: This study overcomes limitations in the existing scholarship where data on the consequences of COVID-19 on family violence are lacking. We contribute to understanding family violence during the pandemic by providing surveillance via tweets. This is essential for identifying potentially useful policy programs that can offer targeted support for victims and survivors as we prepare for future outbreaks. ",
doi="10.2196/24361",
url="http://www.jmir.org/2020/11/e24361/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33108315"
}


@Article{info:doi/10.2196/22287,
author="Shah, Sarwar Syed Ghulam
and Nogueras, David
and van Woerden, Cornelis Hugo
and Kiparoglou, Vasiliki",
title="The COVID-19 Pandemic: A Pandemic of Lockdown Loneliness and the Role of Digital Technology",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="5",
volume="22",
number="11",
pages="e22287",
keywords="COVID-19",
keywords="coronavirus",
keywords="pandemic",
keywords="social isolation",
keywords="loneliness",
keywords="lockdown",
keywords="social distancing",
keywords="digital technology",
keywords="social connectedness",
keywords="social networking",
keywords="online digital tools",
doi="10.2196/22287",
url="http://www.jmir.org/2020/11/e22287/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33108313"
}


@Article{info:doi/10.2196/22835,
author="De Boni, Brandini Raquel
and Balanz{\'a}-Mart{\'i}nez, Vicent
and Mota, Correa Jurema
and Cardoso, Azevedo Taiane De
and Ballester, Pedro
and Atienza-Carbonell, Beatriz
and Bastos, I. Francisco
and Kapczinski, Flavio",
title="Depression, Anxiety, and Lifestyle Among Essential Workers: A Web Survey From Brazil and Spain During the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="30",
volume="22",
number="10",
pages="e22835",
keywords="COVID-19",
keywords="depression",
keywords="anxiety",
keywords="lifestyle",
keywords="Brazil",
keywords="Spain",
abstract="Background: Essential workers have been shown to present a higher prevalence of positive screenings for anxiety and depression during the COVID-19 pandemic. Individuals from countries with socioeconomic inequalities may be at increased risk for mental health disorders. Objective: We aimed to assess the prevalence and predictors of depression, anxiety, and their comorbidity among essential workers in Brazil and Spain during the COVID-19 pandemic. Methods: A web survey was conducted between April and May 2020 in both countries. The main outcome was a positive screening for depression only, anxiety only, or both. Lifestyle was measured using a lifestyle multidimensional scale adapted for the COVID-19 pandemic (Short Multidimensional Inventory Lifestyle Evaluation--Confinement). A multinomial logistic regression model was performed to evaluate the factors associated with depression, anxiety, and the presence of both conditions. Results: From the 22,786 individuals included in the web survey, 3745 self-reported to be essential workers. Overall, 8.3\% (n=311), 11.6\% (n=434), and 27.4\% (n=1027) presented positive screenings for depression, anxiety, and both, respectively. After adjusting for confounding factors, the multinomial model showed that an unhealthy lifestyle increased the likelihood of depression (adjusted odds ratio [AOR] 4.00, 95\% CI 2.72-5.87), anxiety (AOR 2.39, 95\% CI 1.80-3.20), and both anxiety and depression (AOR 8.30, 95\% CI 5.90-11.7). Living in Brazil was associated with increased odds of depression (AOR 2.89, 95\% CI 2.07-4.06), anxiety (AOR 2.81, 95\%CI 2.11-3.74), and both conditions (AOR 5.99, 95\% CI 4.53-7.91). Conclusions: Interventions addressing lifestyle may be useful in dealing with symptoms of common mental disorders during the strain imposed among essential workers by the COVID-19 pandemic. Essential workers who live in middle-income countries with higher rates of inequality may face additional challenges. Ensuring equitable treatment and support may be an important challenge ahead, considering the possible syndemic effect of the social determinants of health. ",
doi="10.2196/22835",
url="http://www.jmir.org/2020/10/e22835/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33038075"
}


@Article{info:doi/10.2196/21814,
author="Hsu, Michael
and Ahern, K. David
and Suzuki, Joji",
title="Digital Phenotyping to Enhance Substance Use Treatment During the COVID-19 Pandemic",
journal="JMIR Ment Health",
year="2020",
month="Oct",
day="26",
volume="7",
number="10",
pages="e21814",
keywords="digital phenotyping",
keywords="digital psychiatry",
keywords="addiction",
keywords="psychiatry",
keywords="coronavirus",
keywords="COVID-19",
keywords="digital health",
keywords="treatment",
keywords="drugs",
keywords="substance use disorder",
doi="10.2196/21814",
url="http://mental.jmir.org/2020/10/e21814/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33031044"
}


@Article{info:doi/10.2196/22043,
author="Jewell, S. Jennifer
and Farewell, V. Charlotte
and Welton-Mitchell, Courtney
and Lee-Winn, Angela
and Walls, Jessica
and Leiferman, A. Jenn",
title="Mental Health During the COVID-19 Pandemic in the United States: Online Survey",
journal="JMIR Form Res",
year="2020",
month="Oct",
day="23",
volume="4",
number="10",
pages="e22043",
keywords="COVID-19",
keywords="mental health",
keywords="pandemic",
keywords="depression",
keywords="anxiety",
keywords="well-being",
keywords="stress",
abstract="Background: The COVID-19 pandemic has had numerous worldwide effects. In the United States, there have been 8.3 million cases and nearly 222,000 deaths as of October 21, 2020. Based on previous studies of mental health during outbreaks, the mental health of the population will be negatively affected in the aftermath of this pandemic. The long-term nature of this pandemic may lead to unforeseen mental health outcomes and/or unexpected relationships between demographic factors and mental health outcomes. Objective: This research focused on assessing the mental health status of adults in the United States during the early weeks of an unfolding pandemic. Methods: Data was collected from English-speaking adults from early April to early June 2020 using an online survey. The final convenience sample included 1083 US residents. The 71-item survey consisted of demographic questions, mental health and well-being measures, a coping mechanisms checklist, and questions about COVID-19--specific concerns. Hierarchical multivariable logistic regression was used to explore associations among demographic variables and mental health outcomes. Hierarchical linear regression was conducted to examine associations among demographic variables, COVID-19--specific concerns, and mental health and well-being outcomes. Results: Approximately 50\% (536/1076) of the US sample was aged ?45 years. Most of the sample was White (1013/1054, 96\%), non-Hispanic (985/1058, 93\%), and female (884/1073, 82\%). Participants reported high rates of depression (295/1034, 29\%), anxiety (342/1007, 34\%), and stress (773/1058, 73\%). Older individuals were less likely to report depressive symptomology (OR 0.78, P<.001) and anxiety symptomology (OR 0.72, P<.001); in addition, they had lower stress scores (--0.15 points, SE 0.01, P<.001) and increased well-being scores (1.86 points, SE 0.22, P<.001). Individuals who were no longer working due to COVID-19 were 2.25 times more likely to report symptoms of depression (P=.02), had a 0.51-point increase in stress (SE 0.17, P=.02), and a 3.9-point decrease in well-being scores (SE 1.49, P=.009) compared to individuals who were working remotely before and after COVID-19. Individuals who had partial or no insurance coverage were 2-3 times more likely to report depressive symptomology compared to individuals with full coverage (P=.02 and P=.01, respectively). Individuals who were on Medicare/Medicaid and individuals with no coverage were 1.97 and 4.48 times more likely to report moderate or severe anxiety, respectively (P=.03 and P=.01, respectively). Financial and food access concerns were significantly and positively related to depression, anxiety, and stress (all P<.05), and significantly negatively related to well-being (both P<.001). Economy, illness, and death concerns were significantly positively related to overall stress scores (all P<.05). Conclusions: Our findings suggest that many US residents are experiencing high stress, depressive, and anxiety symptomatology, especially those who are underinsured, uninsured, or unemployed. Longitudinal investigation of these variables is recommended. Health practitioners may provide opportunities to allay concerns or offer coping techniques to individuals in need of mental health care. These messages should be shared in person and through practice websites and social media. ",
doi="10.2196/22043",
url="http://formative.jmir.org/2020/10/e22043/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006939"
}


@Article{info:doi/10.2196/23463,
author="Stull, W. Samuel
and McKnight, R. Erin
and Bonny, E. Andrea",
title="Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward?",
journal="JMIR Pediatr Parent",
year="2020",
month="Oct",
day="9",
volume="3",
number="2",
pages="e23463",
keywords="adolescent",
keywords="opioid use disorder",
keywords="treatment",
keywords="telehealth",
keywords="drug",
keywords="perspective",
keywords="opioid",
keywords="COVID-19",
keywords="young adult",
doi="10.2196/23463",
url="http://pediatrics.jmir.org/2020/2/e23463/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33016885"
}


@Article{info:doi/10.2196/22596,
author="Pan, Yihang
and Xin, Meiqi
and Zhang, Changhua
and Dong, Willa
and Fang, Yuan
and Wu, Wenhui
and Li, Mingzhe
and Pang, Jun
and Zheng, Zilong
and Wang, Zixin
and Yuan, Jinqiu
and He, Yulong",
title="Associations of Mental Health and Personal Preventive Measure Compliance With Exposure to COVID-19 Information During Work Resumption Following the COVID-19 Outbreak in China: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="8",
volume="22",
number="10",
pages="e22596",
keywords="COVID-19",
keywords="information exposure",
keywords="risk",
keywords="communication",
keywords="mental health",
keywords="personal preventive measures",
keywords="China",
keywords="cross-sectional",
keywords="public health",
keywords="prevention",
abstract="Background: Risk and crisis communication plays an essential role in public health emergency responses. The COVID-19 pandemic has triggered spontaneous and intensive media attention, which has affected people's adoption of personal preventive measures and their mental health. Objective: The aim of this study was to investigate the associations between exposure to COVID-19--specific information and mental health (depression and sleep quality) and self-reported compliance with personal preventive measures (face mask wearing and hand sanitizing). We also tested whether these associations were moderated by thoughtful consideration of the veracity of the information to which people were exposed. Methods: A cross-sectional, closed web-based survey was conducted among a sample of 3035 factory workers at the beginning of work resumption following the COVID-19 outbreak in Shenzhen, China. A stratified two-stage cluster sampling design was used for recruitment. Multivariate linear and logistic regression models were used for the analyses. Results: The prevalence of probable moderate-to-severe depression was 170/3035 (5.6\%), while that of good or excellent sleep quality was 2110/3035 (69.5\%). The prevalence of self-reported consistent face mask wearing in public places was 2903/3035 (95.7\%), while that of sanitizing hands every time after returning from public spaces or touching public installations was 2151/3035 (70.9\%). Of the 3035 respondents, 1013 to 1638 (33.3\% to 54.0\%) reported >1 hour of daily exposure to COVID-19--specific information through web-based media and television. After controlling for significant background variables, higher information exposure via television and via newspapers and magazines was associated with better sleep quality and higher compliance with hand sanitizing. Higher exposure via unofficial web-based media was associated with higher compliance with hand sanitizing but was also associated with higher depressive symptoms. In contrast, higher exposure through face-to-face communication was associated with higher depressive symptoms, worse sleep quality, and lower compliance with hand sanitizing. Exposure to information about positive outcomes for patients with COVID-19, development of vaccines and effective treatments, and heroic stories about frontline health care workers were associated with both better mental health and higher compliance with preventive measures. Higher overall information exposure was associated with higher depressive symptoms among participants who were less likely to carefully consider the veracity of the information to which they were exposed; it was also associated with better sleep quality among people who reported more thoughtful consideration of information veracity. Conclusions: This study provides empirical evidence of how the amount, sources, and contents of information to which people were exposed influenced their mental health and compliance with personal preventive measures at the initial phase of work resumption in China. Thoughtful consideration of information quality was found to play an important moderating role. Our findings may inform strategic risk communication by government and public health authorities during the COVID-19 pandemic. ",
doi="10.2196/22596",
url="http://www.jmir.org/2020/10/e22596/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32936776"
}


@Article{info:doi/10.2196/21344,
author="Bierbooms, A. Joyce J. P.
and van Haaren, Monique
and IJsselsteijn, A. Wijnand
and de Kort, W. Yvonne A.
and Feijt, Milou
and Bongers, B. Inge M.",
title="Integration of Online Treatment Into the ``New Normal'' in Mental Health Care in Post--COVID-19 Times: Exploratory Qualitative Study",
journal="JMIR Form Res",
year="2020",
month="Oct",
day="8",
volume="4",
number="10",
pages="e21344",
keywords="online treatment",
keywords="sustainability",
keywords="mental health care",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic has necessitated an immediate and large-scale uptake of online treatment for mental health care. However, there is uncertainty about what the ``new normal'' in mental health care will be like in post--COVID-19 times. To what extent will the experiences gained during the pandemic influence a sustainable adoption and implementation of online mental health care treatment in the future? Objective: In this paper, we aim to formulate expectations with regard to the sustainability of online mental health care after COVID-19. Methods: In an interview study, 11 mental health care professionals were asked about their experiences and expectations for the future. Participants were recruited from a mental health care organization in the Netherlands. The interviews took place between April 7-30, 2020, at the peak of the COVID-19 crisis in the Netherlands. The data were analyzed using a thematic coding method. Results: From the interviews, we learn that the new normal in mental health care will most likely consist of more blended treatments. Due to skill enhancement and (unexpected) positive experiences with online treatment, an increase in adoption is likely to take place. However, not all experiences promise a successful and sustainable upscaling of online treatment in the future. Mental health care professionals are learning that not all clients are able to benefit from this type of treatment. Conclusions: Sustainable upscaling of online mental health care requires customized solutions, investments in technology, and flexibility of mental health care providers. Online treatment could work for those who are open to it, but many factors influence whether it will work in specific situations. There is work to be done before online treatment is inherently part of mental health care. ",
doi="10.2196/21344",
url="http://formative.jmir.org/2020/10/e21344/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33001835"
}


@Article{info:doi/10.2196/23716,
author="Serlachius, Anna
and Schache, Kiralee
and Boggiss, Anna
and Lim, David
and Wallace-Boyd, Kate
and Brenton-Peters, Jennifer
and Buttenshaw, Elise
and Chadd, Stephanie
and Cavadino, Alana
and Cao, Nicholas
and Morunga, Eva
and Thabrew, Hiran",
title="Coping Skills Mobile App to Support the Emotional Well-Being of Young People During the COVID-19 Pandemic: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2020",
month="Oct",
day="8",
volume="9",
number="10",
pages="e23716",
keywords="COVID-19",
keywords="pandemic",
keywords="mental health",
keywords="mobile applications",
keywords="apps",
keywords="mHealth",
keywords="coping skills",
keywords="wellbeing",
keywords="adolescent",
keywords="young adult",
keywords="coping",
abstract="Background: The COVID-19 pandemic is likely to increase anxiety and distress in young people worldwide. It is important to prioritize mental health during crisis events to mitigate the negative and often long-term effects of the crises on young people, families, and society. Mental health and well-being apps represent a scalable approach for improving psychological outcomes in young people and have potential to improve the equity of service access. Objective: The Whitu: 7 Ways in 7 Days well-being app was recently developed by our group to address the urgent need for innovative approaches to reach young New Zealanders who are struggling to cope with the COVID-19 pandemic. The aim of this study is twofold: to evaluate the acceptability of the prototype app and to examine the effectiveness of the refined app at improving mental and emotional well-being and reducing depression, anxiety, and stress in young people in New Zealand. Methods: A two-phase mixed methods study will be undertaken to achieve these aims. During the first phase, 20 young people aged 16-30 years (including those of M?ori and Pacific ethnicity) will participate in a qualitative study to help refine the prototype app. During the second phase, 90 young people aged 16-30 years will participate in a randomized waitlist-controlled trial (RCT) to evaluate the efficacy of the refined Whitu app at 4 weeks and 3 months after baseline. Outcomes will be evaluated using validated web-based questionnaires at baseline, 4 weeks, and 3 months. Results: The study received ethics approval in May 2020, and recruitment for the focus groups commenced in June 2020. Recruitment for the RCT is expected to commence in October 2020. Participants for both study phases will be recruited via social media and web-based communities. Data collection for the RCT is expected to be completed by January 2021, and analyses are expected to be completed by March 2021. Linear mixed modelling will be used to determine between-group differences in psychological outcomes. Conclusions: There is an urgent need to develop culturally appropriate, scalable mental health interventions to address the psychological consequences of the COVID-19 pandemic. In this study, we will develop and test an evidence-based well-being app that, if effective, can be made available to all young people in New Zealand and internationally. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12620000516987); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379597. International Registered Report Identifier (IRRID): PRR1-10.2196/23716 ",
doi="10.2196/23716",
url="https://www.researchprotocols.org/2020/10/e23716",
url="http://www.ncbi.nlm.nih.gov/pubmed/32991303"
}


@Article{info:doi/10.2196/21301,
author="Deng, Cheng-Hu
and Wang, Jing-Qiang
and Zhu, Li-Ming
and Liu, He-Wang
and Guo, Yu
and Peng, Xue-Hua
and Shao, Jian-Bo
and Xia, Wei",
title="Association of Web-Based Physical Education With Mental Health of College Students in Wuhan During the COVID-19 Outbreak: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="5",
volume="22",
number="10",
pages="e21301",
keywords="COVID-19",
keywords="college students",
keywords="mental status",
keywords="physical education",
keywords="young adults",
keywords="web-based education",
keywords="global health",
keywords="web-based survey",
keywords="physical activity",
keywords="mental health",
abstract="Background: The COVID-19 outbreak has affected people's health worldwide. For college students, web-based physical education is a challenge, as these course are normally offered outdoors. Objective: The aim of this study was to use data from a web-based survey to evaluate the relationship between the mental health status of college students and their sports-related lifestyles. Problems related to web-based physical education were also examined. Methods: A web-based survey was conducted by snowball sampling from May 8 to 11, 2020. Demographic data, mental health status, and sports-related lifestyles of college students in Wuhan as well as issues related to web-based physical education were collected. Mental health status was assessed by the Depression, Anxiety, and Stress Scale (DASS-21). Results: The study included 1607 respondents from 267 cities. The average scores of the DASS-21 subscales (2.46 for depression, 1.48 for anxiety, and 2.59 for stress) were significantly lower in our study than in a previous study (P<.05). Lower DASS-21 scores were significantly correlated with regular exercise, maintaining exercise habits during the outbreak of COVID-19, exercising more than 1 to 2 times a week, exercise duration >1 hour, and >2000 pedometer steps (all P<.05). None of the three forms of web-based physical education was preferred by more than 50\% of respondents. Frequent technical problems were confronted by 1087/1607 students (67.6\%). Shape-up exercises (846/1607, 52.6\%), a designed combination of exercises (710/1607, 44.2\%), and Chinese kung fu (559/1607, 34.8\%) were suggested sports for web-based physical education. Conclusions: Mental status was significantly correlated with regular exercise and sufficient exercise duration. Professional physical guidance is needed for college students in selected sports. Exercises not meeting students' preferences, frequent technical problems, and the distant interaction involved in web-based physical education were the main problems that should be solved in future. ",
doi="10.2196/21301",
url="http://www.jmir.org/2020/10/e21301/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32997639"
}


@Article{info:doi/10.2196/22523,
author="Sasangohar, Farzan
and Bradshaw, R. Major
and Carlson, Millen Marianne
and Flack, N. James
and Fowler, C. James
and Freeland, Diana
and Head, John
and Marder, Kate
and Orme, William
and Weinstein, Benjamin
and Kolman, M. Jacob
and Kash, Bita
and Madan, Alok",
title="Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="1",
volume="22",
number="10",
pages="e22523",
keywords="telemedicine",
keywords="psychiatry",
keywords="preventive psychiatry",
keywords="SARS virus",
keywords="pandemic",
keywords="prevention",
keywords="COVID-19",
keywords="telehealth",
keywords="perspective",
doi="10.2196/22523",
url="https://www.jmir.org/2020/10/e22523",
url="http://www.ncbi.nlm.nih.gov/pubmed/32936768"
}


@Article{info:doi/10.2196/21237,
author="Reilly, E. Shannon
and Zane, L. Katherine
and McCuddy, T. William
and Soulliard, A. Zachary
and Scarisbrick, M. David
and Miller, E. Liv
and Mahoney III, J. James",
title="Mental Health Practitioners' Immediate Practical Response During the COVID-19 Pandemic: Observational Questionnaire Study",
journal="JMIR Ment Health",
year="2020",
month="Oct",
day="1",
volume="7",
number="9",
pages="e21237",
keywords="COVID-19",
keywords="clinical practice",
keywords="tele--mental health",
keywords="mental health",
keywords="survey",
abstract="Background: The COVID-19 pandemic has been associated with increased psychological distress, signaling the need for increased mental health services in the context of stay-at-home policies. Objective: This study aims to characterize how mental health practitioners have changed their practices during the pandemic. The authors hypothesize that mental health practitioners would increase tele--mental health services and that certain provider types would be better able to adapt to tele--mental health than others. Methods: The study surveyed 903 practitioners, primarily psychologists/doctoral-level (Psych/DL) providers, social workers/master's-level (SW/ML) providers, and neuropsychologists employed in academic medical centers or private practices. Differences among providers were examined using Bonferroni-adjusted chi-square tests and one-way Bonferroni-adjusted analyses of covariance. Results: The majority of the 903 mental health practitioners surveyed rapidly adjusted their practices, predominantly by shifting to tele--mental health appointments (n=729, 80.82\%). Whereas 80.44\% (n=625) were not using tele--mental health in December 2019, only 22.07\% (n=188) were not by late March or early April 2020. Only 2.11\% (n=19) reported no COVID-19--related practice adjustments. Two-thirds (596/888, 67.10\%) reported providing additional therapeutic services specifically to treat COVID-19--related concerns. Neuropsychologists were less likely and Psych/DL providers and SW/ML providers were more likely than expected to transition to tele--mental health (P<.001). Trainees saw fewer patients (P=.01) and worked remotely more than licensed practitioners (P=.03). Despite lower rates of information technology service access (P<.001), private practice providers reported less difficulty implementing tele--mental health than providers in other settings (P<.001). Overall, the majority (530/889, 59.62\%) were interested in continuing to provide tele--mental health services in the future. Conclusions: The vast majority of mental health providers in this study made practice adjustments in response to COVID-19, predominantly by rapidly transitioning to tele--mental health services. Although the majority reported providing additional therapeutic services specifically to treat COVID-19--related concerns, only a small subset endorsed offering such services to medical providers. This has implications for future practical directions, as frontline workers may begin to seek mental health treatment related to the pandemic. Despite differences in tele--mental health uptake based on provider characteristics, the majority were interested in continuing to provide such services in the future. This may help to expand clinical services to those in need via tele--mental health beyond the COVID-19 pandemic. ",
doi="10.2196/21237",
url="https://mental.jmir.org/2020/10/e21237/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32931440"
}


@Article{info:doi/10.2196/22767,
author="Tsai, Jiun-Yi
and Phua, Joe
and Pan, Shuya
and Yang, Chia-chen",
title="Intergroup Contact, COVID-19 News Consumption, and the Moderating Role of Digital Media Trust on Prejudice Toward Asians in the United States: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="25",
volume="22",
number="9",
pages="e22767",
keywords="COVID-19",
keywords="prejudice",
keywords="news exposure",
keywords="news trust",
keywords="infodemic",
keywords="media bias",
keywords="racism",
keywords="social media use",
keywords="intergroup contact",
keywords="regression",
keywords="moderation analysis",
keywords="cross-sectional survey",
abstract="Background: The perceived threat of a contagious virus may lead people to be distrustful of immigrants and out-groups. Since the COVID-19 outbreak, the salient politicized discourses of blaming Chinese people for spreading the virus have fueled over 2000 reports of anti-Asian racial incidents and hate crimes in the United States. Objective: The study aims to investigate the relationships between news consumption, trust, intergroup contact, and prejudicial attitudes toward Asians and Asian Americans residing in the United States during the COVID-19 pandemic. We compare how traditional news, social media use, and biased news exposure cultivate racial attitudes, and the moderating role of media use and trust on prejudice against Asians is examined. Methods: A cross-sectional study was completed in May 2020. A total of 430 US adults (mean age 36.75, SD 11.49 years; n=258, 60\% male) participated in an online survey through Amazon's Mechanical Turk platform. Respondents answered questions related to traditional news exposure, social media use, perceived trust, and their top three news channels for staying informed about the novel coronavirus. In addition, intergroup contact and racial attitudes toward Asians were assessed. We performed hierarchical regression analyses to test the associations. Moderation effects were estimated using simple slopes testing with a 95\% bootstrap confidence interval approach. Results: Participants who identified as conservatives ($\beta$=.08, P=.02), had a personal infection history ($\beta$=.10, P=.004), and interacted with Asian people frequently in their daily lives ($\beta$=.46, P<.001) reported more negative attitudes toward Asians after controlling for sociodemographic variables. Relying more on traditional news media ($\beta$=.08, P=.04) and higher levels of trust in social media ($\beta$=.13, P=.007) were positively associated with prejudice against Asians. In contrast, consuming news from left-leaning outlets ($\beta$=--.15, P=.001) and neutral outlets ($\beta$=--.13, P=.003) was linked to less prejudicial attitudes toward Asians. Among those who had high trust in social media, exposure had a negative relationship with prejudice. At high levels of trust in digital websites and apps, frequent use was related to less unfavorable attitudes toward Asians. Conclusions: Experiencing racial prejudice among the Asian population during a challenging pandemic can cause poor psychological outcomes and exacerbate health disparities. The results suggest that conservative ideology, personal infection history, frequency of intergroup contact, traditional news exposure, and trust in social media emerge as positive predictors of prejudice against Asians and Asian Americans, whereas people who get COVID-19 news from left-leaning and balanced outlets show less prejudice. For those who have more trust in social media and digital news, frequent use of these two sources is associated with lower levels of prejudice. Our findings highlight the need to reshape traditional news discourses and use social media and mobile news apps to develop credible messages for combating racial prejudice against Asians. ",
doi="10.2196/22767",
url="http://www.jmir.org/2020/9/e22767/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32924948"
}


@Article{info:doi/10.2196/22142,
author="Liu, J. Jean C.
and Tong, W. Eddie M.",
title="The Relation Between Official WhatsApp-Distributed COVID-19 News Exposure and Psychological Symptoms: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="25",
volume="22",
number="9",
pages="e22142",
keywords="mental health",
keywords="social media",
keywords="pandemic",
keywords="depression",
keywords="anxiety",
keywords="stress",
keywords="COVID-19",
keywords="app",
keywords="risk factor",
keywords="psychology",
abstract="Background: In a global pandemic, digital technology offers innovative methods to disseminate public health messages. As an example, the messenger app WhatsApp was adopted by both the World Health Organization and government agencies to provide updates on the coronavirus disease (COVID-19). During a time when rumors and excessive news threaten psychological well-being, these services allow for rapid transmission of information and may boost resilience. Objective: In this study, we sought to accomplish the following: (1) assess well-being during the pandemic; (2) replicate prior findings linking exposure to COVID-19 news with psychological distress; and (3) examine whether subscription to an official WhatsApp channel can mitigate this risk. Methods: Across 8 weeks of the COVID-19 outbreak (March 7 to April 21, 2020), we conducted a survey of 1145 adults in Singapore. As the primary outcome measure, participants completed the Depression, Anxiety, and Stress Scale (DASS-21). As predictor variables, participants also answered questions pertaining to the following: (1) their exposure to COVID-19 news; (2) their use of the Singapore government's WhatsApp channel; and (3) their demographics. Results: Within the sample, 7.9\% of participants had severe or extremely severe symptoms on at least one DASS-21 subscale. Depression scores were associated with increased time spent receiving COVID-19 updates, whereas use of the official WhatsApp channel emerged as a protective factor (b=--0.07, t[863]=--2.04, P=.04). Similarly, increased anxiety scores were associated with increased exposure to both updates and rumors, but this risk was mitigated by trust in the government's WhatsApp messages (b=--0.05, t[863]=--2.13, P=.03). Finally, although stress symptoms increased with the amount of time spent receiving updates, these symptoms were not significantly related to WhatsApp use. Conclusions: Our findings suggest that messenger apps may be an effective medium for disseminating pandemic-related information, allowing official agencies to reach a broad sector of the population rapidly. In turn, this use may promote public well-being amid an ``infodemic.'' Trial Registration: ClinicalTrials.gov NCT04305574; https://clinicaltrials.gov/ct2/show/NCT04305574 ",
doi="10.2196/22142",
url="http://www.jmir.org/2020/9/e22142/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32877349"
}


@Article{info:doi/10.2196/22408,
author="Mrklas, Kelly
and Shalaby, Reham
and Hrabok, Marianne
and Gusnowski, April
and Vuong, Wesley
and Surood, Shireen
and Urichuk, Liana
and Li, Daniel
and Li, Xin-Min
and Greenshaw, James Andrew
and Agyapong, Opoku Vincent Israel",
title="Prevalence of Perceived Stress, Anxiety, Depression, and Obsessive-Compulsive Symptoms in Health Care Workers and Other Workers in Alberta During the COVID-19 Pandemic: Cross-Sectional Survey",
journal="JMIR Ment Health",
year="2020",
month="Sep",
day="25",
volume="7",
number="9",
pages="e22408",
keywords="health care worker",
keywords="COVID-19",
keywords="pandemic",
keywords="mental health",
keywords="depression",
keywords="anxiety",
keywords="stress",
keywords="obsessive compulsive",
abstract="Background: During pandemics, effective containment and mitigation measures may also negatively influence psychological stability. As knowledge about COVID-19 rapidly evolves, global implementation of containment and mitigation measures has varied greatly, with impacts to mental wellness. Assessing the impact of COVID-19 on the mental health needs of health care workers and other workers may help mitigate mental health impacts and secure sustained delivery of health care and other essential goods and services. Objective: This study assessed the self-reported prevalence of stress, anxiety, depression, and obsessive-compulsive symptoms in health care workers and other workers seeking support through Text4Hope, an evidence-based SMS text messaging service supporting the mental health of residents of Alberta, Canada, during the COVID-19 pandemic. Methods: An online cross-sectional survey gathered demographic (age, gender, ethnicity, education, relationship, housing and employment status, employment type, and isolation status) and clinical characteristics using validated tools (self-reported stress, anxiety, depression, and contamination/hand hygiene obsessive-compulsive symptoms). Descriptive statistics and chi-square analysis were used to compare the clinical characteristics of health care workers and other workers. Post hoc analysis was conducted on variables with >3 response categories using adjusted residuals. Logistic regression determined associations between worker type and likelihood of self-reported symptoms of moderate or high stress, generalized anxiety disorder, and major depressive disorder, while controlling for other variables. Results: Overall, 8267 surveys were submitted by 44,992 Text4Hope subscribers (19.39\%). Of these, 5990 respondents were employed (72.5\%), 958 (11.6\%) were unemployed, 454 (5.5\%) were students, 559 (6.8\%) were retired, 234 (2.8\%) selected ``other,'' and 72 (0.9\%) did not indicate their employment status. Most employed survey respondents were female (n=4621, 86.2\%). In the general sample, the 6-week prevalence rates for moderate or high stress, anxiety, and depression symptoms were 85.6\%, 47.0\%, and 44.0\%, respectively. Self-reported symptoms of moderate or high stress, anxiety, and depression were all statistically significantly higher in other workers than in health care workers (P<.001). Other workers reported higher obsessive-compulsive symptoms (worry about contamination and compulsive handwashing behavior) after the onset of the pandemic (P<.001), while health care worker symptoms were statistically significantly higher before and during the COVID-19 pandemic (P<.001). This finding should be interpreted with caution, as it is unclear the extent to which the adaptive behavior of health care workers or the other workers might be misclassified by validated tools during a pandemic. Conclusions: Assessing symptoms of prevalent stress, anxiety, depression, and obsessive-compulsive behavior in health care workers and other workers may enhance our understanding of COVID-19 mental health needs. Research is needed to understand more fully the relationship between worker type, outbreak phase, and mental health changes over time, as well as the utility of validated tools in health care workers and other workers during pandemics. Our findings underscore the importance of anticipating and mitigating the mental health effects of pandemics using integrated implementation strategies. Finally, we demonstrate the ease of safely and rapidly assessing mental health needs using an SMS text messaging platform during a pandemic. International Registered Report Identifier (IRRID): RR2-10.2196/19292 ",
doi="10.2196/22408",
url="http://mental.jmir.org/2020/9/e22408/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32915764"
}


@Article{info:doi/10.2196/23153,
author="Clavier, Thomas
and Popoff, Benjamin
and Selim, Jean
and Beuzelin, Marion
and Roussel, Melanie
and Compere, Vincent
and Veber, Benoit
and Besnier, Emmanuel",
title="Association of Social Network Use With Increased Anxiety Related to the COVID-19 Pandemic in Anesthesiology, Intensive Care, and Emergency Medicine Teams: Cross-Sectional Web-Based Survey Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="24",
volume="8",
number="9",
pages="e23153",
keywords="social network",
keywords="nurse",
keywords="physician",
keywords="anxiety",
keywords="emergency medicine, anesthesiology, critical care medicine",
keywords="coronavirus disease 2019",
keywords="mental health",
keywords="COVID-19",
abstract="Background: Critical care teams are on the front line of managing the COVID-19 pandemic, which is stressful for members of these teams. Objective: Our objective was to assess whether the use of social networks is associated with increased anxiety related to the COVID-19 pandemic among members of critical care teams. Methods: We distributed a web-based survey to physicians, residents, registered and auxiliary nurses, and nurse anesthetists providing critical care (anesthesiology, intensive care, or emergency medicine) in several French hospitals. The survey evaluated the respondents' use of social networks, their sources of information on COVID-19, and their levels of anxiety and information regarding COVID-19 on analog scales from 0 to 10. Results: We included 641 respondents in the final analysis; 553 (86.3\%) used social networks, spending a median time of 60 minutes (IQR 30-90) per day on these networks. COVID-19--related anxiety was higher in social network users than in health care workers who did not use these networks (median 6, IQR 5-8 vs median 5, IQR 3-7) in univariate (P=.02) and multivariate (P<.001) analyses, with an average anxiety increase of 10\% in social network users. Anxiety was higher among health care workers using social networks to obtain information on COVID-19 than among those using other sources (median 6, IQR 5-8 vs median 6, IQR 4-7; P=.04). Social network users considered that they were less informed about COVID-19 than those who did not use social networks (median 8, IQR 7-9 vs median 7, IQR 6-8; P<.01). Conclusions: Our results suggest that social networks contribute to increased anxiety in critical care teams. To protect their mental health, critical care professionals should consider limiting their use of these networks during the COVID-19 pandemic. ",
doi="10.2196/23153",
url="http://mhealth.jmir.org/2020/9/e23153/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32924946"
}


@Article{info:doi/10.2196/22181,
author="Lin, Yu-Hsuan
and Chiang, Ting-Wei
and Lin, Yu-Lun",
title="Increased Internet Searches for Insomnia as an Indicator of Global Mental Health During the COVID-19 Pandemic: Multinational Longitudinal Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="21",
volume="22",
number="9",
pages="e22181",
keywords="internet search",
keywords="Google Trends",
keywords="infodemiology",
keywords="infoveillance",
keywords="COVID-19",
keywords="insomnia",
keywords="mental health",
abstract="Background: Real-time global mental health surveillance is urgently needed for tracking the long-term impact of the COVID-19 pandemic. Objective: This study aimed to use Google Trends data to investigate the impact of the pandemic on global mental health by analyzing three keywords indicative of mental distress: ``insomnia,'' ``depression,'' and ``suicide.'' Methods: We examined increases in search queries for 19 countries. Significant increases were defined as the actual daily search value (from March 20 to April 19, 2020) being higher than the 95\% CIs of the forecast from the 3-month baseline via ARIMA (autoregressive integrated moving average) modeling. We examined the correlation between increases in COVID-19--related deaths and the number of days with significant increases in search volumes for insomnia, depression, and suicide across multiple nations. Results: The countries with the greatest increases in searches for insomnia were Iran, Spain, the United States, and Italy; these countries exhibited a significant increase in insomnia searches on more than 10 of the 31 days observed. The number of COVID-19--related deaths was positively correlated to the number of days with an increase in searches for insomnia in the 19 countries ($\rho$=0.64, P=.003). By contrast, there was no significant correlation between the number of deaths and increases in searches for depression ($\rho$=--0.12, P=.63) or suicide ($\rho$=--0.07, P=.79). Conclusions: Our analysis suggests that insomnia could be a part of routine mental health screening during the COVID-19 pandemic. ",
doi="10.2196/22181",
url="http://www.jmir.org/2020/9/e22181/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32924951"
}


@Article{info:doi/10.2196/20606,
author="Huang, Huaping
and Zhao, Wen-Jun
and Li, Gui-Rong",
title="Knowledge and Psychological Stress Related to COVID-19 Among Nursing Staff in a Hospital in China: Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2020",
month="Sep",
day="18",
volume="4",
number="9",
pages="e20606",
keywords="COVID-19",
keywords="nursing staff",
keywords="knowledge",
keywords="psychological stress",
abstract="Background: Since December 2019, coronavirus disease (COVID-19) has been rapidly spreading worldwide. Nurses play a key role in fighting this disease and are at risk of COVID-19 infection. Therefore, there is an urgent need to assess the mental health condition of nurses and establish appropriate interventions to reduce the negative psychiatric outcomes of the pandemic. Objective: The objectives of this study were to evaluate the knowledge and psychological stress related to COVID-19 among nursing staff and to provide evidence of the need for targeted training and psychological intervention. Methods: This cross-sectional web-based survey study was performed in a class 3 grade A general hospital in a southwest province of China from March 1 to March 15, 2020. A self-designed questionnaire with questions about COVID-19--related prevention and control knowledge and the Triage Assessment Form (TAF) were used to assess nursing staff's knowledge of COVID-19 and their degree of psychological stress, respectively. SPSS 23.0 was applied for statistical analysis of the collected data. Results: A total of 979 nurses completed the questionnaire. The results showed that the nursing staff provided the fewest correct answers to questions about continuous viral nucleic acid testing specifications (379/979 correct answers, 38.7\%), isolation/discharge criteria (539/979 correct answers, 55.1\%), and management measures for patients with suspected symptoms (713/979 correct answers, 72.8\%). The median total score of the TAF was 7.0 (IQR 5.0-12.0), and there were statistically significant differences in scores between different nursing roles, years of work experience, and hospital departments (P<.05). Conclusions: This study indicated that nursing staff have insufficient knowledge about COVID-19. Meanwhile, although the psychological damage to nurses during the pandemic was found to be low, nurse managers must continue to monitor the mental health of nursing staff and perform timely interventions. ",
doi="10.2196/20606",
url="https://formative.jmir.org/2020/9/e20606",
url="http://www.ncbi.nlm.nih.gov/pubmed/32640419"
}


@Article{info:doi/10.2196/20157,
author="Ramtekkar, Ujjwal
and Bridge, A. Jeffrey
and Thomas, Glenn
and Butter, Eric
and Reese, Jennifer
and Logan, Erica
and Lin, Simon
and Axelson, David",
title="Pediatric Telebehavioral Health: A Transformational Shift in Care Delivery in the Era of COVID-19",
journal="JMIR Ment Health",
year="2020",
month="Sep",
day="18",
volume="7",
number="9",
pages="e20157",
keywords="telepsychiatry",
keywords="telebehavioral health",
keywords="child and adolescent psychiatry",
keywords="COVID-19",
doi="10.2196/20157",
url="https://mental.jmir.org/2020/9/e20157",
url="http://www.ncbi.nlm.nih.gov/pubmed/32525485"
}


@Article{info:doi/10.2196/21490,
author="Singh, Parvati
and Cumberland, G. William
and Ugarte, Dominic
and Bruckner, Tim-Allen
and Young, D. Sean",
title="Association Between Generalized Anxiety Disorder Scores and Online Activity Among US Adults During the COVID-19 Pandemic: Cross-Sectional Analysis",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="10",
volume="22",
number="9",
pages="e21490",
keywords="online activity",
keywords="COVID-19",
keywords="anxiety",
keywords="generalized anxiety disorder",
keywords="GAD",
keywords="scores",
keywords="stress",
keywords="internet",
keywords="survey",
keywords="cross-sectional",
abstract="Background: Evidence from past pandemics suggests that fear, uncertainty, and loss of control during large-scale public health crises may lead to increased pandemic-related information seeking, particularly among persons predisposed to high anxiety. In such groups, a greater consumption of information pertaining to the COVID-19 pandemic may increase anxiety. Objective: In this study, we examine the association between online activity and Generalized Anxiety Disorder 7 (GAD-7) scores in the United States. Methods: We recruited participants for an online survey through advertisements on various platforms such as Google, Facebook, and Reddit. A total of 406 adult US participants with moderate to severe (?10) GAD-7 scores met the inclusion criteria and completed the survey. Anxiety levels measured using the GAD-7 scale formed our primary outcome. Our key independent variables were average daily time spent online and average daily time spent online searching about COVID-19 within the past 14 days. We used as controls potential confounders of the relation between our key independent variables and GAD-7 scores, namely, sleep quality, the COVID-19 Fear Inventory scale, binge drinking, substance use, prescription drug abuse, and sociodemographic attributes. Results: Linear multivariate regression analyses showed that GAD-7 scores were higher among those who spent >4 hours online (per day) searching for information about COVID-19 (coefficient 1.29, P=.002), controlling for all other covariates. The total time spent online was not statistically associated with GAD-7 scores. Conclusions: Results from this study indicate that limiting pandemic-related online information seeking may aid anxiety management in our study population. ",
doi="10.2196/21490",
url="http://www.jmir.org/2020/9/e21490/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32841152"
}


@Article{info:doi/10.2196/22002,
author="Chivers, R. Bonnie
and Garad, M. Rhonda
and Boyle, A. Jacqueline
and Skouteris, Helen
and Teede, J. Helena
and Harrison, L. Cheryce",
title="Perinatal Distress During COVID-19: Thematic Analysis of an Online Parenting Forum",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="7",
volume="22",
number="9",
pages="e22002",
keywords="pregnancy",
keywords="perinatal",
keywords="maternal",
keywords="COVID-19",
keywords="communication",
keywords="social support",
keywords="qualitative research",
keywords="mental health",
keywords="health information",
keywords="online support",
keywords="thematic analysis",
keywords="sentiment analysis",
keywords="word frequency",
abstract="Background: The COVID-19 global pandemic has impacted the whole of society, requiring rapid implementation of individual-, population-, and system-level public health responses to contain and reduce the spread of infection. Women in the perinatal period (pregnant, birthing, and postpartum) have unique and timely needs for directives on health, safety, and risk aversion during periods of isolation and physical distancing for themselves, their child or children, and other family members. In addition, they are a vulnerable group at increased risk of psychological distress that may be exacerbated in the context of social support deprivation and a high-risk external environment. Objective: The aim of this study is to examine the public discourse of a perinatal cohort to understand unmet health information and support needs, and the impacts on mothering identity and social dynamics in the context of COVID-19. Methods: A leading Australian online support forum for women pre- through to postbirth was used to interrogate all posts related to COVID-19 from January 27 to May 12, 2020, inclusive. Key search terms included ``COVID,'' ``corona,'' and ``pandemic.'' A three-phase analysis was conducted, including thematic analysis, sentiment analysis, and word frequency calculations. Results: The search yielded 960 posts, of which 831 were included in our analysis. The qualitative thematic analysis demonstrated reasonable understanding, interpretation, and application of relevant restrictions in place, with five emerging themes identified. These were (1) heightened distress related to a high-risk external environment; (2) despair and anticipatory grief due to deprivation of social and family support, and bonding rituals; (3) altered family and support relationships; (4) guilt-tampered happiness; and (5) family future postponed. Sentiment analysis revealed that the content was predominantly negative (very negative: n=537 and moderately negative: n=443 compared to very positive: n=236 and moderately positive: n=340). Negative words were frequently used in the 831 posts with associated derivatives including ``worried'' (n=165, 19.9\%), ``risk'' (n=143, 17.2\%), ``anxiety'' (n=98, 11.8\%), ``concerns'' (n=74, 8.8\%), and ``stress'' (n=69, 8.3\%). Conclusions: Women in the perinatal period are uniquely impacted by the current pandemic. General information on COVID-19 safe behaviors did not meet the particular needs of this cohort. The lack of nuanced and timely information may exacerbate the risk of psychological and psychosocial distress in this vulnerable, high-risk group. State and federal public health departments need to provide a central repository of information that is targeted, consistent, accessible, timely, and reassuring. Compensatory social and emotional support should be considered, using alternative measures to mitigate the risk of mental health disorders in this cohort. ",
doi="10.2196/22002",
url="http://www.jmir.org/2020/9/e22002/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32857707"
}


@Article{info:doi/10.2196/21279,
author="Son, Changwon
and Hegde, Sudeep
and Smith, Alec
and Wang, Xiaomei
and Sasangohar, Farzan",
title="Effects of COVID-19 on College Students' Mental Health in the United States: Interview Survey Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="3",
volume="22",
number="9",
pages="e21279",
keywords="COVID-19",
keywords="pandemic",
keywords="college student",
keywords="mental health",
keywords="stress",
keywords="anxiety",
keywords="self-management",
abstract="Background: Student mental health in higher education has been an increasing concern. The COVID-19 pandemic situation has brought this vulnerable population into renewed focus. Objective: Our study aims to conduct a timely assessment of the effects of the COVID-19 pandemic on the mental health of college students. Methods: We conducted interview surveys with 195 students at a large public university in the United States to understand the effects of the pandemic on their mental health and well-being. The data were analyzed through quantitative and qualitative methods. Results:  Of the 195 students, 138 (71\%) indicated increased stress and anxiety due to the COVID-19 outbreak. Multiple stressors were identified that contributed to the increased levels of stress, anxiety, and depressive thoughts among students. These included fear and worry about their own health and of their loved ones (177/195, 91\% reported negative impacts of the pandemic), difficulty in concentrating (173/195, 89\%), disruptions to sleeping patterns (168/195, 86\%), decreased social interactions due to physical distancing (167/195, 86\%), and increased concerns on academic performance (159/195, 82\%). To cope with stress and anxiety, participants have sought support from others and helped themselves by adopting either negative or positive coping mechanisms. Conclusions:  Due to the long-lasting pandemic situation and onerous measures such as lockdown and stay-at-home orders, the COVID-19 pandemic brings negative impacts on higher education. The findings of our study highlight the urgent need to develop interventions and preventive strategies to address the mental health of college students. ",
doi="10.2196/21279",
url="https://www.jmir.org/2020/9/e21279",
url="http://www.ncbi.nlm.nih.gov/pubmed/32805704"
}


@Article{info:doi/10.2196/23023,
author="Jain, Nikhil
and Jayaram, Mahesh",
title="Comment on ``Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow''",
journal="JMIR Ment Health",
year="2020",
month="Aug",
day="21",
volume="7",
number="8",
pages="e23023",
keywords="telepsychiatry",
keywords="COVID-19",
keywords="Australia",
doi="10.2196/23023",
url="https://mental.jmir.org/2020/8/e23023",
url="http://www.ncbi.nlm.nih.gov/pubmed/32750003"
}


@Article{info:doi/10.2196/19706,
author="Zhang, Melvyn
and Smith, Elizabeth Helen",
title="Digital Tools to Ameliorate Psychological Symptoms Associated With COVID-19: Scoping Review",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="21",
volume="22",
number="8",
pages="e19706",
keywords="COVID-19",
keywords="digital tool",
keywords="psychiatry",
keywords="mental health",
keywords="digital health",
keywords="psychology",
keywords="distress",
keywords="stress",
keywords="anxiety",
keywords="depression",
abstract="Background: In the four months after the discovery of the index case of coronavirus disease (COVID-19), several studies highlighted the psychological impact of COVID-19 on frontline health care workers and on members of the general public. It is evident from these studies that individuals experienced elevated levels of anxiety and depression in the acute phase, when they first became aware of the pandemic, and that the psychological distress persisted into subsequent weeks. It is becoming apparent that technological tools such as SMS text messages, web-based interventions, mobile interventions, and conversational agents can help ameliorate psychological distress in the workplace and in society. To our knowledge, there are few publications describing how digital tools have been used to ameliorate psychological symptoms among individuals. Objective: The aim of this review was to identify existing SMS text message, web-based, mobile, and conversational agents that the general public can access to ameliorate the psychological symptoms they are experiencing during the COVID-19 pandemic. Methods: To identify digital tools that were published specifically for COVID-19, a search was performed in the PubMed and MEDLINE databases from the inception of the databases through June 17, 2020. The following search strings were used: ``NCOV OR 2019-nCoV OR SARS-CoV-2 OR Coronavirus OR COVID19 OR COVID'' and ``mHealth OR eHealth OR text''. Another search was conducted in PubMed and MEDLINE to identify existing digital tools for depression and anxiety disorders. A web-based search engine (Google) was used to identify if the cited web-based interventions could be accessed. A mobile app search engine, App Annie, was used to determine if the identified mobile apps were commercially available. Results: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83\%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22\%) could be accessed. Of the 7 identified conversational agents, only 2 (29\%) could be accessed. Results: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83\%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22\%) could be accessed. Of the 7 identified conversational agents, only 2 (29\%) could be accessed. Conclusions: The COVID-19 pandemic has caused significant psychological distress. Digital tools that are commercially available may be useful for at-risk individuals or individuals with pre-existing psychiatric symptoms. ",
doi="10.2196/19706",
url="http://www.jmir.org/2020/8/e19706/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32721922"
}


@Article{info:doi/10.2196/20961,
author="Li, Guanjian
and Tang, Dongdong
and Song, Bing
and Wang, Chao
and Qunshan, Shen
and Xu, Chuan
and Geng, Hao
and Wu, Huan
and He, Xiaojin
and Cao, Yunxia",
title="Impact of the COVID-19 Pandemic on Partner Relationships and Sexual and Reproductive Health: Cross-Sectional, Online Survey Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="6",
volume="22",
number="8",
pages="e20961",
keywords="COVID-19",
keywords="survey",
keywords="novel coronavirus",
keywords="sexual behavior",
keywords="sexual health",
keywords="reproductive health",
keywords="young adults",
keywords="youth",
keywords="China",
abstract="Background: In the past few months, the coronavirus disease (COVID-19) pandemic has caused extensive economic and social damage. Objective: The purpose of this study was to assess the impact of COVID-19--related measures on partner relationships and sexual and reproductive health in China. Methods: From May 1 to 5, 2020, 3500 young Chinese individuals were recruited through WeChat or Weibo to participate in a survey to obtain information on sexual and reproductive health (eg, sexual desire, frequency of sexual intercourse, sexual satisfaction, etc). The questionnaire also collected demographic data (eg, age, race, education, current financial status, sexual orientation, relationship status, etc). Results: In total, 967 participants were included in the sexual health analysis. Due to the COVID-19 pandemic and related containment measures, 22\% of participants (n=212) reported a decrease in sexual desire; 41\% (n=396) experienced a decrease in the sexual intercourse frequency; 30\% (n=291) reported an increase in the frequency of masturbation; 20\% (n=192) reported a decrease in alcohol consumption before or during sexual activities, and 31\% (n=298) reported a deterioration in partner relationships during the pandemic. The logistic regression analysis indicated that the following influenced partner relationships: accommodations during the pandemic (P=.046; odds ratio [OR] 0.59; 95\% CI 0.30-0.86); exclusive relationship status (yes or no) (P<.001; OR 0.44; 95 \% CI\thinspace0.27-0.73); sexual desire (P=.02; OR 2.01; 95\% CI\thinspace1.38-2.97); and sexual satisfaction (P<.001; OR 1.92; 95\% CI\thinspace1.54-2.50). COVID-19 also caused disruptions in reproductive health services such as prenatal and postnatal care, childbirth and abortion services, contraception availability, and the management of sexually transmitted infections. Conclusions: Our results show that many young people have wide-ranging issues affecting their sexual and reproductive health due to the COVID-19 pandemic and related containment measures. Strategies and guidelines are needed to safeguard the sexual and reproductive health of young people during this pandemic. ",
doi="10.2196/20961",
url="https://www.jmir.org/2020/8/e20961",
url="http://www.ncbi.nlm.nih.gov/pubmed/32716895"
}


@Article{info:doi/10.2196/20186,
author="Pahayahay, Amber
and Khalili-Mahani, Najmeh",
title="What Media Helps, What Media Hurts: A Mixed Methods Survey Study of Coping with COVID-19 Using the Media Repertoire Framework and the Appraisal Theory of Stress",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="6",
volume="22",
number="8",
pages="e20186",
keywords="Netflix",
keywords="social network",
keywords="stress",
keywords="COVID-19",
keywords="information and communication technologies",
keywords="survey",
keywords="media",
keywords="coping",
keywords="infodemic",
keywords="infodemiology",
abstract="Background: Social and physical distancing in response to the coronavirus disease (COVID-19) pandemic has made screen-mediated information and communication technologies (media) indispensable. Whether an increase in screen use is a source of or a relief for stress remains to be seen. Objective: In the immediate aftermath of the COVID-19 lockdowns, we investigated the relation between subjective stress and changes in the pattern of media use. Based on Lazarus's transactional model of appraisal and coping, and building on an earlier similar survey, we hypothesize that individual differences in the appraisal of media predict variations in approach or avoidance of media for coping with COVID-19 stress. Methods: Between March 20 and April 20, 2020, a brief snowball survey entitled: ``What media helps, what media hurts: coping with COVID19 through screens'' was distributed via Concordia University's mailing lists and social media (PERFORM Centre, EngAGE Centre, and Media Health Lab). Using a media repertoire method, we asked questions about preferences, changes in use, and personal appraisal of media experiences (approach, avoid, and ignore) as a result of the COVID-19 pandemic and investigated interindividual differences in media use by factors such as subjective stress, age, gender, and self-reported mental health. Results: More than 90\% of the survey respondents were in Canada and the east coast of the United States. From 685 completed responses, 169 respondents were ``very stressed'' and 452 were ``slightly worried'' about the pandemic. COVID-19 stress led to increased use of Facebook ($\chi$23=11.76, P=.008), television ($\chi$23=12.40, P=.006), YouTube ($\chi$23=8.577, P=.04), and streaming services such as Netflix ($\chi$23=10.71, P=.01). Respondents who considered their mental health ``not good'' were twice as likely to prefer streaming services as a coping tool for self-isolation. Women and nonbinary respondents were twice as likely than men to pick social media for coping. Individuals younger than 35 years were 3 times more likely to pick computer games, and individuals older than 55 years were more likely to pick network television or print media. Gender affected the appraisal of media (less in men than others) in terms of avoid (F1,637=5.84, P=.02) and approach scores (F1,637=14.31, P<.001). Subjective mental health affected the ignore score (less in those who said ``good'' than others; F1,637=13.88, P<.001). The appraisal score and use increase explained variations in worrying about physical and mental health stress due to increased screen time. A qualitative analysis of open-ended questions revealed that media (especially social networks) were important for coping if they provided support and connection through the dissemination of factual and positive information while avoiding the overflow of sensational and false news. Conclusions: The relationship between appraisal of media's positive and negative facets vary with demographic differences in mental health resiliency. The media repertoire approach is an important tool in studies that focus on assessing the benefits and harms of screen overuse in different populations, especially in the context of the COVID-19 pandemic. ",
doi="10.2196/20186",
url="https://www.jmir.org/2020/8/e20186",
url="http://www.ncbi.nlm.nih.gov/pubmed/32701459"
}


@Article{info:doi/10.2196/20429,
author="Fortuna, L. Karen
and Myers, L. Amanda
and Walsh, Danielle
and Walker, Robert
and Mois, George
and Brooks, M. Jessica",
title="Strategies to Increase Peer Support Specialists' Capacity to Use Digital Technology in the Era of COVID-19: Pre-Post Study",
journal="JMIR Ment Health",
year="2020",
month="Jul",
day="23",
volume="7",
number="7",
pages="e20429",
keywords="COVID-19",
keywords="peer support",
keywords="telemental health",
keywords="mental health",
keywords="training",
abstract="Background: Prior to the outbreak of coronavirus disease (COVID-19), telemental health to support mental health services was primarily designed for individuals with professional clinical degrees, such as psychologists, psychiatrists, registered nurses, and licensed clinical social workers. For the first the time in history, peer support specialists are offering Medicaid-reimbursable telemental health services during the COVID-19 crisis; however, little effort has been made to train peer support specialists on telehealth practice and delivery. Objective: The aim of this study was to explore the impact of the Digital Peer Support Certification on peer support specialists' capacity to use digital peer support technology. Methods: The Digital Peer Support Certification was co-produced with peer support specialists and included an education and simulation training session, synchronous and asynchronous support services, and audit and feedback. Participants included 9 certified peer support specialists between the ages of 25 and 54 years (mean 39 years) who were employed as peer support specialists for 1 to 11 years (mean 4.25 years) and had access to a work-funded smartphone device and data plan. A pre-post design was implemented to examine the impact of the Digital Peer Support Certification on peer support specialists' capacity to use technology over a 3-month timeframe. Data were collected at baseline, 1 month, 2 months, and 3 months. Results: Overall, an upward trend in peer support specialists' capacity to offer digital peer support occurred during the 3-month certification period. Conclusions: The Digital Peer Support Certification shows promising evidence of increasing the capacity of peer support specialists to use specific digital peer support technology features. Our findings also highlighted that this capacity was less likely to increase with training alone and that a combinational knowledge translation approach that includes both training and management will be more successful. ",
doi="10.2196/20429",
url="http://mental.jmir.org/2020/7/e20429/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32629424"
}


@Article{info:doi/10.2196/21718,
author="Balcombe, Luke
and De Leo, Diego",
title="An Integrated Blueprint for Digital Mental Health Services Amidst COVID-19",
journal="JMIR Ment Health",
year="2020",
month="Jul",
day="22",
volume="7",
number="7",
pages="e21718",
keywords="digital mental health",
keywords="mental well-being online assessments",
keywords="machine learning",
keywords="automation",
keywords="COVID-19",
keywords="well-being services",
doi="10.2196/21718",
url="https://mental.jmir.org/2020/7/e21718",
url="http://www.ncbi.nlm.nih.gov/pubmed/32668402"
}


@Article{info:doi/10.2196/19246,
author="Inkster, Becky
and O'Brien, Ross
and Selby, Emma
and Joshi, Smriti
and Subramanian, Vinod
and Kadaba, Madhura
and Schroeder, Knut
and Godson, Suzi
and Comley, Kerstyn
and Vollmer, J. Sebastian
and Mateen, A. Bilal",
title="Digital Health Management During and Beyond the COVID-19 Pandemic: Opportunities, Barriers, and Recommendations",
journal="JMIR Ment Health",
year="2020",
month="Jul",
day="6",
volume="7",
number="7",
pages="e19246",
keywords="digital mental health",
keywords="call to action",
keywords="due diligence",
keywords="data insights",
keywords="COVID-19",
doi="10.2196/19246",
url="https://mental.jmir.org/2020/7/e19246",
url="http://www.ncbi.nlm.nih.gov/pubmed/32484783"
}


@Article{info:doi/10.2196/20696,
author="van Agteren, Joep
and Bartholomaeus, Jonathan
and Fassnacht, B. Daniel
and Iasiello, Matthew
and Ali, Kathina
and Lo, Laura
and Kyrios, Michael",
title="Using Internet-Based Psychological Measurement to Capture the Deteriorating Community Mental Health Profile During COVID-19: Observational Study",
journal="JMIR Ment Health",
year="2020",
month="Jun",
day="11",
volume="7",
number="6",
pages="e20696",
keywords="psychological measurement",
keywords="positive mental health",
keywords="resilience",
keywords="mental health",
keywords="psychological distress",
keywords="internet",
keywords="COVID-19",
keywords="pandemic",
abstract="Background: The coronavirus disease (COVID-19) is expected to have widespread and pervasive implications for mental health in terms of deteriorating outcomes and increased health service use, leading to calls for empirical research on mental health during the pandemic. Internet-based psychological measurement can play an important role in collecting imperative data, assisting to guide evidence-based decision making in practice and policy, and subsequently facilitating immediate reporting of measurement results to participants. Objective: The aim of this study is to use an internet-based mental health measurement platform to compare the mental health profile of community members during COVID-19 with community members assessed before the pandemic. Methods: This study uses an internet-based self-assessment tool to collect data on psychological distress, mental well-being, and resilience in community cohorts during (n=673) and prior to the pandemic (two cohorts, n=1264 and n=340). Results: Our findings demonstrate significantly worse outcomes on all mental health measures for participants measured during COVID-19 compared to those measured before (P<.001 for all outcomes, effect sizes ranging between Cohen d=0.32 to Cohen d=0.81. Participants who demonstrated problematic scores for at least one of the mental health outcomes increased from 58\% (n=197/340) before COVID-19 to 79\% (n=532/673) during COVID-19, leading to only 21\% (n=141) of measured participants displaying good mental health during the pandemic. Conclusions: The results clearly demonstrate deterioration in mental health outcomes during COVID-19. Although further research is needed, our findings support the serious mental health implications of the pandemic and highlight the utility of internet-based data collection tools in providing evidence to innovate and strengthen practice and policy during and after the pandemic. ",
doi="10.2196/20696",
url="http://mental.jmir.org/2020/6/e20696/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32490845"
}


@Article{info:doi/10.2196/19347,
author="Jacobson, C. Nicholas
and Lekkas, Damien
and Price, George
and Heinz, V. Michael
and Song, Minkeun
and O'Malley, James A.
and Barr, J. Paul",
title="Flattening the Mental Health Curve: COVID-19 Stay-at-Home Orders Are Associated With Alterations in Mental Health Search Behavior in the United States",
journal="JMIR Ment Health",
year="2020",
month="Jun",
day="1",
volume="7",
number="6",
pages="e19347",
keywords="COVID-19",
keywords="coronavirus",
keywords="stay-at-home orders",
keywords="mental health",
keywords="suicide",
keywords="anxiety",
keywords="infodemiology",
keywords="infoveillance",
keywords="search trends",
keywords="health information needs",
abstract="Background: The coronavirus disease (COVID-19) has led to dramatic changes worldwide in people's everyday lives. To combat the pandemic, many governments have implemented social distancing, quarantine, and stay-at-home orders. There is limited research on the impact of such extreme measures on mental health. Objective: The goal of this study was to examine whether stay-at-home orders produced differential changes in mental health symptoms using internet search queries on a national scale. Methods: In the United States, individual states vary in their adoption of measures to reduce the spread of COVID-19; as of March 23, 2020, 11 of the 50 states had issued stay-at-home orders. The staggered rollout of stay-at-home measures across the United States allows us to investigate whether these measures impact mental health by exploring variations in mental health search queries across the states. This paper examines the changes in mental health search queries on Google between March 16-23, 2020, across each state and Washington, DC. Specifically, this paper examines differential changes in mental health searches based on patterns of search activity following issuance of stay-at-home orders in these states compared to all other states. The participants were all the people who searched mental health terms in Google between March 16-23. Between March 16-23, 11 states underwent stay-at-home orders to prevent the transmission of COVID-19. Outcomes included search terms measuring anxiety, depression, obsessive-compulsive, negative thoughts, irritability, fatigue, anhedonia, concentration, insomnia, and suicidal ideation. Results: Analyzing over 10 million search queries using generalized additive mixed models, the results suggested that the implementation of stay-at-home orders are associated with a significant flattening of the curve for searches for suicidal ideation, anxiety, negative thoughts, and sleep disturbances, with the most prominent flattening associated with suicidal ideation and anxiety. Conclusions: These results suggest that, despite decreased social contact, mental health search queries increased rapidly prior to the issuance of stay-at-home orders, and these changes dissipated following the announcement and enactment of these orders. Although more research is needed to examine sustained effects, these results suggest mental health symptoms were associated with an immediate leveling off following the issuance of stay-at-home orders. ",
doi="10.2196/19347",
url="https://mental.jmir.org/2020/6/e19347",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459186"
}


@Article{info:doi/10.2196/19009,
author="Ni, Y. Michael
and Yang, Lin
and Leung, C. Candi M.
and Li, Na
and Yao, I. Xiaoxin
and Wang, Yishan
and Leung, M. Gabriel
and Cowling, J. Benjamin
and Liao, Qiuyan",
title="Mental Health, Risk Factors, and Social Media Use During the COVID-19 Epidemic and Cordon Sanitaire Among the Community and Health Professionals in Wuhan, China: Cross-Sectional Survey",
journal="JMIR Ment Health",
year="2020",
month="May",
day="12",
volume="7",
number="5",
pages="e19009",
keywords="COVID-19",
keywords="nonpharmaceutical interventions",
keywords="population mental health",
keywords="depression",
keywords="anxiety",
keywords="community",
keywords="health professionals",
keywords="social media",
keywords="WeChat",
keywords="pandemic",
keywords="outbreak",
keywords="public health",
keywords="mental health",
keywords="intervention",
abstract="Background: The mental health consequences of the coronavirus disease (COVID-19) pandemic, community-wide interventions, and social media use during a pandemic are unclear. The first and most draconian interventions have been implemented in Wuhan, China, and these countermeasures have been increasingly deployed by countries around the world. Objective: The aim of this study was to examine risk factors, including the use of social media, for probable anxiety and depression in the community and among health professionals in the epicenter, Wuhan, China. Methods: We conducted an online survey via WeChat, the most widely used social media platform in China, which was administered to 1577 community-based adults and 214 health professionals in Wuhan. Probable anxiety and probable depression were assessed by the validated Generalized Anxiety Disorder-2 (cutoff ?3) and Patient Health Questionnaire-2 (cutoff ?3), respectively. A multivariable logistic regression analysis was used to examine factors associated with probable anxiety and probable depression. Results: Of the 1577 community-based adults, about one-fifth of respondents reported probable anxiety (n=376, 23.84\%, 95\% CI 21.8-26.0) and probable depression (n=303, 19.21\%, 95\% CI 17.3-21.2). Similarly, of the 214 health professionals, about one-fifth of surveyed health professionals reported probable anxiety (n=47, 22.0\%, 95\% CI 16.6-28.1) or probable depression (n=41, 19.2\%, 95\% CI 14.1-25.1). Around one-third of community-based adults and health professionals spent ?2 hours daily on COVID-19 news via social media. Close contact with individuals with COVID-19 and spending ?2 hours daily on COVID-19 news via social media were associated with probable anxiety and depression in community-based adults. Social support was associated with less probable anxiety and depression in both health professionals and community-based adults. Conclusions: The internet could be harnessed for telemedicine and restoring daily routines, yet caution is warranted toward spending excessive time searching for COVID-19 news on social media given the infodemic and emotional contagion through online social networks. Online platforms may be used to monitor the toll of the pandemic on mental health. ",
doi="10.2196/19009",
url="https://mental.jmir.org/2020/5/e19009",
url="http://www.ncbi.nlm.nih.gov/pubmed/32365044"
}


@Article{info:doi/10.2196/19547,
author="Whelan, Pauline
and Stockton-Powdrell, Charlotte
and Jardine, Jenni
and Sainsbury, John",
title="Comment on ``Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow'': A UK Perspective",
journal="JMIR Ment Health",
year="2020",
month="Apr",
day="27",
volume="7",
number="4",
pages="e19547",
keywords="digital mental health",
keywords="digital psychiatry",
keywords="COVID-19",
keywords="mhealth",
keywords="mobile apps",
keywords="learning health system",
doi="10.2196/19547",
url="http://mental.jmir.org/2020/4/e19547/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32330113"
}


@Article{info:doi/10.2196/18848,
author="Torous, John
and J{\"a}n Myrick, Keris
and Rauseo-Ricupero, Natali
and Firth, Joseph",
title="Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow",
journal="JMIR Ment Health",
year="2020",
month="Mar",
day="26",
volume="7",
number="3",
pages="e18848",
keywords="digital health",
keywords="emergency response",
keywords="telehealth",
keywords="apps",
doi="10.2196/18848",
url="http://mental.jmir.org/2020/3/e18848/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32213476"
}