%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70508 %T Adolescent Cyberbullying and Cyber Victimization: Longitudinal Study Before and During COVID-19 %A Schulz,Peter Johannes %A Boldi,Marc-Olivier %A van Ackere,Ann %+ Faculty of Communication, Culture and Society, Università della Svizzera Italiana, Via G. Buffi 13, Lugano, 6900, Switzerland, 41 58666724, schulzp@usi.ch %K cyberbullying and cyber victimization among adolescents %K COVID-19 %K panel study %K longitudinal data analysis %K parental communication %K exposure to violent media content %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescent cyberbullying has been a persistent issue, exacerbated by the shift to remote learning and increased screen time during the COVID-19 pandemic. These changes have sparked concerns about potential increases in cyberbullying and its associated risks. Objective: This study aims to explore how factors such as age, exposure to violent media, parental communication quality, internet access, sex, and sibling relationships influence cyberbullying behavior at school. Additionally, we examine how the COVID-19 pandemic may have altered these dynamics. Methods: Leveraging a panel dataset, we examine the same group of adolescents both before and during the pandemic. The analysis focused on identifying relationships between the selected factors and cyberbullying perpetration and victimization, with an emphasis on the dynamics introduced by the COVID-19 pandemic. Results: Perceived quality of parental communication was found to reduce the risk of both cyberbullying perpetration and victimization, with the former effect becoming more pronounced during the COVID-19 pandemic. Exposure to violent media increased both cyberbullying perpetration and victimization, but the effect on perpetration decreased during the COVID-19 pandemic. The well-established correlation between internet access and both cyberbullying perpetration and victimization remained unaffected by COVID-19. Surprisingly, adolescents with siblings were less likely to become victims or perpetrators of school-related cyberbullying, irrespective of the pandemic. Conclusions: In hindsight, COVID-19, functioning as a kind of natural experiment, has provided us with a unique opportunity to examine the effects of a global event, forcing major behavioral changes on the persistent challenge of cyberbullying in middle schools. %M 40132197 %R 10.2196/70508 %U https://www.jmir.org/2025/1/e70508 %U https://doi.org/10.2196/70508 %U http://www.ncbi.nlm.nih.gov/pubmed/40132197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64965 %T Investigating the Magnitude and Persistence of COVID-19–Related Impacts on Affect and GPS-Derived Daily Mobility Patterns in Adolescence and Emerging Adulthood: Insights From a Smartphone-Based Intensive Longitudinal Study of Colorado-Based Youths From June 2016 to April 2022 %A Alexander,Jordan D %A Duffy,Kelly A %A Freis,Samantha M %A Chow,Sy-Miin %A Friedman,Naomi P %A Vrieze,Scott I %+ Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN, 55455, United States, 1 6126252818, alexa877@umn.edu %K adolescence %K emerging adulthood %K intensive longitudinal assessment %K COVID-19 %K affect %K GPS %K mobility patterns %K smartphone data %K respiratory %K infectious %K pulmonary %K pandemic %K adolescents %K teens %K teenagers %K mobility %K apps %K smartphones %K intensive longitudinal panel studies %K emotional well-being %K well-being %K daily routines %K affect survey %D 2025 %7 17.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The onset of the COVID-19 pandemic in early 2020 introduced unprecedented disruptions impacting the emotional well-being and daily routines of US youths. However, the patterns and persistence of these impacts over the pandemic’s multiyear course remain less well understood. Objective: This study examined longitudinal changes in affect and daily mobility patterns observed in adolescence and young adulthood from June 2016 to April 2022. The study aimed to quantify changes in youths’ mood and daily routines following the pandemic’s onset and in response to local COVID-19 case rates as well as the persistence of these effects over the pandemic’s multiyear course. Methods: Colorado-based adolescent and young adult twins (N=887; n=479, 54% female; meanage 19.2, SDage 1.5 years on January 01, 2020) participating in the CoTwins study between June 2016 and April 2022 were followed via a smartphone app, which recorded persistent GPS location data and, beginning in February 2019, administered an abbreviated Positive and Negative Affect Schedule every 2 weeks. Nonlinear trajectories in affect and daily mobility over time and in response to local COVID-19 counts were modeled via generalized additive mixed models, while the magnitude and persistence of pandemic-related changes were quantified via linear mixed effects regressions. Results: Between January and April 2020, participants experienced a 28.6% decline in daily locations visited (from 3.5 to 2.5; SD 0.9) and a 60% reduction in daily travel distance (from 20.0 to 8.0 km; SD 9.4). Mean positive affect similarly declined by 0.3 SD (from 3.0 to 2.79; SD 0.6), while, correspondingly, mean negative affect increased by 0.3 SD (from 1.85 to 2.10; SD 0.6). Though mobility levels partially recovered beginning in the summer of 2020, daily locations visited remained slightly below 2019 levels through the study’s conclusion in April 2022 (standardized β=–0.10; P<.001). Average positive affect similarly remained slightly below (standardized β=–0.20; P<.001) and negative affect slightly above (standardized β=0.14; P=.04) 2019 levels through April 2022. Weekly county-level COVID-19 transmission rates were negatively associated with mobility and positive affect and positively with negative affect, though these effects were greatly weakened later in the pandemic (eg, early 2022) or when transmission rates were high (eg, >200 new cases per 100,000 people per week). Conclusions: Findings demonstrate large initial declines in daily mobility, a moderate decline in positive affect, and a moderate increase in negative affect following the pandemic’s onset in 2020. Though most effects attenuated over time, affect and mobility levels had not recovered to prepandemic levels by April 2022. Findings support theories of hedonic adaptation and resiliency while also identifying lingering emotional and behavioral consequences. The study highlights both youth’s resiliency in adapting to major stressors while also underscoring the need for continued support for youth mental health and psychosocial functioning in the pandemic’s aftermath. %M 40096681 %R 10.2196/64965 %U https://www.jmir.org/2025/1/e64965 %U https://doi.org/10.2196/64965 %U http://www.ncbi.nlm.nih.gov/pubmed/40096681 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e57962 %T Nationwide Trends in Screen Time and Associated Risk Factors by Family Structures Among Adolescents, 2008-2022: Nationwide Cross-Sectional Study %A Kim,Seokjun %A Jo,Hyesu %A Son,Yejun %A Shin,Min Kyung %A Lee,Kyeongmin %A Park,Jaeyu %A Lee,Hayeon %A Smith,Lee %A Dragioti,Elena %A Fond,Guillaume %A Boyer,Laurent %A López Sánchez,Guillermo F %A Tully,Mark A %A Rahmati,Masoud %A Pizzol,Damiano %A Woo,Selin %A Yon,Dong Keon %+ , Department of Medicine, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 269352476, yonkkang@gmail.com %K adolescents %K family type %K pandemic %K screen time %K South Korea %K sedentary activity %K risk factor %K mobile phone %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although understanding long-term trends in adolescent screen time and the influence of family structure is essential, there is a lack of research addressing these issues comprehensively. Objective: This study aimed to conduct comprehensive investigations into adolescent screen time before and during the COVID-19 pandemic, with a particular focus on family structures. Methods: This study used nationwide, large-scale data from the Korea Youth Risk Behavior Web-Based Survey from South Korea. We aimed to indicate the changes in adolescent screen time over 15 years from 2008 to 2022. Weighted linear regression was used to analyze annual trends in screen time before and during the pandemic, and stratified analyses were conducted to examine associated risk factors across different family structures. Results: This study used data from a total of 836,972 individuals (n=403,456, 48.2% women), with an age range of 12-18 years. The analysis revealed an overall increase in screen time prepandemic (β=8.06, 95% CI 7.74-8.39), with a notable increase observed at the onset of the pandemic (β=162.06, 95% CI 159.49-164.64). Among diverse family structures, the orphanage group showed the most substantial increase in screen time during the pandemic (βdiff=221.90, 95% CI 159.62-284.17). Risk factors associated with screen time during the pandemic varied by family structure. Notably, the nuclear family group presented distinct screen time–related risk factors, including grade, region of residence, physical activity frequency, sadness and despair, and the highest education level of parents. Conclusions: There has been a notable increase in average screen time among adolescents since the onset of the pandemic, with the orphanage group exhibiting a pronounced trend. The risk factors associated with screen time during the pandemic varied for each family structure. Findings from this study suggest that the implementation of individualized measures tailored to each family structure should be adopted to effectively address the increased issue of adolescent screen time since the pandemic. %M 40063937 %R 10.2196/57962 %U https://publichealth.jmir.org/2025/1/e57962 %U https://doi.org/10.2196/57962 %U http://www.ncbi.nlm.nih.gov/pubmed/40063937 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54543 %T Exploring Psychological Trends in Populations With Chronic Obstructive Pulmonary Disease During COVID-19 and Beyond: Large-Scale Longitudinal Twitter Mining Study %A Zhang,Chunyan %A Wang,Ting %A Dong,Caixia %A Dai,Duwei %A Zhou,Linyun %A Li,Zongfang %A Xu,Songhua %+ School of Electrical Engineering, Xi'an Jiaotong University, No. 28, Xianning West Road, Xi'an, 710049, China, 86 13289346632, wang.ting@xjtu.edu.cn %K COVID-19 %K chronic obstructive pulmonary disease (COPD) %K psychological trends %K Twitter %K data mining %K deep learning %D 2025 %7 5.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) ranks among the leading causes of global mortality, and COVID-19 has intensified its challenges. Beyond the evident physical effects, the long-term psychological effects of COVID-19 are not fully understood. Objective: This study aims to unveil the long-term psychological trends and patterns in populations with COPD throughout the COVID-19 pandemic and beyond via large-scale Twitter mining. Methods: A 2-stage deep learning framework was designed in this study. The first stage involved a data retrieval procedure to identify COPD and non-COPD users and to collect their daily tweets. In the second stage, a data mining procedure leveraged various deep learning algorithms to extract demographic characteristics, hashtags, topics, and sentiments from the collected tweets. Based on these data, multiple analytical methods, namely, odds ratio (OR), difference-in-difference, and emotion pattern methods, were used to examine the psychological effects. Results: A cohort of 15,347 COPD users was identified from the data that we collected in the Twitter database, comprising over 2.5 billion tweets, spanning from January 2020 to June 2023. The attentiveness toward COPD was significantly affected by gender, age, and occupation; it was lower in females (OR 0.91, 95% CI 0.87-0.94; P<.001) than in males, higher in adults aged 40 years and older (OR 7.23, 95% CI 6.95-7.52; P<.001) than in those younger than 40 years, and higher in individuals with lower socioeconomic status (OR 1.66, 95% CI 1.60-1.72; P<.001) than in those with higher socioeconomic status. Across the study duration, COPD users showed decreasing concerns for COVID-19 and increasing health-related concerns. After the middle phase of COVID-19 (July 2021), a distinct decrease in sentiments among COPD users contrasted sharply with the upward trend among non-COPD users. Notably, in the post-COVID era (June 2023), COPD users showed reduced levels of joy and trust and increased levels of fear compared to their levels of joy and trust in the middle phase of COVID-19. Moreover, males, older adults, and individuals with lower socioeconomic status showed heightened fear compared to their counterparts. Conclusions: Our data analysis results suggest that populations with COPD experienced heightened mental stress in the post-COVID era. This underscores the importance of developing tailored interventions and support systems that account for diverse population characteristics. %M 40053739 %R 10.2196/54543 %U https://www.jmir.org/2025/1/e54543 %U https://doi.org/10.2196/54543 %U http://www.ncbi.nlm.nih.gov/pubmed/40053739 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e69417 %T Efficacy and Safety of Acupuncture for Post–COVID-19 Insomnia: Protocol for a Systematic Review and Meta-Analysis %A Li,Yadi %A Zhou,Jianlong %A Wei,Zheng %A Liang,Lizhu %A Xu,Hualing %A Lv,Caihong %A Liu,Gang %A Li,Wenlin %A Wu,Xin %A Xiao,Yunhui %A Sunzi,Kejimu %+ Deyang People's Hospital, No. 173, Section 1, Taishan, North Road, Jingyang District, Deyang, 618000, China, 86 18383092896, 819228903@qq.com %K acupuncture %K traditional Chinese medicine %K post–COVID-19 condition %K long COVID-19 %K insomnia %K sleep disorder %K depression %K complementary and alternative medicine %K treatment %K public health %K study protocol %K systematic review %D 2025 %7 3.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has had a profound global impact, leading to a range of persistent sequelae referred to as post–COVID-19 condition or “long COVID” that continue to affect patients worldwide. Among these sequelae, post–COVID-19 insomnia (PCI) has emerged as a significant issue. Conventional treatments, including cognitive behavioral therapy and pharmacological interventions, face limitations such as variable efficacy, potential side effects, and substantial costs. Recently, acupuncture has gained traction due to its efficacy, cost-effectiveness, and safety profile. Objective: This study aims to conduct a meta-analysis and systematic review evaluating the efficacy and safety of acupuncture for the treatment of PCI to delineate the optimal modality, intervention frequency, and duration for achieving the most beneficial outcomes, thereby providing a comprehensive understanding of acupuncture’s role in managing PCI, contributing to evidence-based clinical practice, and informing clinical decision-making. Methods: Electronic searches will be performed in 12 databases from inception to October 2024 without language restrictions. This includes both English databases (PubMed, Cochrane Library, Web of Science, Embase, OVID and Scopus), as well as Chinese databases (China National Knowledge Infrastructure, Wan-Fang Data, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, Duxiu Database and the Chinese Clinical Trial Registry Center). Randomized controlled trials on acupuncture for PCI will be included. Primary outcomes will include the response rate and insomnia severity; secondary outcomes will include the Traditional Chinese Medicine Symptom Scale (TCMSS) and adverse event rates. Data synthesis will use risk ratios for dichotomous data and mean differences for continuous data. Study selection, data extraction, and quality assessment will be conducted independently by 2 reviewers. Methodological quality of eligible studies will be evaluated following the Cochrane Handbook for Systematic Reviews of Interventions (version 6.3). Meta-analysis will be performed with RevMan 5.3. Results: Based on the data on response rate, insomnia severity, TCMSS score, and adverse event rates, this study will provide an evidence-based review of the efficacy and safety of acupuncture for PCI treatment. Conclusions: This systematic review will present the current evidence for acupuncture for PCI, aiming to inform clinical practices and decision-making and to enhance the understanding of acupuncture’s role in managing PCI. Furthermore, it will identify research gaps and suggest potential areas for future investigation. Trial Registration: PROSPERO CRD42024499284; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=499284 International Registered Report Identifier (IRRID): DERR1-10.2196/69417 %M 40053784 %R 10.2196/69417 %U https://www.researchprotocols.org/2025/1/e69417 %U https://doi.org/10.2196/69417 %U http://www.ncbi.nlm.nih.gov/pubmed/40053784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54608 %T Relative Preference for In-Person, Telehealth, Digital, and Pharmacologic Mental Health Care After the COVID-19 Pandemic: Cross-Sectional Questionnaire Study %A Parsons,E Marie %A Figueroa,Zoë G %A Hiserodt,Michele %A Cornelius,Talea %A Otto,Michael W %+ Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Boston, MA, 02115, United States, 1 617 353 9610, mariepar@bu.edu %K stigma %K digital CBT %K age %K generalized anxiety disorder %K insomnia %K adult %K telehealth %K digital health %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Most adults and children in the United States fail to receive timely care for mental health symptoms, with even worse rates of care access for individuals who belong to racial and ethnic minority groups. Digital (ie, app-based) care has proven to be an efficacious and empirically supported treatment option with the potential to address low rates of care and reduce care disparities, yet little is known about the relative preference for such treatment. Furthermore, the rapid adoption of telehealth care during the COVID-19 pandemic may have shifted care preferences. Objective: This study aimed to examine relative treatment preferences for 4 different types of mental health care: in-person psychological care, telehealth psychological care, digital treatment, or pharmacologic care. Care preferences were also examined relative to potential predictors of care use (ie, gender, race, age, stigma, discrimination, and level of shame). Methods: In this cross-sectional online survey study of adults (N=237, mean age 35 years, range 19-68 years), we ranked 4 mental health care modalities based on care preference: (1) in-person care, (2) telehealth care, (3) digital care, and (4) pharmacologic care. Preference for treatment modality was assessed based on vignette presentation for generalized anxiety disorder and insomnia. In addition, participants completed self-report questionnaires for demographics, symptom severity, and psychological and stigma-related variables. Results: We found no difference in overall preference for in-person versus both telehealth and digital care. For both generalized anxiety disorder and insomnia, participants preferred in-person care to telehealth care, although this finding was attenuated amongst older participants for insomnia treatment. Participants’ depressed mood was associated with a greater relative preference for pharmacologic care. There was no evidence of differential preference for digital care according to demographics, symptom severity, or psychological and stigma-related variables. Conclusions: These results indicate that digital care now competes well in terms of treatment preference with in-person, telehealth, and pharmacologic treatment options. %M 39946715 %R 10.2196/54608 %U https://www.jmir.org/2025/1/e54608 %U https://doi.org/10.2196/54608 %U http://www.ncbi.nlm.nih.gov/pubmed/39946715 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e66448 %T Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study %A Kim,Sol I %A Jin,Jae-Chan %A Yoo,Seo-Koo %A Han,Doug Hyun %+ Department of Psychiatry, Chung Ang University Hospital, 102 Heusok ro, Seoul, 06973, Republic of Korea, 82 62993132, hduk70@gmail.com %K coronavirus pandemic %K internet use pattern %K internet games %K short-form videos %K social network system %K depressed mood %K internet use %K pandemic %K internet %K COVID-19 %K video %K internet behavior %K social media %K internet addiction %K depression %K anxiety %K digital platforms %K mobile phone %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: As adolescents increasingly engage with digital experiences, the internet serves as a platform for social interaction, entertainment, and learning. The COVID-19 pandemic accelerated this trend, with remote learning and restricted physical interactions driving changes in internet behavior. Adolescents spent more time on gaming and social media, reflecting a notable shift in use patterns. Objective: We hypothesized that the COVID-19 pandemic changed internet use patterns among Korean adolescents, including content types, time spent on web-based activities, and pathological use prevalence. Additionally, we anticipated that these changes would correlate with shifts in adolescents’ psychological status during the pandemic. Methods: Data from 827 adolescents aged 12 to 15 years (n=144 in 2018, n=142 in 2019, n=126 in 2020, n=130 in 2021, n=143 in 2022, and n=142 in 2023) were gathered over 6 years from 43 middle schools across 16 regions and 1 hospital in South Korea. The demographic data collected included age, sex, and school year. Participants also provided information on their internet use patterns and levels of internet addiction. Additionally, psychological status, including mood, anxiety, attention, and self-esteem, was assessed. Results: There were significant differences in the depression scale (Patient Health Questionnaire 9). The Patient Health Questionnaire 9 scores for 2018, 2019, and 2023 decreased compared to those in 2020, 2021, and 2022 (F5=3.07; P=.007). Regarding changes in internet use behavior, game playing among adolescents decreased after the pandemic compared to before, while watching videos increased. Additionally, the rate of problematic internet use was highest for games before COVID-19, but after COVID-19, it was highest for videos, and this trend continued until 2023 (χ23=8.16, P=.04). Furthermore, this study showed that the Young’s Internet Addiction Scale (YIAS) score was highest in the game group in 2018 compared to other groups before COVID-19 (F5=14.63; P<.001). In 2019, both the game and video groups had higher YIAS scores than other groups (F5=9.37; P<.001), and by 2022, the YIAS scores among the game, video, and Social Network Service groups did not differ significantly. The degree of influence on the severity of internet addiction was also greatest for games before COVID-19, but after COVID-19, the effect was greater for videos than for games. Conclusions: During the COVID-19 pandemic, internet use for academic and commercial purposes, including remote classes and videoconferences, increased rapidly worldwide, leading to a significant rise in overall internet use time. The demand for and dependence on digital platforms is expected to grow even further in the coming era. Until now, concerns have primarily focused on the use of games, but it is now necessary to consider what types of internet behaviors cause problems and how to address them. %M 39933170 %R 10.2196/66448 %U https://pediatrics.jmir.org/2025/1/e66448 %U https://doi.org/10.2196/66448 %U http://www.ncbi.nlm.nih.gov/pubmed/39933170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63824 %T Understanding Citizens’ Response to Social Activities on Twitter in US Metropolises During the COVID-19 Recovery Phase Using a Fine-Tuned Large Language Model: Application of AI %A Saito,Ryuichi %A Tsugawa,Sho %+ , Institute of Systems and Information Engineering, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8577, Japan, 81 08055751714, saito.ryuichi.tkb_gw@u.tsukuba.ac.jp %K COVID-19 %K restriction %K United States %K X %K Twitter %K sentiment analysis %K large language model %K LLM %K GPT-3.5 %K fine-tuning %D 2025 %7 11.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic continues to hold an important place in the collective memory as of 2024. As of March 2024, >676 million cases, 6 million deaths, and 13 billion vaccine doses have been reported. It is crucial to evaluate sociopsychological impacts as well as public health indicators such as these to understand the effects of the COVID-19 pandemic. Objective: This study aimed to explore the sentiments of residents of major US cities toward restrictions on social activities in 2022 during the transitional phase of the COVID-19 pandemic, from the peak of the pandemic to its gradual decline. By illuminating people’s susceptibility to COVID-19, we provide insights into the general sentiment trends during the recovery phase of the pandemic. Methods: To analyze these trends, we collected posts (N=119,437) on the social media platform Twitter (now X) created by people living in New York City, Los Angeles, and Chicago from December 2021 to December 2022, which were impacted by the COVID-19 pandemic in similar ways. A total of 47,111 unique users authored these posts. In addition, for privacy considerations, any identifiable information, such as author IDs and usernames, was excluded, retaining only the text for analysis. Then, we developed a sentiment estimation model by fine-tuning a large language model on the collected data and used it to analyze how citizens’ sentiments evolved throughout the pandemic. Results: In the evaluation of models, GPT-3.5 Turbo with fine-tuning outperformed GPT-3.5 Turbo without fine-tuning and Robustly Optimized Bidirectional Encoder Representations from Transformers Pretraining Approach (RoBERTa)–large with fine-tuning, demonstrating significant accuracy (0.80), recall (0.79), precision (0.79), and F1-score (0.79). The findings using GPT-3.5 Turbo with fine-tuning reveal a significant relationship between sentiment levels and actual cases in all 3 cities. Specifically, the correlation coefficient for New York City is 0.89 (95% CI 0.81-0.93), for Los Angeles is 0.39 (95% CI 0.14-0.60), and for Chicago is 0.65 (95% CI 0.47-0.78). Furthermore, feature words analysis showed that COVID-19–related keywords were replaced with non–COVID-19-related keywords in New York City and Los Angeles from January 2022 onward and Chicago from March 2022 onward. Conclusions: The results show a gradual decline in sentiment and interest in restrictions across all 3 cities as the pandemic approached its conclusion. These results are also ensured by a sentiment estimation model fine-tuned on actual Twitter posts. This study represents the first attempt from a macro perspective to depict sentiment using a classification model created with actual data from the period when COVID-19 was prevalent. This approach can be applied to the spread of other infectious diseases by adjusting search keywords for observational data. %M 39932775 %R 10.2196/63824 %U https://www.jmir.org/2025/1/e63824 %U https://doi.org/10.2196/63824 %U http://www.ncbi.nlm.nih.gov/pubmed/39932775 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e63708 %T Exploring the Impact of the COVID-19 Pandemic on Learning Experience, Mental Health, Adaptability, and Resilience Among Health Informatics Master’s Students: Focus Group Study %A Davoody,Nadia %A Stathakarou,Natalia %A Swain,Cara %A Bonacina,Stefano %+ Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, Stockholm, S-17177 Stockholm, Sweden, 46 08 524 864 86, nadia.davoody@ki.se %K COVID-19 pandemic %K eHealth %K blended learning %K health informatics %K higher education adaptation %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Med Educ %G English %X Background: The shift to online education due to the COVID-19 pandemic posed significant challenges and opportunities for students, affecting their academic performance, mental well-being, and engagement. Objective: This study aimed to explore the overall learning experience among health informatics master’s students at Karolinska Institutet, Sweden, and the strategies they used to overcome learning challenges posed by the COVID-19 pandemic. Methods: Through 3 structured focus groups, this study explored health informatics master’s students’ experiences of shifting learning environments for classes that started in 2019, 2020, and 2021. All focus group sessions were recorded and transcribed verbatim. Inductive content analysis was used to analyze the data. Results: The results highlight the benefits of increased autonomy and flexibility and identify challenges such as technical difficulties, diminished social interactions, and psychological impacts. This study underscores the importance of effective online educational strategies, technological preparedness, and support systems to enhance student learning experiences during emergencies. The findings of this study highlight implications for educators, students, and higher education institutions to embrace adaptation and foster innovation. Implications for educators, students, and higher education institutions include the need for educators to stay current with the latest educational technologies and design teaching strategies and pedagogical approaches suited to both online and in-person settings to effectively foster student engagement. Students must be informed about the technological requirements for online learning and adequately prepared to meet them. Institutions play a critical role in ensuring equitable access to technology, guiding and supporting educators in adopting innovative tools and methods, and offering mental health resources to assist students in overcoming the challenges of evolving educational environments. Conclusions: This research contributes to understanding the complexities of transitioning to online learning in urgent circumstances and offers insights for better preparing educational institutions for future pandemics. %M 39928927 %R 10.2196/63708 %U https://mededu.jmir.org/2025/1/e63708 %U https://doi.org/10.2196/63708 %U http://www.ncbi.nlm.nih.gov/pubmed/39928927 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58164 %T Investigating the Efficacy of the Web-Based Common Elements Toolbox (COMET) Single-Session Interventions in Improving UK University Student Well-Being: Randomized Controlled Trial %A Lambert,Jeffrey %A Loades,Maria %A Marshall,Noah %A Higson-Sweeney,Nina %A Chan,Stella %A Mahmud,Arif %A Pile,Victoria %A Maity,Ananya %A Adam,Helena %A Sung,Beatrice %A Luximon,Melanie %A MacLennan,Keren %A Berry,Clio %A Chadwick,Paul %+ Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 1225 385249, m.e.loades@bath.ac.uk %K Common Elements Toolbox %K mental well-being %K online interventions %K single-session interventions %K university students %D 2025 %7 31.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health problems in university students are associated with many negative outcomes, yet there is a gap between need and timely access to help. Single-session interventions (SSIs) are designed to be scalable and accessible, delivering core evidence-based intervention components within a one-off encounter. Objective: COMET (Common Elements Toolbox) is an online self-help SSI that includes behavioral activation, cognitive restructuring, gratitude, and self-compassion. COMET has previously been evaluated in India, Kenya, and the United States with promising results. This study tests the acceptability, appropriateness, perceived utility, and efficacy of COMET among UK university students during the peripandemic period. Methods: We conducted a randomized controlled trial evaluating the efficacy of COMET compared with a control group, with 2- and 4-week follow-ups. Outcome variables were subjective well-being, depression severity, anxiety severity, positive affect, negative affect, and perceived stress. We also measured intervention satisfaction immediately after completion of COMET. All UK university students with access to the internet were eligible to participate and were informed of the study online. The data were analyzed using linear mixed models and reported in accordance with the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist. Results: Of the 831 people screened, 468 participants were randomized to a condition, 407 completed the postintervention survey, 147 returned the 2-week follow-up survey, 118 returned the 4-week follow-up survey, and 89 returned both. Of the 239 randomized, 212 completed COMET. Significant between-group differences in favor of the COMET intervention were observed at 2-week follow-ups for subjective well-being (Warwick-Edinburgh Mental Well-Being Scale; mean difference [MD] 1.39, 95% CI 0.19-2.61; P=.03), depression severity (9-item Patient Health Questionnaire; MD –1.31, 95% CI –2.51 to –0.12; P=.03), and perceived stress (4-item Perceived Stress Scale; MD –1.33, 95% CI –2.10 to –0.57; P<.001). Overall, participants were satisfied with COMET, with the majority endorsing the intervention and its modules as acceptable, appropriate, and exhibiting high utility. The self-compassion module was most often reported as the participants’ favorite module and the behavioral activation module was their least favorite. Qualitative analysis revealed that participants found COMET generally accessible, but too long, and experienced immediate and long-term beneficial effects. Conclusions: This study demonstrated high engagement with the COMET intervention, along with preliminary short-term efficacy. Almost all participants completed the intervention, but study attrition was high. Participant feedback indicated a high level of overall satisfaction with the intervention, with perceived accessibility, immediate benefits, and potential long-term impact being notable findings. These findings support the potential value of COMET as a mental health intervention and highlight important areas for further improvement. Trial Registration: ClinicalTrials.gov NCT05718141; https://clinicaltrials.gov/ct2/show/NCT05718141 %M 39888663 %R 10.2196/58164 %U https://www.jmir.org/2025/1/e58164 %U https://doi.org/10.2196/58164 %U http://www.ncbi.nlm.nih.gov/pubmed/39888663 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63634 %T Health and Experiences During the COVID-19 Pandemic Among Children and Young People: Analysis of Free-Text Responses From the Children and Young People With Long COVID Study %A Rojas,Natalia K %A Martin,Sam %A Cortina-Borja,Mario %A Shafran,Roz %A Fox-Smith,Lana %A Stephenson,Terence %A Ching,Brian C F %A d'Oelsnitz,Anaïs %A Norris,Tom %A Xu,Yue %A McOwat,Kelsey %A Dalrymple,Emma %A Heyman,Isobel %A Ford,Tamsin %A Chalder,Trudie %A Simmons,Ruth %A , %A Pinto Pereira,Snehal M %+ Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, 43-45 Foley St, W1W 7TY, London, United Kingdom, 44 (0) 20 7679 200, n.rojas@ucl.ac.uk %K children and young people %K text mining %K free-text responses %K experiences %K COVID-19 %K long COVID %K InfraNodus %K sentiment analysis %K discourse analysis %K AI %K artificial intelligence %D 2025 %7 28.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The literature is equivocal as to whether the predicted negative mental health impact of the COVID-19 pandemic came to fruition. Some quantitative studies report increased emotional problems and depression; others report improved mental health and well-being. Qualitative explorations reveal heterogeneity, with themes ranging from feelings of loss to growth and development. Objective: This study aims to analyze free-text responses from children and young people participating in the Children and Young People With Long COVID study to get a clearer understanding of how young people were feeling during the pandemic. Methods: A total of 8224 free-text responses from children and young people were analyzed using InfraNodus, an artificial intelligence–powered text network analysis tool, to determine the most prevalent topics. A random subsample of 411 (5%) of the 8224 responses underwent a manual sentiment analysis; this was reweighted to represent the general population of children and young people in England. Results: Experiences fell into 6 main overlapping topical clusters: school, examination stress, mental health, emotional impact of the pandemic, social and family support, and physical health (including COVID-19 symptoms). Sentiment analysis showed that statements were largely negative (314/411, 76.4%), with a small proportion being positive (57/411, 13.9%). Those reporting negative sentiment were mostly female (227/314, 72.3%), while those reporting positive sentiment were mostly older (170/314, 54.1%). There were significant observed associations between sentiment and COVID-19 status as well as sex (P=.001 and P<.001, respectively) such that the majority of the responses, regardless of COVID-19 status or sex, were negative; for example, 84.1% (227/270) of the responses from female individuals and 61.7% (87/141) of those from male individuals were negative. There were no observed associations between sentiment and all other examined demographics. The results were broadly similar when reweighted to the general population of children and young people in England: 78.52% (negative), 13.23% (positive), and 8.24% (neutral). Conclusions: We used InfraNodus to analyze free-text responses from a large sample of children and young people. The majority of responses (314/411, 76.4%) were negative, and many of the children and young people reported experiencing distress across a range of domains related to school, social situations, and mental health. Our findings add to the literature, highlighting the importance of specific considerations for children and young people when responding to national emergencies. %M 39874576 %R 10.2196/63634 %U https://www.jmir.org/2025/1/e63634 %U https://doi.org/10.2196/63634 %U http://www.ncbi.nlm.nih.gov/pubmed/39874576 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58656 %T Cross-Cultural Sense-Making of Global Health Crises: A Text Mining Study of Public Opinions on Social Media Related to the COVID-19 Pandemic in Developed and Developing Economies %A Kahlawi,Adham %A Masri,Firas %A Ahmed,Wasim %A Vidal-Alaball,Josep %+ Unitat de Recerca i Innovació, Gerència d'Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 36, Sant Fruitós de Bages, 08272, Spain, 34 936930040, jvidal.cc.ics@gencat.cat %K COVID-19 %K SARS-CoV-2 %K pandemic %K citizen opinion %K text mining %K LDA %K health crisis %K developing economies %K Italy %K Egypt %K UK %K dataset %K content analysis %K social media %K twitter %K tweet %K sentiment %K attitude %K perception %K perspective %K machine learning %K latent Dirichlet allocation %K vaccine %K vaccination %K public health %K infectious %D 2025 %7 27.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic reshaped social dynamics, fostering reliance on social media for information, connection, and collective sense-making. Understanding how citizens navigate a global health crisis in varying cultural and economic contexts is crucial for effective crisis communication. Objective: This study examines the evolution of citizen collective sense-making during the COVID-19 pandemic by analyzing social media discourse across Italy, the United Kingdom, and Egypt, representing diverse economic and cultural contexts. Methods: A total of 755,215 social media posts from X (formerly Twitter) were collected across 3 time periods: the virus' emergence (February 15 to March 31, 2020), strict lockdown (April 1 to May 30, 2020), and the vaccine rollout (December 1, 2020 to January 15, 2021). In total, 284,512 posts from Italy, 261,978 posts from the United Kingdom, and 209,725 posts from Egypt were analyzed using the latent Dirichlet allocation algorithm to identify key thematic topics and track shifts in discourse across time and regions. Results: The analysis revealed significant regional and temporal differences in collective sense-making during the pandemic. In Italy and the United Kingdom, public discourse prominently addressed pragmatic health care measures and government interventions, reflecting higher institutional trust. By contrast, discussions in Egypt were more focused on religious and political themes, highlighting skepticism toward governmental capacity and reliance on alternative frameworks for understanding the crisis. Over time, all 3 countries displayed a shift in discourse toward vaccine-related topics during the later phase of the pandemic, highlighting its global significance. Misinformation emerged as a recurrent theme across regions, demonstrating the need for proactive measures to ensure accurate information dissemination. These findings emphasize the role of cultural, economic, and institutional factors in shaping public responses during health crises. Conclusions: Crisis communication is influenced by cultural, economic, and institutional contexts, as evidenced by regional variations in citizen engagement. Transparent and culturally adaptive communication strategies are essential to combat misinformation and build public trust. This study highlights the importance of tailoring crisis responses to local contexts to improve compliance and collective resilience. %M 39869893 %R 10.2196/58656 %U https://www.jmir.org/2025/1/e58656 %U https://doi.org/10.2196/58656 %U http://www.ncbi.nlm.nih.gov/pubmed/39869893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e52043 %T Parental Mental Health and Child Maltreatment in the COVID-19 Pandemic: Importance of Sampling in a Quantitative Statistical Study %A Engelke,Lara %A Calvano,Claudia %A Pohl,Steffi %A Winter,Sibylle Maria %A Renneberg,Babette %+ Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany, 49 30 838 76522, engelke.l@fu-berlin.de %K COVID-19 %K parental stress %K parental mental health %K child maltreatment %K data collection methods %K web-based surveys %K convenience sample %K sampling methods %D 2025 %7 24.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Results on parental burden during the COVID-19 pandemic are predominantly available from nonrepresentative samples. Although sample selection can significantly influence results, the effects of sampling strategies have been largely underexplored. Objective: This study aimed to investigate how sampling strategy may impact study results. Specifically, we aimed to (1) investigate if outcomes on parental health and child maltreatment during the COVID-19 pandemic from a convenience sample differ from those of a specific representative sample and (2) investigate reasons for differences in the results. Methods: In 2020, we simultaneously conducted 2 studies: (1) a web-based survey using a convenience sample of 4967 parents of underage children, primarily recruited via social media, and (2) a study using a quota sample representative of the German adult population with underage children (N=1024), recruited through a combination of telephone interviews and computer-assisted web interviews. In both studies, the same questionnaire was used. To evaluate the impact of sampling, we compared the results on outcomes (parental stress, subjective health, parental mental health, general stress, pandemic-related stress, and the occurrence of child maltreatment) between the 2 samples. To explain differences in the results between the 2 studies, we controlled for sociodemographic data, parent-related risk factors, and COVID-19–related experiences. Results: Compared to parents from the quota sample, parents from the convenience sample reported significantly more parental stress (η2=0.024); decreased subjective health (η2=0.016); more anxiety and depression symptoms (η2=0.055); more general stress (η2=0.044); more occurrences of verbal emotional abuse (VEA; φ=0.12), witnessing domestic violence (WDV; φ=0.13), nonverbal emotional abuse (NEA; φ=0.03), physical abuse (φ=0.10), and emotional neglect (φ=0.06); and an increase of child maltreatment (VEA: exp(B)=2.95; WDV: exp(B)=3.19; NEA: exp(B)=1.65). Sociodemographic data, parent-related risk factors, and COVID-19–related experiences explained the differences in parental stress (remaining difference between samples after controlling for covariates: η2=0.002) and subjective health (remaining difference between samples after controlling for covariates: η2=0.004) and partially explained differences in parental mental health (remaining: η2=0.016), general stress (remaining: η2=0.014), and child maltreatment (remaining: VEA: exp(B)=2.05 and WDV: exp(B)=2.02) between the 2 samples. The covariates could not explain the difference in NEA (exp(B)=1.70). We discuss further factors that may explain the unexplained differences. Conclusions: Results of studies can be heavily impacted by the sampling strategy. Scientists are advised to collect relevant explaining variables (covariates) that are possibly related to sample selection and the outcome under investigation. This approach enables us to identify the individuals to whom the results apply and to combine findings from different studies. Furthermore, if data on the distribution of these explanatory variables in the population are available, it becomes possible to adjust for sample selection bias. %M 39854726 %R 10.2196/52043 %U https://www.jmir.org/2025/1/e52043 %U https://doi.org/10.2196/52043 %U http://www.ncbi.nlm.nih.gov/pubmed/39854726 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62943 %T Supervised and Unsupervised Screen Time and Its Association With Physical, Mental, and Social Health of School-Going Children in Dhaka, Bangladesh: Cross-Sectional Study %A Kakon,Shahria Hafiz %A Soron,Tanjir Rashid %A Hossain,Mohammad Sharif %A Haque,Rashidul %A Tofail,Fahmida %K screen time %K parental supervision %K Strength and Difficulties Questionnaire %K Spencer Children Anxiety Scale %K Pittsburgh Sleep Quality Scale %K children %K sleep quality %K headache %K behavioral problems %D 2025 %7 14.1.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Children’s screen time has substantially increased worldwide, including in Bangladesh, especially since the pandemic, which is raising concern about its potential adverse effects on their physical, mental, and social health. Parental supervision may play a crucial role in mitigating these negative impacts. However, there is a lack of empirical evidence assessing the relationship between parental screen time supervision and health outcomes among school children in Dhaka, Bangladesh. Objective: We aimed to explore the association between supervised and unsupervised screen time on the physical, mental, and social health of school-going children in Dhaka, Bangladesh. Methods: We conducted a cross-sectional descriptive study between July 2022 and June 2024. A total of 420 children, aged 6‐14 years, were enrolled via the stratified random sampling method across three English medium and three Bangla medium schools in Dhaka. Data were collected through a semistructured questionnaire; anthropometry measurements; and the Bangla-validated Strength and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI) Scale, and Spencer Children Anxiety Scale (SCAS). Results: A total of 234 out of 420 students (56%) used digital screen devices without parental supervision. We did not find a substantial difference in the duration of the daily mean use of digital devices among the supervised students (4.5 hours, SD 2.2 hours) and the unsupervised students (4.6 hours, SD 2.4 hours). According to the type of school, English medium school children had a mean higher screen time (5.46 hours, SD 2.32 hours) compared to Bangla medium school children (3.67 hours, SD 2.00 hours). Headache was significantly higher among the unsupervised digital screen users compared to those who used digital screens with parental supervision (175/336 students, 52.1% versus 161/336 students, 47.9%; P<.003). Moreover, students who used digital screens without parental supervision had poor quality of sleep. Behavioral problems such as conduct issues (119/420 students, 28.3%) and peer difficulties (121/420 students, 28.8%) were observed among the participants. However, when comparing supervised and unsupervised students, we found no statistically significant differences in the prevalence of these issues. Conclusions: The findings of the study showed that the lack of screen time supervision is associated with negative health effects in children. The roles of various stakeholders, including schools, parents, policy makers, and students themselves, are crucial in developing effective guidelines for managing screen use among students. Further research is needed to demonstrate causal mechanisms; identify the best interventions; and determine the role of mediators and moderators in households, surroundings, and schools. %R 10.2196/62943 %U https://pediatrics.jmir.org/2025/1/e62943 %U https://doi.org/10.2196/62943 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67627 %T Trends in Mental Health Outcomes of College Students Amid the Pandemic (Roadmap mHealth App): Longitudinal Observational Study %A Jayaraj,Gautham %A Cao,Xiao %A Horwitz,Adam %A Rozwadowski,Michelle %A Shea,Skyla %A Hanauer,Shira N %A Hanauer,David A %A Tewari,Muneesh %A Shedden,Kerby %A Choi,Sung Won %+ Department of Pediatrics, Medical School, University of Michigan, 1200 E Hospital Dr, Medical Professional Building D4115, Ann Arbor, MI, 48109, United States, 1 734 615 5707, sungchoi@med.umich.edu %K mHealth %K college %K student %K mental health %K positive psychology %K flourishing %K COVID-19 %K wellbeing %K mobile phone %K SARS-CoV-2 %K coronavirus %K pandemic %K COVID %K app %K digital health %K smartphone %K eHealth %K telehealth %K telemedicine %K longitudinal %K higher education %K depression %K anxiety %K loneliness %D 2025 %7 9.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The mental health crisis among college students intensified amid the COVID-19 pandemic, suggesting an urgent need for innovative solutions to support them. Previous efforts to address mental health concerns have been constrained, often due to the underuse or shortage of services. Mobile health (mHealth) technology holds significant potential for providing resilience-building support and enhancing access to mental health care. Objective: This study aimed to examine the trends in mental health and well-being outcomes over 3 years among college students, with an exploratory aim to assess the potential impact of the Roadmap mHealth app on these outcomes. Methods: A fully automated longitudinal observational study was conducted remotely from a large public academic institution in the Midwestern United States, evaluating mental health and well-being outcomes among college students using the Roadmap mHealth app over 3 fall semesters from 2020 to 2022. The study enrolled 2164 college students in Year I, with 1128 and 1033 students returning in Years II and III, respectively. Participants completed various self-reported measures, including the Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 for anxiety, and additional metrics for coping, flourishing, and loneliness. Results: The findings indicated an evolving trajectory in students’ mental health. In Year I, depression and anxiety levels were higher compared with levels reported between 2014 and 2019, remaining stable into Year II. However, significant decreases were noted by Year III for both depression (Year I mean 7.78, SD 5.65 vs Year III mean 6.21, SD 4.68; t108=–2.90; P=.01) and anxiety (Year I mean 6.61, SD 4.91 vs Year III mean 5.62, SD 4.58; t116=–2.02; P=.046). Problem-focused coping decreased initially from Year I (mean 2.46, SD 0.58) to Year II (mean 2.36, SD 0.60; t1073=–5.87; P<.001), then increased by Year III (mean 2.40, SD 0.63; t706=2.26; P=.02). Emotion-focused (Year I mean 2.33, SD 0.41 vs Year III mean 2.22, SD 0.47; t994=–7.47; P<.001) and avoidant coping (Year I mean 1.76, SD 0.37 vs Year III mean 1.65, SD 0.38; t997=–8.53; P=.02) consistently decreased. Loneliness significantly decreased from Year I (mean 5.79, SD 1.74) to Year III (mean 5.17, SD 1.78; t1013=–10.74; P<.001), accompanied by an increase in flourishing from Year I (mean 63.78, SD 14.76) to Year III (mean 66.98, SD 15.06; t994=7.22; P<.001). Analysis of app usage indicated that the positive piggy bank and gratitude journal were the favored activities. Greater engagement with the app was positively correlated with enhanced flourishing, even after adjusting for demographic and sociobehavioral factors (β=.04, SE .016; t3974=2.17; P=.03). Conclusions: In this study, students’ mental health and well-being improved, with notable reductions in depression, anxiety, and loneliness, associated with an increase in flourishing. The app did not appear to worsen students’ mental health. Based on the usage pattern, it is possible the app enhanced positive psychology-based practices. Future research should explore the efficacy of mHealth interventions through randomized controlled trials to further understand their impact on college students’ mental health outcomes. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): RR2-10.2196/29561 %M 39787592 %R 10.2196/67627 %U https://www.jmir.org/2025/1/e67627 %U https://doi.org/10.2196/67627 %U http://www.ncbi.nlm.nih.gov/pubmed/39787592 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46497 %T Mental Health Benefits of Listening to Music During COVID-19 Quarantine: Cross-Sectional Study %A Xian,Xuechang %A Zhang,Xiaoran %A Zheng,Danhe %A Wang,Yanlin %K COVID-19 %K quarantine %K social connectedness %K sense of security %K mental well-being %K cross-sectional study %K contagion %K treatment %K music %K security %K mental health %K questionnaire %K China %K intervention %K relaxation %K meditation %K mental illness %K stimuli %K environmental %D 2024 %7 16.12.2024 %9 %J JMIR Form Res %G English %X Background: COVID-19 has posed a significant global threat to public health due to its high contagion risk and lack of effective treatment. While quarantine measures have been crucial in controlling the virus’ spread, they have also contributed to negative impacts on individuals’ mental health. Music listening has emerged as a potential coping mechanism, yet it remains unclear whether mental well-being varies across music preferences. Objective: This study examined individuals’ music-listening preferences in the context of COVID-19 quarantine and assessed the mediation pathways linking 5 types of music to mental health levels, mediated by perceived social connectedness as well as sense of security. Methods: A web-based survey was conducted among people with quarantine experience in September 2022, in mainland China. A total of 712 valid questionnaires were returned and 596 samples were finally included in our study for mediation analysis. Results: The results revealed that the vast majority (596/623, 96%) of respondents had music-listening experiences during the COVID-19 quarantine, with pop music emerging as the most popular preference among respondents, while quyi was the least listened-to genre. Additionally, listening to music across 5 different genres appeared as a significant parameter indirectly linked to mental health through perceived social connectedness. Specifically, engaging with quyi was associated with higher levels of perceived social connectedness and sense of security, which in turn correlated with improved mental well-being. Conversely, individuals listening to jazz reported lower social connectedness and sense of security, which was subsequently linked to increased mental health problems. The potential reasons for these findings and implications are discussed. Conclusions: This study significantly contributes to the understanding of the mechanisms behind music-listening preferences in stressful environments. Specifically, our findings highlight the mediating roles of perceived social connectedness and sense of security in the relationship between music preferences and mental health outcomes during the quarantine period. These insights provide valuable guidance for developing interventions that use music to enhance mental health, thereby broadening the scope of studies on environmental stimuli and their impact on mental well-being. %R 10.2196/46497 %U https://formative.jmir.org/2024/1/e46497 %U https://doi.org/10.2196/46497 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53522 %T Investigating the Associations Between COVID-19, Long COVID, and Sleep Disturbances: Cross-Sectional Study %A Shao,Heng %A Chen,Hui %A Xu,Kewang %A Gan,Quan %A Chen,Meiling %A Zhao,Yanyu %A Yu,Shun %A Li,Yutong Kelly %A Chen,Lihua %A Cai,Bibo %K COVID-19 %K long COVID %K sleep disturbances %K psychological outcomes %K socioeconomic factors %K cross-sectional study %D 2024 %7 13.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: COVID-19 has not only resulted in acute health issues but also led to persistent symptoms known as long COVID, which have been linked to disruptions in sleep quality. Objective: This study aims to investigate the associations between COVID-19, long COVID, and sleep disturbances, focusing on demographic, socioeconomic, and psychological factors among a Chinese population. Methods: This cross-sectional study included 1062 participants from China. Demographic, socioeconomic, and clinical data were collected through web-based questionnaires. Participants were divided into 2 groups based on COVID-19 infection status: infected and noninfected. Within the infected group, participants were further categorized into those with long COVID and those without long COVID. Noninfected participants were included in the non–long COVID group for comparison. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while depression and anxiety were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scales, respectively. Multivariable linear regression was conducted to examine the associations between COVID-19, long COVID, and sleep quality, adjusting for demographic and psychosocial factors. Results: COVID-19 infection was confirmed in 857 participants, with 273 of them developing long COVID. No significant sex disparities were observed in infection rates (P=.63). However, a marginal statistical difference was noted in the prevalence of long COVID among females (P=.051). Age was significantly associated with both infection rates (P<.001) and long COVID (P=.001). Participants aged 60‐70 years were particularly vulnerable to both outcomes. Sleep latency was significantly longer in the infected group (mean 1.73, SD 0.83) compared to the uninfected group (mean 1.57, SD 0.78; P=.01), and PSQI scores were higher (mean 8.52, SD 4.10 vs. 7.76, SD 4.31; P=.02). Long COVID participants had significantly worse sleep outcomes across all metrics (P<.001), except for sleep medication use (P=.17). Conclusions: Our findings indicate that long COVID is strongly associated with significant sleep disturbances, while initial COVID-19 infection shows a more moderate association with sleep issues. Long COVID–related sleep disturbances were exacerbated by factors such as age, income, and chronic health conditions. The study highlights the need for targeted interventions that address the multifaceted impacts of long COVID on sleep, especially among vulnerable groups such as older adults and those with lower socioeconomic status. Future research should use longitudinal designs to better establish the temporal relationships and causal pathways between COVID-19 and sleep disturbances. %R 10.2196/53522 %U https://publichealth.jmir.org/2024/1/e53522 %U https://doi.org/10.2196/53522 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e47856 %T Relationship Between Perceived COVID-19 Risk and Change in Perceived Breast Cancer Risk: Prospective Observational Study %A Baxter-King,Ryan %A Naeim,Arash %A Huang,Tina Q %A Sepucha,Karen %A Stanton,Annette %A Rudkin,Aaron %A Ryu,Rita %A Sabacan,Leah %A Vavreck,Lynn %A Esserman,Laura %A Stover Fiscalini,Allison %A Wenger,Neil S %+ Division of General Internal Medicine and Health Services Research, UCLA, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, United States, 1 3107942288, nwenger@mednet.ucla.edu %K breast cancer %K COVID-19 risk perception %K cancer screening %K anxiety %K cancer %K COVID-19 %K prevention %K medical care %K screening %K survey %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Whether COVID-19 is associated with a change in risk perception about other health conditions is unknown. Because COVID-19 occurred during a breast cancer study, we evaluated the effect of COVID-19 risk perception on women’s breast cancer risk perception. Objective: This study aims to evaluate the relationship between perceived risk of COVID-19 and change in perceived breast cancer risk. We hypothesized that women who perceived greater COVID-19 risk would evidence increased perceived breast cancer risk and this risk would relate to increased anxiety and missed cancer screening. Methods: Women aged 40-74 years with no breast cancer history were enrolled in a US breast cancer prevention trial in outpatient settings. They had provided breast cancer risk perception and general anxiety before COVID-19. We performed a prospective observational study of the relationship between the perceived risk of COVID-19 and the change in perceived breast cancer risk compared to before the pandemic. Each woman was surveyed up to 4 times about COVID-19 and breast cancer risk perception, general anxiety, and missed medical care early in COVID-19 (May to December 2020). Results: Among 13,002 women who completed a survey, compared to before COVID-19, anxiety was higher during COVID-19 (mean T score 53.5 vs 49.7 before COVID-19; difference 3.8, 95% CI 3.6-4.0; P<.001) and directly related to perceived COVID-19 risk. In survey wave 1, anxiety increased by 2.3 T score points for women with very low perceived COVID-19 risk and 5.2 points for those with moderately or very high perceived COVID-19 risk. Despite no overall difference in breast cancer risk perception (mean 32.5% vs 32.5% before COVID-19; difference 0.24, 95% CI –0.47 to 0.52; P=.93), there was a direct relationship between change in perceived breast cancer risk with COVID-19 risk perception, ranging in survey wave 4 from a 2.4% decrease in breast cancer risk perception for those with very low COVID-19 risk perception to a 3.4% increase for women with moderately to very high COVID-19 risk perception. This was not explained by the change in anxiety or missed cancer screening. After adjustment for age, race, education, and survey wave, compared to women with very low perceived COVID-19 risk, perceived breast cancer risk increased by 1.54% (95% CI 0.75%-2.33%; P<.001), 4.28% (95% CI 3.30%-5.25%; P<.001), and 3.67% (95% CI 1.94%-5.40%; P<.001) for women with moderately low, neither high nor low, and moderately or very high perceived COVID-19 risk, respectively. Conclusions: Low perceived COVID-19 risk was associated with reduced perceived breast cancer risk, and higher levels of perceived COVID-19 risk were associated with increased perceived breast cancer risk. This natural experiment suggests that a threat such as COVID-19 may have implications beyond the pandemic. Preventive health behaviors related to perceived risk may need attention as COVID-19 becomes endemic. %M 39622037 %R 10.2196/47856 %U https://cancer.jmir.org/2024/1/e47856 %U https://doi.org/10.2196/47856 %U http://www.ncbi.nlm.nih.gov/pubmed/39622037 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53767 %T Evaluation and Future Challenges in a Self-Guided Web-Based Intervention With and Without Chat Support for Depression and Anxiety Symptoms During the COVID-19 Pandemic: Randomized Controlled Trial %A Dominguez-Rodriguez,Alejandro %A Sanz-Gomez,Sergio %A González Ramírez,Leivy Patricia %A Herdoiza-Arroyo,Paulina Erika %A Trevino Garcia,Lorena Edith %A de la Rosa-Gómez,Anabel %A González-Cantero,Joel Omar %A Macias-Aguinaga,Valeria %A Arenas Landgrave,Paulina %A Chávez-Valdez,Sarah Margarita %+ School of Medicine and Health Sciences, Tecnologico de Monterrey, Avenue Gral Ramón Corona #2514, Colonia Nuevo México, Zapopan, 45201, Mexico, 52 3336693000, leivy@tec.mx %K self-guided web-based intervention %K chat support %K depression %K anxiety %K COVID-19 %K opinion %K usability %K randomized control trial %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has had an impact on mental health worldwide. Low- and middle-income countries were largely affected by it. Mexico was one of the most affected countries. Extended periods of lockdowns, isolation, and social distancing, among other factors, highlighted the need to introduce web-based psychological interventions to the Mexican population. In this context, Mental Health COVID-19 emerged as a self-guided web-based intervention (SGWI) aimed at adults to improve mental health during the COVID-19 pandemic. Objective: This study aims to assess the efficacy of 2 modalities of a self-guided intervention (with and without chat support) in reducing depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation. In addition, it aimed to compare the moderating role of coping strategies, acceptance, and satisfaction in participants’ symptom reduction. We hypothesize that the self-guided, chat-supported modality will show higher efficacy than the modality without chat support in achieving clinical change and better performance as a moderator of depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation, as well as an increase in participants’ satisfaction and acceptability. Methods: A randomized controlled trial was conducted. Data were collected from May 2020 to June 2022. We performed intrasubject measures at 4 evaluation periods: pretest, posttest, and follow-up measurements at 3 and 6 months. Differences between intervention groups were assessed through the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Changes due to intervention were analyzed using Wilcoxon W test. Moderated regression analysis was performed to test the hypothesized moderating role of coping strategies, usability, and opinion about treatment on clinical change. Results: A total of 36 participants completed the intervention; of these, 5 (14%) were part of the SGWI group, and 31 (86%) were on the SGWI plus chat support (SGWI+C) group, which included a chat service with therapists. The perceived high complexity of the system for the SGWI group had a moderating effect associated with a lack of efficacy of the intervention regarding depression, but not when controlled for sociodemographic variables. A perception of lower helpfulness of the intervention was associated with poorer outcomes. Coping strategies did not show moderating effects. Conclusions: Enhancing the utility of web-based interventions for reducing clinical symptoms by incorporating a support chat to boost treatment adherence seemed to improve the perception of the intervention’s usefulness. Web-based interventions face several challenges, such as eliminating complexities in platform use and increasing the users’ perceived utility of the intervention, among other issues identified in the study. Trial Registration: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/study/NCT04468893?tab=results International Registered Report Identifier (IRRID): RR2-10.2196/23117 %M 39348893 %R 10.2196/53767 %U https://formative.jmir.org/2024/1/e53767 %U https://doi.org/10.2196/53767 %U http://www.ncbi.nlm.nih.gov/pubmed/39348893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45530 %T Messenger Use and Video Calls as Correlates of Depressive and Anxiety Symptoms: Results From the Corona Health App Study of German Adults During the COVID-19 Pandemic %A Edler,Johanna-Sophie %A Terhorst,Yannik %A Pryss,Rüdiger %A Baumeister,Harald %A Cohrdes,Caroline %+ Mental Health Research Unit, Department of Epidemiology and Health Monitoring, Robert Koch Institute, PO Box 650261, Berlin, 12101, Germany, 49 30187542692, cohrdesc@rki.de %K passive data %K depression %K anxiety %K predicting mental health %K mobile phone %D 2024 %7 16.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Specialized studies have shown that smartphone-based social interaction data are predictors of depressive and anxiety symptoms. Moreover, at times during the COVID-19 pandemic, social interaction took place primarily remotely. To appropriately test these objective data for their added value for epidemiological research during the pandemic, it is necessary to include established predictors. Objective: Using a comprehensive model, we investigated the extent to which smartphone-based social interaction data contribute to the prediction of depressive and anxiety symptoms, while also taking into account well-established predictors and relevant pandemic-specific factors. Methods: We developed the Corona Health App and obtained participation from 490 Android smartphone users who agreed to allow us to collect smartphone-based social interaction data between July 2020 and February 2021. Using a cross-sectional design, we automatically collected data concerning average app use in terms of the categories video calls and telephony, messenger use, social media use, and SMS text messaging use, as well as pandemic-specific predictors and sociodemographic covariates. We statistically predicted depressive and anxiety symptoms using elastic net regression. To exclude overfitting, we used 10-fold cross-validation. Results: The amount of variance explained (R2) was 0.61 for the prediction of depressive symptoms and 0.57 for the prediction of anxiety symptoms. Of the smartphone-based social interaction data included, only messenger use proved to be a significant negative predictor of depressive and anxiety symptoms. Video calls were negative predictors only for depressive symptoms, and SMS text messaging use was a negative predictor only for anxiety symptoms. Conclusions: The results show the relevance of smartphone-based social interaction data in predicting depressive and anxiety symptoms. However, even taken together in the context of a comprehensive model with well-established predictors, the data only add a small amount of value. %M 39283658 %R 10.2196/45530 %U https://www.jmir.org/2024/1/e45530 %U https://doi.org/10.2196/45530 %U http://www.ncbi.nlm.nih.gov/pubmed/39283658 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59171 %T Psychological Interventions and Those With Elements of Positive Psychology for Child and Youth Mental Health During the COVID-19 Pandemic: Literature Review, Lessons Learned, and Areas for Future Knowledge Dissemination %A Lyzwinski,Lynnette %A Zwicker,Jennifer D %A Mcdonald,Sheila %A Tough,Suzanne %+ Department of Pediatrics, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N4N1, Canada, 1 1 403 220 6843, lynnette.lyzwinski@ucalgary.ca %K positive psychology %K mindfulness %K resilience %K mental health %K flourishing %K knowledge translation %K depression %K anxiety %K stress %D 2024 %7 13.9.2024 %9 Review %J JMIR Pediatr Parent %G English %X Background: There was a marked decline in child and teenage mental health worldwide during the pandemic, with increasing prevalence of depression, anxiety, and suicide. Research indicates that positive psychological interventions may be beneficial for mental health. Objective: The aims of this review were to evaluate positive psychological interventions for child and youth mental health implemented during the COVID-19 pandemic and assess overall effectiveness for mental health and knowledge. Methods: We undertook a literature search of PubMed, MEDLINE, and Google Scholar for all eligible studies on digital and hybrid in-person psychological interventions for youth mental health during the COVID-19 pandemic. A particular emphasis was placed on positive psychological interventions or interventions that had components of positive psychology, including gratitude, acceptance, positive emotions, or resilience building. Results: A total of 41 interventions were included in this review. Most of the interventions were digital. Overall, most of the interventions assisted with one or more mental health or psychological indicators, such as depression, anxiety, posttraumatic stress disorder, stress, and resilience. However, findings were mixed when it came to targeting both depression and anxiety together. The interventions that promoted youth mental health most often had a range of diverse positive psychology components and were evidence based. Not all studies measured changes in mindfulness. Few studies examined knowledge acquired on mental health self-care, managing mental health problems, knowledge of positive psychological techniques, mindfulness knowledge, or mental health self-efficacy. Conclusions: Diverse multicomponent interventions appear to assist with youth mental health overall, although their effects on both depression and anxiety are less clear. There is also a need for more research on knowledge gains to determine whether the interventions improved knowledge on mental health–supportive behaviors, which may be sustained beyond the intervention. Finally, more studies need to evaluate whether the interventions assisted with increasing self-efficacy for practicing positive psychological techniques as well as changes in mindfulness levels. Future studies should not only assess effectiveness for mental health outcomes but also assess knowledge translation, with valid measures of knowledge and self-efficacy for mental health–supportive behaviors and positive psychological skills acquired (eg, the ability to practice mindfulness). %M 39269752 %R 10.2196/59171 %U https://pediatrics.jmir.org/2024/1/e59171 %U https://doi.org/10.2196/59171 %U http://www.ncbi.nlm.nih.gov/pubmed/39269752 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52978 %T COVID-19–Related Social Isolation, Self-Control, and Internet Gaming Disorder Among Chinese University Students: Cross-Sectional Survey %A Guo,Yufang %A Yue,Fangyan %A Lu,Xiangyu %A Sun,Fengye %A Pan,Meixing %A Jia,Yannan %+ School of Nursing and Rehabilitation, Shandong University, 44 Wen Hua Xi Road, Jinan, 250012, China, 86 15269163352, cdguoyufang@163.com %K COVID-19 pandemic %K internet gaming disorder %K self-control %K social isolation %K university students %K game %K gaming %K games %K addict %K addictive %K addiction %K addictions %K university %K universities %K college %K colleges %K postsecondary %K higher education %K student %K students %K China %K Chinese %K isolation %K isolated %K self-compassion %K mental health %K association %K associations %K correlation %K causal %K correlated %K correlations %D 2024 %7 10.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet gaming disorder among university students has become a great concern for university counsellors worldwide since the COVID-19 pandemic. The factors influencing the development of internet gaming disorder in students during the COVID-19 pandemic could be different from those before the pandemic. Objective: This study aims to explore the associations among social isolation, self-control, and internet gaming disorder in Chinese university students and to examine whether self-control mediates the positive effects of social isolation on internet gaming disorder. Methods: A cross-sectional survey was employed to collect data from university students in Shandong province of China from April to September 2022. The Isolation subscale of the Self-Compassion Scale, Self-Control Scale, and Internet Gaming Disorder Scale were used to assess the social isolation, self-control, and internet gaming disorder among university students, respectively. Models 4 and 5 of PROCESS software were used to analyze the mediating role of self-control and the moderating role of gender on the association between social isolation and internet gaming disorder. Results: A total of 479 students were recruited from 6 universities located in 3 different regions of Shandong, China. Students had low levels of internet gaming disorder and moderate levels of social isolation and self-control, with mean scores of 8.94 (SD 9.06), 12.04 (SD 3.53), and 57.15 (SD 8.44), respectively. Social isolation was positively correlated with internet gaming disorder (r=0.217; P<.001), and self-control was negatively correlated with social isolation (r=–0.355; P<.001) and internet gaming disorder (r=–0.260; P<.001). Self-control played a mediating role in the association between social isolation and internet gaming disorder (β=–.185, 95% CI –.295 to –.087). The effects of social isolation on internet gaming disorder among female students were lower than those among male students. Conclusions: Self-control was a mediator in the association between social isolation and internet gaming disorder. Moreover, gender played a moderating role in the association between social isolation and internet gaming disorder. This study highlights the need to alleviate the development of internet gaming disorder among students during a pandemic, especially that of male students. Effective interventions that lessen social isolation and promote self-control should be developed. %M 39255486 %R 10.2196/52978 %U https://www.jmir.org/2024/1/e52978 %U https://doi.org/10.2196/52978 %U http://www.ncbi.nlm.nih.gov/pubmed/39255486 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51653 %T Loneliness and Social Isolation Factors Under the Prolonged COVID-19 Pandemic in Japan: 2-Year Longitudinal Study %A Sugaya,Nagisa %A Yamamoto,Tetsuya %A Suzuki,Naho %A Uchiumi,Chigusa %+ National Institute of Occupational Safety and Health, Japan, 6-21-1 Nagao,Tama-ku, Kawasaki, 214-8585, Japan, 81 44 865 6111 ext 8568, sugaya-nagisa@h.jniosh.johas.go.jp %K COVID-19 %K pandemic %K loneliness %K social isolation %K longitudinal survey %K epidemiology %K mental health %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Worsening loneliness and social isolation during the COVID-19 pandemic have become serious public health concerns worldwide. Despite previous research reporting persistent loneliness and social isolation under repeated emergency declarations and prolonged pandemics, long-term studies are needed to identify the actual conditions of loneliness and social isolation, and the factors that explain them. Objective: In this study, 3 web-based surveys were conducted at 1-year intervals during the 2 years after the first state of emergency to examine changes in loneliness and social isolation and the psychosocial factors associated with them in the Japanese population. Methods: The first survey (phase 1, May 11-12, 2020) was conducted at the end of the first emergency declaration period, the second survey (phase 2, June 14-20, 2021) was conducted at the end of the third emergency declaration period, and the third survey (phase 3, May 13-30, 2022) was conducted when the state of emergency had not been declared but many COVID-19–positive cases occurred during this period. We collected data on 3892 inhabitants (n=1813, 46.58% women; age: mean 50.3, SD 13.4 y) living in the 4 prefectures where emergency declaration measures were applied in phases 1 and 2. A linear mixed model analysis was performed to examine the association between psychosocial variables as explanatory variables and loneliness scores as the dependent variable in each phase. Results: While many psychosocial and physical variables showed improvement for the 2 years, loneliness, social isolation, and the relationship with familiar people deteriorated, and the opportunities for exercise, favorite activities, and web-based interaction with familiar people decreased. Approximately half of those experiencing social isolation in phase 1 remained isolated throughout the 2-year period, and a greater number of people developed social isolation than those who were able to resolve it. The results of the linear mixed model analysis showed that most psychosocial and physical variables were related to loneliness regardless of the phase. Regarding the variables that showed a significant interaction with the phase, increased altruistic preventive behavior and a negative outlook for the future were more strongly associated with severe loneliness in phase 3 (P=.01 to <.001), while the association between fewer social networks and stronger loneliness tended to be more pronounced in phase 2. Although the interaction was not significant, the association between reduced face-to-face interaction, poorer relationships with familiar people, and increased loneliness tended to be stronger in phase 3. Conclusions: This study found that loneliness and social isolation remained unresolved throughout the long-term COVID-19 pandemic. Additionally, in the final survey phase, these issues were influenced by a broader and more complex set of factors compared to earlier phases. %M 39250195 %R 10.2196/51653 %U https://publichealth.jmir.org/2024/1/e51653 %U https://doi.org/10.2196/51653 %U http://www.ncbi.nlm.nih.gov/pubmed/39250195 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50071 %T Effectiveness of a Smartphone-Based Stress Management Program for Depression in Hospital Nurses During COVID-19 in Vietnam and Thailand: 2-Arm Parallel-Group Randomized Controlled Trial %A Watanabe,Kazuhiro %A Tran,Thuy Thi Thu %A Sripo,Narisara %A Sakuraya,Asuka %A Imamura,Kotaro %A Boonyamalik,Plernpit %A Sasaki,Natsu %A Tienthong,Thanate %A Asaoka,Hiroki %A Iida,Mako %A Nguyen,Quynh Thuy %A Nguyen,Nga Thi %A Vu,Son Thai %A Ngo,Thuy Thi %A Luyen,Tham Thi %A Nguyen,Long Duc %A Nguyen,Nga Thi Viet %A Nguyen,Binh Thanh %A Matsuyama,Yutaka %A Takemura,Yukie %A Nishi,Daisuke %A Tsutsumi,Akizumi %A Nguyen,Huong Thanh %A Kaewboonchoo,Orawan %A Kawakami,Norito %+ Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 5800 9621, nkawakami@m.u-tokyo.ac.jp %K digital mental health intervention %K unguided program %K universal prevention %K health care workers %K nurses %K COVID-19 %K depression %K mobile phone %D 2024 %7 30.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, health care professionals experienced high levels of depression. However, extant research has not highlighted effective internet-based psychological interventions to improve the mental health in this population during the pandemic. It remains unclear whether self-guided, internet-based cognitive behavioral therapy (iCBT) programs are effective in improving the mental health of health care workers during the COVID-19 pandemic. Objective: The aim of this study was to evaluate the effectiveness of a smartphone-based iCBT stress management program for reducing the depression experienced by nurses in Vietnam and Thailand. Methods: From March to April 2022, a 2-arm, parallel-group randomized controlled trial was implemented. One arm offered a 7-week self-guided iCBT program, and the other offered treatment as usual as a control arm. Full-time nurses were recruited from 6 hospitals: 2 hospitals in Vietnam and 4 hospitals in Thailand. The primary outcome of this program was the severity of depression measured by the Depression Anxiety Stress Scale-21 items. Follow-up surveys were conducted to measure the change in depression severity at 3 months (July-August 2022) and at 6 months (October-November 2022) after baseline. Mixed modeling for repeated measures was used to test the effects of the intervention compared with the control for the follow-up. Results: A total of 1203 nurses were included in this study: 602 in the intervention group and 601 in the control group. The follow-up rate at 3 and 6 months ranged from 85.7% (515/601) to 87.5% (527/602). The completion rate for the program was 68.1% (410/602). The group difference in depression was significant at the 3-month follow-up (coefficient=–0.92, 95% CI –1.66 to –0.18; P=.02) and nonsignificant at the 6-month follow-up (coefficient=–0.33, 95% CI –1.11 to 0.45; P=.41). The estimated effect sizes were –0.15 and –0.06 at the 3- and 6-month follow-ups, respectively. Conclusions: Our study shows that the smartphone-based iCBT program was effective in reducing depression at the 3-month follow-up among hospital nurses in Vietnam and Thailand during the COVID-19 pandemic. However, the effect size was small, and therefore, these results may not be clinically meaningful. Trial Registration: UMIN Clinical Trials Registry UMIN000044145; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050128 International Registered Report Identifier (IRRID): RR2-10.20944/preprints202303.0450.v1 %M 39213033 %R 10.2196/50071 %U https://www.jmir.org/2024/1/e50071 %U https://doi.org/10.2196/50071 %U http://www.ncbi.nlm.nih.gov/pubmed/39213033 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e45689 %T Health and Well-Being Among College Students in the United States During the COVID-19 Pandemic: Daily Diary Study %A Lanza,Stephanie T %A Whetzel,Courtney %A Bhandari,Sandesh %+ Department of Biobehavioral Health, The Pennsylvania State University, 302 Biobehavioral Health Building, University Park, PA, 16802, United States, 1 814 865 7095, SLanza@psu.edu %K daily diary %K college student %K young adult %K mental health %K substance use %K stress %K well-being %K belonging %D 2024 %7 23.8.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: There is evidence that anxiety and stress increased among college students during the COVID-19 pandemic. However, less is known about daily experiences of affect, worry, substance use behaviors, experiences of pleasure, concern over food security, experiences of bias or discrimination, feelings of belongingness, and other indicators of well-being and how they vary across days in this population. Objective: This study surveyed a wide range of indicators of health and well-being in daily life over 21 days with a sample of college students in a large university system in the United States during the pandemic. The overall variance in each daily measure was partitioned to reflect the proportion due to (1) between-person differences versus (2) within-person, day-to-day variability. This is important because measures that vary primarily due to between-person differences may be more amenable to interventions that target particular students, whereas measures that vary more due to day-to-day variability may be more amenable to interventions that target day-level contextual factors. Methods: A sample of 2068 young adult college students (aged 18-24, mean 19.8, SD 1.3 years; 66.6% women) completed a baseline survey; 97.3% (n=2012) then completed up to 21 consecutive daily surveys that assessed a comprehensive set of daily markers of health, behavior, and well-being. The daily diary study produced a total of 33,722 person-days. Results: Among all person-days, a minority were substance use days (eg, 14.5% of days involved alcohol use, 5.6% vaping, and 5.5% cannabis). Experiences of pleasure were reported on most (73.5%) days. Between-person differences explained more than 50% of the variance in numerous indicators of health and well-being, including daily vaping, cannabis use, other illicit substance use, experiences of bias or discrimination, positive affect, negative affect, worry, food insecurity, and feelings of belonging at the university. In contrast, within-person differences explained more than 50% of the variance in daily alcohol use, cigarette use, stress, experiences of pleasure, where the student slept last night, and physical activity. Conclusions: College student health and well-being are multifaceted, with some aspects likely driven by person-level characteristics and experiences and other aspects by more dynamic, contextual risk factors that occur in daily life. These findings implicate services and interventions that should target individual students versus those that should target days on which students are at high risk for poor experiences or behaviors. %M 39178037 %R 10.2196/45689 %U https://www.i-jmr.org/2024/1/e45689 %U https://doi.org/10.2196/45689 %U http://www.ncbi.nlm.nih.gov/pubmed/39178037 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48907 %T Identifying Reddit Users at a High Risk of Suicide and Their Linguistic Features During the COVID-19 Pandemic: Growth-Based Trajectory Model %A Yan,Yifei %A Li,Jun %A Liu,Xingyun %A Li,Qing %A Yu,Nancy Xiaonan %+ Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, HKSAR, P. R. China, Hong Kong, 000, China (Hong Kong), 852 34429436, nancy.yu@cityu.edu.hk %K COVID-19 pandemic %K Reddit %K suicide risk %K trajectory %D 2024 %7 8.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide has emerged as a critical public health concern during the COVID-19 pandemic. With social distancing measures in place, social media has become a significant platform for individuals expressing suicidal thoughts and behaviors. However, existing studies on suicide using social media data often overlook the diversity among users and the temporal dynamics of suicide risk. Objective: By examining the variations in post volume trajectories among users on the r/SuicideWatch subreddit during the COVID-19 pandemic, this study aims to investigate the heterogeneous patterns of change in suicide risk to help identify social media users at high risk of suicide. We also characterized their linguistic features before and during the pandemic. Methods: We collected and analyzed post data every 6 months from March 2019 to August 2022 for users on the r/SuicideWatch subreddit (N=6163). A growth-based trajectory model was then used to investigate the trajectories of post volume to identify patterns of change in suicide risk during the pandemic. Trends in linguistic features within posts were also charted and compared, and linguistic markers were identified across the trajectory groups using regression analysis. Results: We identified 2 distinct trajectories of post volume among r/SuicideWatch subreddit users. A small proportion of users (744/6163, 12.07%) was labeled as having a high risk of suicide, showing a sharp and lasting increase in post volume during the pandemic. By contrast, most users (5419/6163, 87.93%) were categorized as being at low risk of suicide, with a consistently low and mild increase in post volume during the pandemic. In terms of the frequency of most linguistic features, both groups showed increases at the initial stage of the pandemic. Subsequently, the rising trend continued in the high-risk group before declining, while the low-risk group showed an immediate decrease. One year after the pandemic outbreak, the 2 groups exhibited differences in their use of words related to the categories of personal pronouns; affective, social, cognitive, and biological processes; drives; relativity; time orientations; and personal concerns. In particular, the high-risk group was discriminant in using words related to anger (odds ratio [OR] 3.23, P<.001), sadness (OR 3.23, P<.001), health (OR 2.56, P=.005), achievement (OR 1.67, P=.049), motion (OR 4.17, P<.001), future focus (OR 2.86, P<.001), and death (OR 4.35, P<.001) during this stage. Conclusions: Based on the 2 identified trajectories of post volume during the pandemic, this study divided users on the r/SuicideWatch subreddit into suicide high- and low-risk groups. Our findings indicated heterogeneous patterns of change in suicide risk in response to the pandemic. The high-risk group also demonstrated distinct linguistic features. We recommend conducting real-time surveillance of suicide risk using social media data during future public health crises to provide timely support to individuals at potentially high risk of suicide. %M 39115925 %R 10.2196/48907 %U https://www.jmir.org/2024/1/e48907 %U https://doi.org/10.2196/48907 %U http://www.ncbi.nlm.nih.gov/pubmed/39115925 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52683 %T Secular Trends in Depressive Symptoms in Adolescents in Yunnan, Southwest China From Before COVID-19 to During the COVID-19 Pandemic: Longitudinal, Observational Study %A Yang,Yunjuan %A Zha,Shun %A Li,Tunan %+ Public Health School, Xi'an Jiaotong University, NO.76 Yanta West Road, Xi, 710061, China, 86 13116290467, yncdcyyj@126.com %K COVID-19 exposure %K depressive symptom %K adolescent %K epidemic trend %K prevalence %K observational study %K epidemic %K COVID-19 %K depression %K symptoms %K teen %K youth %K China %K mental health %K psychological %K logistic regression %K lifestyle intervention %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Yunnan province borders Myanmar, Laos, and Vietnam, giving it one of the longest borders in China. We aimed to determine the trends in prevalence and impact of COVID-19 on depressive symptoms among adolescents (12-18 years) from 2018 to 2022 in Yunnan, southwest China. Objective: We evaluated the impact of the COVID-19 epidemic on adolescents’ mental health, with the aim of reducing the effect of psychological emergency syndrome and promoting healthy, happy adolescent growth. Methods: This longitudinal, observational study used Students’ Health Survey data on adolescents’ depressive symptoms from 2018 to 2022 (before and during COVID-19) in Yunnan. We used multistage, stratified sampling in 3 prefectures in 2018 and 16 prefectures from 2019 to 2022. In each prefecture, the study population was classified by gender and residence (urban or rural), and each group was of equal size. Depressive symptoms were diagnosed based on Center for Epidemiological Studies Depression Scale (CES-D) scores. We used ANOVA to assess the differences in mean CES-D scores stratified by gender, age, residence, grade, and ethnicity. Chi-square tests were used to compare depressive symptoms by different variables. For comparability, the age-standard and gender-standard population prevalences were calculated using the 2010 China Census as the standard population. The association between COVID-19 and the risk of a standardized prevalence of depressive symptoms was identified using unconditional logistic regression analysis. Results: The standardized prevalence of depressive symptoms for all participants was 32.98%: 28.26% in 2018, 30.89% in 2019, 29.81% in 2020, 28.77% in 2021, 36.33% in 2022. The prevalences were 30.49% before COVID-19,29.29% in early COVID-19, and 36.33% during the COVID-19 pandemic. Compared with before COVID-19, the risks of depressive symptoms were 0.793 (95% CI 0.772-0.814) times higher in early COVID-19 and 1.071 (95% CI 1.042-1.100) times higher than during COVID-19. The average annual increase in depressive symptoms was 1.61%. During the epidemic, the prevalence of depressive symptoms in girls (36.87%) was higher than that in boys (28.64%), and the acceleration rate of girls was faster than that of boys. The prevalences of depressive symptoms and acceleration rates by age group were as follows: 27.14% and 1.09% (12-13 years), 33.99% and 1.8% (14-15 years), 36.59% and 1.65% (16-18 years). Prevalences did not differ between Han (32.89%) and minority (33.10%) populations. However, the acceleration rate was faster for the former than for the latter. The rate for senior high school students was the highest (34.94%). However, the acceleration rate for vocational high school students was the fastest (2.88%), followed by that for junior high school students (2.32%). Rural residents (35.10%) had a higher prevalence and faster acceleration than urban residents (30.16%). Conclusions: From 2018 to 2022, there was a significant, continuous increase in the prevalence of depressive symptoms among adolescents in Yunnan, China, especially during the COVID-19 pandemic. This represents an emergency public health problem that should be given more attention. Effective, comprehensive psychological and lifestyle intervention measures should be used to reduce the prevalence of mental health issues in adolescents. %M 39083344 %R 10.2196/52683 %U https://publichealth.jmir.org/2024/1/e52683 %U https://doi.org/10.2196/52683 %U http://www.ncbi.nlm.nih.gov/pubmed/39083344 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49422 %T Retrospecting Digital Media Use, Negative Emotions, and Trust Gaps During the COVID-19 Pandemic in China: Cross-Sectional Web-Based Survey %A Wei,Lu %A Huang,Qing %+ International Communication Institute, College of Media and International Culture, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Hangzhou, 310058, China, 86 0571 87075102, qing_huang@zju.edu.cn %K digital media use %K negative emotions %K family members–strangers trust gap %K family members–acquaintances trust gap %K mediation effect %K COVID-19 %D 2024 %7 10.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Retrospecting the trust gaps and their dynamics during the pandemic is crucial for understanding the root causes of postpandemic challenges and offers valuable insights into preparing for future public health emergencies. The COVID-19 pandemic eroded people’s trust in strangers and acquaintances, while their trust in family members remained relatively stable. This resulted in 2 trust gaps, namely, the family members–strangers trust gap and the family members–acquaintances trust gap. Widening trust gaps impede social integration and undermine the effective management of public health crises. However, little is known about how digital media use shaped trust gaps during a pandemic. Objective: This study aims to investigate the relationships between digital media use, negative emotions, the family members–strangers trust gap, and the family members–acquaintances trust gap during the COVID-19 pandemic in China. We test the mediating role of negative emotions between digital media use and 2 trust gaps and compare the indirect effect of digital media use on 2 trust gaps through negative emotions. Methods: A cross-sectional web-based survey was conducted in China between January 31, 2020, and February 9, 2020. A total of 1568 adults participated in the survey. Questions related to digital media use, negative emotions, trust in family members, trust in acquaintances, and trust in strangers during the pandemic were asked. Regression analyses were performed to test the associations between the examined variables. We used a 95% bootstrap CI approach to estimate the mediation effects. Results: Digital media use was positively associated with negative emotions (B=0.17, SE 0.03; P<.001), which in turn were positively associated with the family members–strangers trust gap (B=0.15, SE 0.03; P<.001). Likewise, digital media use was positively associated with negative emotions (B=0.17, SE 0.03; P<.001), while negative emotions were positively associated with the family members–acquaintances trust gap (B=0.08, SE 0.03; P=.01). Moreover, the indirect effect of digital media use on the family members–strangers trust gap (B=0.03, SE 0.01; 95% CI 0.01-0.04) was stronger than that on the family members–acquaintances trust gap (B=0.01, SE 0.01; 95% CI 0.003-0.027). Conclusions: The results demonstrate that negative emotions resulting from the frequent use of digital media are a key factor that accounts for the widening trust gaps. Considering the increasing reliance on digital media, the findings indicate that the appropriate use of digital media can prevent the overamplification of negative emotions and curb the enlargement of trust gaps. This may help restore social trust and prepare for future public health crises in the postpandemic era. %M 38986127 %R 10.2196/49422 %U https://www.jmir.org/2024/1/e49422 %U https://doi.org/10.2196/49422 %U http://www.ncbi.nlm.nih.gov/pubmed/38986127 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53980 %T In-Person and Teleconsultation Services at a National Hospital in Peru: Time Series Analysis of General and Psychiatric Care Amid the COVID-19 Pandemic %A Villarreal-Zegarra,David %A García-Serna,Jackeline %A Segovia-Bacilio,Piero %A Mayo-Puchoc,Nikol %A Navarro-Flores,Alba %A Huarcaya-Victoria,Jeff %+ Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Carretera Panamericana Sur N° 103, 113 y 123, Ica, Peru, 51 950322888, jeff.huarcaya@upsjb.edu.pe %K health care utilization %K mental health use %K COVID-19 %K mental health %K health care %K psychiatric care %K teleconsultation %K hospital %K Peru %K chronic %K patient %K patients %K telemonitoring %D 2024 %7 8.7.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic led to a global reduction in health care accessibility for both infected and noninfected patients, posing a particular burden on those with chronic conditions, including mental health issues. Peru experienced significant devastation from the pandemic, resulting in a collapsed health care system and leading to the world’s highest per capita mortality rate as a result of COVID-19. Understanding the trends in health care utilization, particularly in mental health care, is crucial for informing pandemic response efforts and guiding future recovery strategies. Objective: This study aims to analyze the trends of outpatient medical and psychiatric consultations during the COVID-19 pandemic in a national hospital in Peru. Methods: This observational study was conducted at a national hospital in Lima, Peru. We analyzed data on user care across all services, including psychiatric services, from May 2019 to December 2022. The data were calculated for users served per month, including the number of users seen monthly in mental health services. Sociodemographic variables such as sex (female or male), age (≥0 years), type of medical appointment (regular or additional), and modality of care (in-person or teleconsultations) were taken into account. An interrupted time series regression model was conducted to assess the number of outpatient medical and psychiatric consultations. Subgroup analyses were performed based on service modality, including overall consultations, telemonitoring/teleconsultations only, or face-to-face only, for all service users and for mental health service users. Results: A total of 1,515,439 participants were included, with females comprising 275,444/484,994 (56.80%) of the samples. Only 345,605/1,515,439 (22.81%) visits involved telemedicine. The total monthly outpatient visits were significantly reduced compared with the expected projection (P<.001) at the beginning of the pandemic, followed by a later monthly increment of 298.7 users. Face-to-face interventions experienced a significant reduction at the beginning of the pandemic (P<.001), gradually recovering in the following months. By contrast, telemedicine use initially increased but subsequently declined toward the end of the pandemic. A similar trend was observed in mental health units. Conclusions: During the pandemic years, health care utilization in both general and psychiatric services experienced a significant decrease, particularly at the beginning of the pandemic (March 2020). However, no significant trends were observed in either case throughout the pandemic period. Telemedicine consultations witnessed a significant increase overall during this period, particularly among mental health users. %M 38976320 %R 10.2196/53980 %U https://mental.jmir.org/2024/1/e53980 %U https://doi.org/10.2196/53980 %U http://www.ncbi.nlm.nih.gov/pubmed/38976320 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e53233 %T Exploring How Youth Use TikTok for Mental Health Information in British Columbia: Semistructured Interview Study With Youth %A Turuba,Roxanne %A Cormier,Willow %A Zimmerman,Rae %A Ow,Nikki %A Zenone,Marco %A Quintana,Yuri %A Jenkins,Emily %A Ben-David,Shelly %A Raimundo,Alicia %A Marcon,Alessandro R %A Mathias,Steve %A Henderson,Jo %A Barbic,Skye %+ Department of Occupational Science and Occupational Therapy, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 6725155337, roxanne.turuba@ubc.ca %K youth %K adolescents %K young adults %K mental health %K TikTok %K social media %K qualitative research %D 2024 %7 5.7.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: TikTok (ByteDance) experienced a surge in popularity during the COVID-19 pandemic as a way for people to interact with others, share experiences and thoughts related to the pandemic, and cope with ongoing mental health challenges. However, few studies have explored how youth use TikTok to learn about mental health. Objective: This study aims to understand how youth used TikTok during the COVID-19 pandemic to learn about mental health and mental health support. Methods: Semistructured interviews were conducted with 21 youths (aged 12-24 years) living in British Columbia, Canada, who had accessed TikTok for mental health information during the COVID-19 pandemic. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed using an inductive, data-driven approach. Results: A total of 3 overarching themes were identified describing youth’s experiences. The first theme centered on how TikTok gave youth easy access to mental health information and support, which was particularly helpful during the COVID-19 pandemic to curb the effects of social isolation and the additional challenges of accessing mental health services. The second theme described how the platform provided youth with connection, as it gave youth a safe space to talk about mental health and allowed them to feel seen by others going through similar experiences. This helped normalize and destigmatize conversations about mental health and brought awareness to various mental health conditions. Finally, the last theme focused on how this information led to action, such as trying different coping strategies, discussing mental health with peers and family, accessing mental health services, and advocating for themselves during medical appointments. Across the 3 themes, youth expressed having to be mindful of bias and misinformation, highlighting the barriers to identifying and reporting misinformation and providing individualized advice on the platform. Conclusions: Findings suggest that TikTok can be a useful tool to increase mental health awareness, reduce stigma, and encourage youth to learn and address their mental health challenges while providing a source of peer connection and support. Simultaneously, TikTok can adversely impact mental health through repetitive exposure to mentally distressing content and misleading diagnosis and treatment information. Regulations against harmful content are needed to mitigate these risks and make TikTok safer for youth. Efforts should also be made to increase media and health literacy among youth so that they can better assess the information they consume online. %M 38967966 %R 10.2196/53233 %U https://infodemiology.jmir.org/2024/1/e53233 %U https://doi.org/10.2196/53233 %U http://www.ncbi.nlm.nih.gov/pubmed/38967966 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48076 %T Association Between Discrimination and Depressive Symptoms Among Hispanic or Latino Adults During the COVID-19 Pandemic: Cross-Sectional Study %A Ormiston,Cameron K %A Villalobos,Kevin %A Montiel Ishino,Francisco Alejandro %A Williams,Faustine %+ National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, Rockville, MD, 20852, United States, 1 301 827 2727, cameron.ormiston@icahn.mssm.edu %K depressive symptoms %K everyday discrimination %K COVID-19 pandemic %K Hispanic and Latino %K immigrant health %D 2024 %7 6.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Discrimination and xenophobia toward Hispanic and Latino communities increased during the COVID-19 pandemic, likely inflicting significant harm on the mental health of Hispanic and Latino individuals. Pandemic-related financial and social instability has disproportionately affected Hispanic and Latino communities, potentially compounding existing disparities and worsening mental health. Objective: This study aims to examine the association between discrimination and depressive symptoms during the COVID-19 pandemic among a national sample of Hispanic and Latino adults. Methods: Data from a 116-item web-based nationally distributed survey from May 2021 to January 2022 were analyzed. The sample (N=1181) was restricted to Hispanic or Latino (Mexican or Mexican American, Puerto Rican; Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults. Depression symptoms were assessed using the 2-item Patient Health Questionnaire. Discrimination was assessed using the 5-item Everyday Discrimination Scale. A multinomial logistic regression with a block entry model was used to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as examine how controls and covariates affected the relationship of interest. Results: Mexican or Mexican American adults comprised the largest proportion of the sample (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%). Approximately 31.26% (367/1181) of the sample had depressive symptoms. Regarding discrimination, 54.56% (634/1181) reported experiencing some form of discrimination. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (adjusted odds ratio [AOR] 3.31, 95% CI 2.42-4.54). Also, we observed that sociodemographic factors such as age and gender were significant. Compared with participants aged 56 years and older, participants aged 18-35 years and those aged 36-55 years had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively). Women had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30) than men. Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000. Conclusions: Our findings provide significant importance especially when considering the compounding, numerous socioeconomic challenges stemming from the pandemic that disproportionately impact the Hispanic and Latino communities. These challenges include rising xenophobia and tensions against immigrants, inadequate access to mental health resources for Hispanic and Latino individuals, and existing hesitations toward seeking mental health services among this population. Ultimately, these findings can serve as a foundation for promoting health equity. %M 38843512 %R 10.2196/48076 %U https://formative.jmir.org/2024/1/e48076 %U https://doi.org/10.2196/48076 %U http://www.ncbi.nlm.nih.gov/pubmed/38843512 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46029 %T Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study %A Law,Graham %A Cooper,Rhiannon %A Pirrie,Melissa %A Ferron,Richard %A McLeod,Brent %A Spaight,Robert %A Siriwardena,A Niroshan %A Agarwal,Gina %A , %+ Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, , Canada, 1 905 525 9140, gina.agarwal@gmail.com %K COVID-19 %K mental health %K overdose %K emergency medical services %K administrative data %K Canada %K the United Kingdom %K ambulance %K sex %K age %K lockdown %K pandemic planning %K emergency service %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic impacted mental health and health care systems worldwide. Objective: This study examined the COVID-19 pandemic’s impact on ambulance attendances for mental health and overdose, comparing similar regions in the United Kingdom and Canada that implemented different public health measures. Methods: An interrupted time series study of ambulance attendances was conducted for mental health and overdose in the United Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulance attendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled the count of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown was initiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age. Results: Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown (United Kingdom: incidence rate ratio [IRR] 1.002, 95% CI 1.002-1.003 for mental health). However, substantial changes were observed at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the study regions of both countries (United Kingdom: IRR 0.573, 95% CI 0.518-0.635 and Canada: IRR 0.743, 95% CI 0.602-0.917), the rate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95% CI 1.031-1.227 and Canada: IRR 0.922, 95% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between study regions. Conclusions: The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differed between the UK and Canada study regions. These results may inform future pandemic planning and further research on the public health measures that may explain observed regional differences. %M 38728683 %R 10.2196/46029 %U https://publichealth.jmir.org/2024/1/e46029 %U https://doi.org/10.2196/46029 %U http://www.ncbi.nlm.nih.gov/pubmed/38728683 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50303 %T Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study %A Gotra,Milena %A Lindberg,Katharine %A Jasinski,Nicholas %A Scarisbrick,David %A Reilly,Shannon %A Perle,Jonathan %A Miller,Liv %A Mahoney III,James %+ Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, 64 Medical Center Dr, Morgantown, WV, 26506, United States, 1 304 598 4740, nicholas.jasinski1@hsc.wvu.edu %K COVID-19 pandemic %K mental health %K social worker %K psychologist %K neuropsychologist %K academic medical center %K community mental health %K private practice %K Veteran’s Affairs hospital %K longitudinal questionnaire study %K COVID-19 %K implementation %K telemental health %K hybrid model %K availability %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. Objective: The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. Methods: This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital). Results: From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66). Conclusions: These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients. %M 38683653 %R 10.2196/50303 %U https://formative.jmir.org/2024/1/e50303 %U https://doi.org/10.2196/50303 %U http://www.ncbi.nlm.nih.gov/pubmed/38683653 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50443 %T The Role of Social Media in the Experiences of COVID-19 Among Long-Hauler Women: Qualitative Study %A Garrett,Camryn %A Aghaei,Atefeh %A Aggarwal,Abhishek %A Qiao,Shan %+ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States, 1 803 777 6844, camrynmg@email.sc.edu %K COVID-19 %K long COVID %K long-haulers %K women %K gender %K social media %K digital media %K qualitative study %D 2024 %7 23.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The extant literature suggests that women are more vulnerable to COVID-19 infection and at higher risk for developing long COVID. Due to pandemic mitigation recommendations, social media was relied upon for various aspects of daily life, likely with differences of usage between genders. Objective: This study aimed to explore the role and functions of social media in the lives of long-hauler women. Methods: Participants were purposively snowball-sampled from an online health promotion intervention for long-hauler women with COVID-19 from March to June 2021. During this time, one-on-one, semistructured interviews were conducted online until data saturation was agreed to have been achieved (ie, 15 interviews). Interview transcripts and field notes were analyzed using an emergent, inductive approach. Results: In total, 15 women were enrolled. The main roles of social media included facilitating support group participation, experience sharing, interpersonal connections, and media consumption. Emergent themes demonstrated that participants rely on social media to fulfill needs of emotional support, social engagement, spirituality, health planning, information gathering, professional support, and recreationally for relaxation. As long-hauler women turn to social media to discuss symptom and health management as well as the intention to vaccinate, this study demonstrates both the associated benefits (ie, decreased isolation) and challenges (ie, misinformation, rumination, resentment, jealousy). Conclusions: The public health implications of these findings support the development of gender-tailored health promotion interventions that leverage the benefits of social media, while mitigating the negative impacts, for women with long COVID. %M 38652515 %R 10.2196/50443 %U https://humanfactors.jmir.org/2024/1/e50443 %U https://doi.org/10.2196/50443 %U http://www.ncbi.nlm.nih.gov/pubmed/38652515 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50064 %T Factors Associated With Worsened Mental Health of Health Care Workers in Canada During the COVID-19 Pandemic: Cross-Sectional Survey Study %A AbdulHussein,Ali %A Butt,Zahid Ahmad %A Dimitrov,Stanko %A Cozzarin,Brian %+ Department of Management Science, Faculty of Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 (519) 888 4567, a9abdulh@uwaterloo.ca %K health care workers %K COVID-19 %K mental health %K demographic factors %K occupational factors %K access to PPE %K pandemic %K health care system %K psychological trauma %K psychological %K trauma %K respirators %K eye protection %K face shields %K support %D 2024 %7 15.2.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Health care workers (HCWs) in Canada have endured difficult conditions during the COVID-19 pandemic. Many worked long hours while attending to patients in a contagious environment. This introduced an additional burden that may have contributed to worsened mental health conditions. Objective: In this study, we examine the factors associated with worsened mental health conditions of HCWs as compared to before the start of the pandemic. Methods: We use data from a survey of HCWs by Statistics Canada. A regression model is used to estimate the odds ratios (ORs) of worsened mental health after the start of the pandemic. The estimated odds ratio (OR) is associated with different independent variables that include demographics (age, sex, immigration status, and geographic area), occupational factors (work status, occupational group, and exposure category), and different access levels to personal protective equipment (PPE). Results: Of 18,139 eligible participants surveyed, 13,990 (77.1%) provided valid responses. We found that HCWs younger than 35 years old were more likely (OR 1.14, 95% CI 1.03-1.27; P=.01) to exhibit worsened mental health as compared to the reference group (35-44 years old). As for sex, male HCWs were less likely (OR 0.76, 95% CI 0.67-0.86; P<.001) to exhibit worsened mental health as compared to female HCWs. Immigrant HCWs were also less likely (OR 0.57, 95% CI 0.51-0.64; P<.001) to exhibit worsened mental health as compared to nonimmigrant HCWs. Further, HCWs working in Alberta had the highest likelihood of exhibiting worsened mental health as compared to HCWs working elsewhere (Atlantic provinces, Quebec, Manitoba, Saskatchewan, Ontario, British Columbia, and Northern Territories). Frontline workers were more likely (OR 1.26, 95% CI 1.16-1.38; P<.001) to exhibit worsened mental health than nonfrontline HCWs. Part-time HCWs were less likely (OR 0.85, 95% CI 0.76-0.93; P<.001) to exhibit worsened mental health than full-time HCWs. HCWs who reported encountering COVID-19 cases were more likely (OR 1.55, 95% CI 1.41-1.70; P<.001) to exhibit worsened mental health as compared to HCWs who reported no contact with the disease. As for PPE, HCWs who never had access to respirators, eye protection, and face shields are more likely to exhibit worsened mental health by 1.31 (95% CI 1.07-1.62; P<.001), 1.51 (95% CI 1.17-1.96; P<.001), and 1.41 (95% CI 1.05-1.92; P=.02) than those who always had access to the same PPE, respectively. Conclusions: Different HCW groups experienced the pandemic differently based on their demographic and occupational backgrounds as well as access to PPE. Such findings are important to stakeholders involved in the planning of personalized support programs and aid mental health mitigation in future crises. Certain groups require more attention. %M 38358785 %R 10.2196/50064 %U https://www.i-jmr.org/2024/1/e50064 %U https://doi.org/10.2196/50064 %U http://www.ncbi.nlm.nih.gov/pubmed/38358785 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48430 %T Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey %A Macaluso,Maurizio %A Rothenberg,Marc E %A Ferkol,Thomas %A Kuhnell,Pierce %A Kaminski,Henry J %A Kimberlin,David W %A Benatar,Michael %A Chehade,Mirna %A , %+ Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave - MLC 5041, Cincinnati, OH, 45229, United States, 1 513 636 2710, maurizio.macaluso@cchmc.org %K rare diseases %K rare %K chronic %K COVID-19 infection %K cross-sectional survey %K access to care %K changes in symptoms and use of medications %K psychological impact on self and family %K access %K accessibility %K cross-sectional %K national %K nationwide %K survey %K surveys %K COVID-19 %K SARS-CoV-2 %K coronavirus %K comorbid %K comorbidity %K vulnerable %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With more than 103 million cases and 1.1 million deaths, the COVID-19 pandemic has had devastating consequences for the health system and the well-being of the entire US population. The Rare Diseases Clinical Research Network funded by the National Institutes of Health was strategically positioned to study the impact of the pandemic on the large, vulnerable population of people living with rare diseases (RDs). Objective: This study was designed to describe the characteristics of COVID-19 in the RD population, determine whether patient subgroups experienced increased occurrence or severity of infection and whether the pandemic changed RD symptoms and treatment, and understand the broader impact on respondents and their families. Methods: US residents who had an RD and were <90 years old completed a web-based survey investigating self-reported COVID-19 infection, pandemic-related changes in RD symptoms and medications, access to care, and psychological impact on self and family. We estimated the incidence of self-reported COVID-19 and compared it with that in the US population; evaluated the frequency of COVID-19 symptoms according to self-reported infection; assessed infection duration, complications and need for hospitalization; assessed the influence of the COVID-19 pandemic on RD symptoms and treatment, and whether the pandemic influenced access to care, special food and nutrition, or demand for professional psychological assistance. Results: Between May 2, 2020, and December 15, 2020, in total, 3413 individuals completed the survey. Most were female (2212/3413, 64.81%), White (3038/3413, 89.01%), and aged ≥25 years (2646/3413, 77.53%). Overall, 80.6% (2751/3413) did not acquire COVID-19, 2.08% (71/3413) acquired it, and 16.58% (566/3413) did not know. Self-reported cases represented an annual incidence rate of 2.2% (95% CI 1.7%-2.8%). COVID-19 cases were more than twice the expected (71 vs 30.3; P<.001). COVID-19 was associated with specific symptoms (loss of taste: odds ratio [OR] 38.9, 95% CI 22.4-67.6, loss of smell: OR 30.6, 95% CI 17.7-53.1) and multiple symptoms (>9 symptoms vs none: OR 82.5, 95% CI 29-234 and 5-9: OR 44.8, 95% CI 18.7-107). Median symptom duration was 16 (IQR 9-30) days. Hospitalization (7/71, 10%) and ventilator support (4/71, 6%) were uncommon. Respondents who acquired COVID-19 reported increased occurrence and severity of RD symptoms and use or dosage of select medications; those who did not acquire COVID-19 reported decreased occurrence and severity of RD symptoms and use of medications; those who did not know had an intermediate pattern. The pandemic made it difficult to access care, receive treatment, get hospitalized, and caused mood changes for respondents and their families. Conclusions: Self-reported COVID-19 was more frequent than expected and was associated with increased prevalence and severity of RD symptoms and greater use of medications. The pandemic negatively affected access to care and caused mood changes in the respondents and family members. Continued surveillance is necessary. %M 38354030 %R 10.2196/48430 %U https://publichealth.jmir.org/2024/1/e48430 %U https://doi.org/10.2196/48430 %U http://www.ncbi.nlm.nih.gov/pubmed/38354030 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45114 %T Depression and Anxiety in Adolescents During the COVID-19 Pandemic in Relation to the Use of Digital Technologies: Longitudinal Cohort Study %A Shen,Chen %A Smith,Rachel B %A Heller,Joel %A Spiers,Alexander D V %A Thompson,Rhiannon %A Ward,Helen %A Roiser,Jonathan P %A Nicholls,Dasha %A Toledano,Mireille B %+ MRC Centre for Environment and Health, School of Public Health, Imperial College London, School of Medicine Building, Norfolk Place, London, W21PG, United Kingdom, 44 02075943298, m.toledano@imperial.ac.uk %K COVID-19 %K depression %K anxiety %K public health %K adolescence %K digital technology use %K sleep %K mobile phone %D 2024 %7 7.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents are susceptible to mental illness and have experienced substantial disruption owing to the COVID-19 pandemic. The digital environment is increasingly important in the context of a pandemic when in-person social connection is restricted. Objective: This study aims to estimate whether depression and anxiety had worsened compared with the prepandemic period and examine potential associations with sociodemographic characteristics and behavioral factors, particularly digital behaviors. Methods: We analyzed cross-sectional and longitudinal data from a large, representative Greater London adolescent cohort study: the Study of Cognition, Adolescents and Mobile Phones (SCAMP). Participants completed surveys at T1 between November 2016 and July 2018 (N=4978; aged 13 to 15 years) and at T2 between July 2020 and June 2021 (N=1328; aged 16 to 18 years). Depression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder scale, respectively. Information on the duration of total mobile phone use, social network site use, and video gaming was also collected using questionnaires. Multivariable logistic regression was used to assess the cross-sectional and longitudinal associations of sociodemographic characteristics, digital technology use, and sleep duration with clinically significant depression and anxiety. Results: The proportion of adolescents who had clinical depression and anxiety significantly increased at T2 (depression: 140/421, 33.3%; anxiety: 125/425, 29.4%) compared with the proportion of adolescents at T1 (depression: 57/421, 13.5%; anxiety: 58/425, 13.6%; P for 2-proportion z test <.001 for both depression and anxiety). Depression and anxiety levels were similar between the summer holiday, school opening, and school closures. Female participants had higher odds of new incident depression (odds ratio [OR] 2.5, 95% CI 1.5-4.18) and anxiety (OR 2.11, 95% CI 1.23-3.61) at T2. A high level of total mobile phone use at T1 was associated with developing depression at T2 (OR 1.89, 95% CI 1.02-3.49). Social network site use was associated with depression and anxiety cross-sectionally at T1 and T2 but did not appear to be associated with developing depression or anxiety longitudinally. Insufficient sleep at T1 was associated with developing depression at T2 (OR 2.26, 95% CI 1.31-3.91). Conclusions: The mental health of this large sample of adolescents from London deteriorated during the pandemic without noticeable variations relating to public health measures. The deterioration was exacerbated in girls, those with preexisting high total mobile phone use, and those with preexisting disrupted sleep. Our findings suggest the necessity for allocating resources to address these modifiable factors and target high-risk groups. %M 38324379 %R 10.2196/45114 %U https://www.jmir.org/2024/1/e45114 %U https://doi.org/10.2196/45114 %U http://www.ncbi.nlm.nih.gov/pubmed/38324379 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46824 %T Internet Use and Effects on Mental Well-being During the Lockdown Phase of the COVID-19 Pandemic in Younger Versus Older Adults: Observational Cross-Sectional Study %A Yu,Chou Chuen %A Tou,Nien Xiang %A Low,James Alvin %+ Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore, 65 68078024, yu.chou.chuen@geri.com.sg %K COVID-19 %K digital divide %K well-being %K older adults %K information and communication technology %K internet of things %K online %K mental health %K lockdown %K depression %K stress %K anxiety %K digital technology %K pandemic %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Majority of individuals, including both younger and older adults, had to adapt to digital means to cope with lockdown measures and pandemic-induced lifestyle changes during the COVID-19 pandemic. While internet accessibility was beneficial during the pandemic, existing literature suggests that excessive use could lead to the rise of problematic internet use in adolescents and younger adults. However, the effects on older adults remain unclear. Objective: This study aimed to examine differences in internet use during the lockdown phase of the COVID-19 pandemic and explore how age differences in mental health could be explained by time spent on the internet. Methods: A door-to-door survey of a nationally representative sample of 602 adults in Singapore was carried out using computer-assisted personal interviewing during the early phase of the COVID-19 pandemic (October to November 2020). Participants were categorized into younger (21-59 years old) and older (60 years or above) age groups. We assessed self-reported measures of depression, anxiety, and stress; psychosocial adaptability; ability to perform essential activities; social support; health status; digital media use patterns, and time spent on the internet. Procedures complied with existing safe distancing measures. Results: Older adults reported being less able to use digital platforms to meet needs and acquire information updates compared with younger adults during the lockdown period of the pandemic. Older adults spent significantly less time on the internet for both work and personal uses per day (mean 146.00 min, SD 9.18 min) compared with younger adults (mean 433.27 min, SD 14.32 min). Significant age differences in depression, anxiety, and stress were found, with younger adults showing poorer mental health. Mediation analysis showed that age differences in depression, anxiety, and stress were partially explained by time spent on the internet. These variables together explained 43%, 40%, and 40% of the variances in depression, anxiety, and stress scores, respectively. Conclusions: The findings showed that younger adults spent significantly more time on the internet compared with older adults during the lockdown phase of the pandemic. They were also ahead in their ability to use digital resources to meet needs and engage socially compared with older adults. Despite this, the mental health of younger adults was poor, and this was partially accounted for by the amount of time spent on the internet. Since past research suggests that excessive time spent on the internet could lead to disordered use, the benefits brought by digital technologies could have been attenuated during the lockdown phase of the pandemic. Considering this potential negative effect, it is imperative to educate both young and old adults in the appropriate use of information and communication technology. %M 38319700 %R 10.2196/46824 %U https://formative.jmir.org/2024/1/e46824 %U https://doi.org/10.2196/46824 %U http://www.ncbi.nlm.nih.gov/pubmed/38319700 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47048 %T Depression and Anxiety Symptoms Among Cisgender Gay and Bisexual Men During the Onset of the COVID-19 Pandemic: Time Series Analysis of a US National Cohort Study %A Mirzayi,Chloe %A Westmoreland,Drew %A Stief,Matthew %A Grov,Christian %+ CUNY Graduate School of Public Health and Health Policy, 55 W 125 Street, New York, NY, 10027, United States, 1 6463640254, cgrov@sph.cuny.edu %K COVID-19 pandemic %K lesbian, gay, bisexual, transgender, and queer %K LGBTQ %K mental health %K depression %K anxiety %K time series %K gay and bisexual men %K cisgender gay %K pandemic %K gay %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The onset of the COVID-19 pandemic in the United States in March 2020 caused a dramatic change in the way many people lived. Few aspects of daily life were left undisrupted by the pandemic’s onset as well as the accompanying policies to control the spread of the disease. Previous research has found that the pandemic may have significantly impacted the mental health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals—potentially more so than other individuals. However, the pandemic did not affect all areas of the United States at the same time, and there may be regional variation in the impact of the onset of the pandemic on depressive symptoms among LGBTQ individuals. Objective: To assess regional variation of the impact of the pandemic, we conducted a time series analysis stratified by US geographic region to examine symptoms of depression and anxiety among a sample of primarily cisgender gay and bisexual men before and after the onset of the COVID-19 pandemic in the United States. Methods: In total, 5007 participants completed assessments as part of the Together 5000 study, an ongoing prospective cohort study. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire-4. Patient Health Questionnaire-4 scores were graphed as a function of days from March 15, 2020. Locally estimated scatterplot smoothing trend lines were applied. A sieve-bootstrap Mann-Kendall test for monotonic trend was conducted to assess the presence and direction of trends in the scatterplots. We then compared the observed trends to those observed for 1 year prior (2018-2019) to the pandemic onset using data collected from the same sample. Results: Significant positive trends were detected for the Northeast (P=.03) and Midwest (P=.01) regions of the United States in the 2020 assessment, indicating that symptoms of anxiety and depression were increasing in the sample in these regions immediately prior to and during the onset of the pandemic. In contrast, these trends were not present in data from the 2018 to 2019 assessment window. Conclusions: Symptoms of anxiety and depression increased among the study population in the Northeast and Midwest during the beginning months of the COVID-19 pandemic, but similar increase was not observed in the South and West regions. These trends were also not found for any region in the 2018 to 2019 assessment window. This may indicate region-specific trends in anxiety and depression, potentially driven by the burden of the pandemic and policies that varied from region to region. Future studies should consider geographic variation in COVID-19 spread and policies as well as explore potential mechanisms by which this could influence the mental health of LGBTQ individuals. %M 38277213 %R 10.2196/47048 %U https://publichealth.jmir.org/2024/1/e47048 %U https://doi.org/10.2196/47048 %U http://www.ncbi.nlm.nih.gov/pubmed/38277213 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e51102 %T Efficacy of an Electronic Cognitive Behavioral Therapy Program Delivered via the Online Psychotherapy Tool for Depression and Anxiety Related to the COVID-19 Pandemic: Pre-Post Pilot Study %A Moghimi,Elnaz %A Stephenson,Callum %A Agarwal,Anika %A Nikjoo,Niloofar %A Malakouti,Niloufar %A Layzell,Gina %A O'Riordan,Anne %A Jagayat,Jasleen %A Shirazi,Amirhossein %A Gutierrez,Gilmar %A Khan,Ferwa %A Patel,Charmy %A Yang,Megan %A Omrani,Mohsen %A Alavi,Nazanin %+ Department of Psychiatry, Faculty of Health Sciences, Queen's University, 166 Brock Street, Kingston, ON, K7L 5G23, Canada, 1 6135443310, nazanin.alavitabari@kingstonhsc.ca %K mental health %K depression %K anxiety %K cognitive behavioral therapy %K online %K COVID-19 %K efficacy %K electronic cognitive behavioral therapy %K online psychotherapy tool %K pandemic %K evidence-based treatment %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Lockdowns and social distancing resulting from the COVID-19 pandemic have worsened the population’s mental health and made it more difficult for individuals to receive care. Electronic cognitive behavioral therapy (e-CBT) is a cost-effective and evidence-based treatment for anxiety and depression and can be accessed remotely. Objective: The objective of the study was to investigate the efficacy of online psychotherapy tailored to depression and anxiety symptoms during the pandemic. Methods: The pilot study used a pre-post design to evaluate the efficacy of a 9-week e-CBT program designed for individuals with depression and anxiety affected by the pandemic. Participants were adults (N=59) diagnosed with major depressive disorder and generalized anxiety disorder, whose mental health symptoms initiated or worsened during the COVID-19 pandemic. The online psychotherapy program focused on teaching coping, mindfulness, and problem-solving skills. Symptoms of anxiety and depression, resilience, and quality of life were assessed. Results: Participants demonstrated significant improvements in symptoms of anxiety (P=.02) and depression (P=.03) after the intervention. Similar trends were observed in the intention-to-treat analysis. No significant differences were observed in resilience and quality-of-life measures. The sample comprised mostly females, making it challenging to discern the benefits of the intervention in males. Although a pre-post design is less rigorous than a controlled trial, this design was selected to observe changes in scores during a critical period. Conclusions: e-CBT for COVID-19 is an effective and accessible treatment option. Improvements in clinical symptoms of anxiety and depression can be observed in individuals whose mental health is affected by the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/study/NCT04476667 International Registered Report Identifier (IRRID): RR2-10.2196/24913 %M 37993984 %R 10.2196/51102 %U https://mental.jmir.org/2023/1/e51102 %U https://doi.org/10.2196/51102 %U http://www.ncbi.nlm.nih.gov/pubmed/37993984 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e50806 %T Efficacy of a Smartphone App in Enhancing Medication Adherence and Accuracy in Individuals With Schizophrenia During the COVID-19 Pandemic: Randomized Controlled Trial %A Chen,Huan Hwa %A Hsu,Hsin Tien %A Lin,Pei Chao %A Chen,Chin-Yin %A Hsieh,Hsiu Fen %A Ko,Chih Hung %+ College of Nursing, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung, 80708, Taiwan, 886 7 3121101 ext 2626, hsiufen96@kmu.edu.tw %K cognitive functions %K medication adherence %K psychiatric symptoms %K schizophrenia %K smartphone app %D 2023 %7 14.12.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Poor medication adherence or inaccuracy in taking prescribed medications plays an important role in the recurrence or worsening of psychiatric symptoms in patients with schizophrenia, and the COVID-19 pandemic impacted their medication adherence with exacerbated symptoms or relapse. The use of mobile health services increased during the COVID-19 pandemic, and their role in improving mental health is becoming clearer. Objective: This study aimed to explore the effectiveness of a smartphone app (MedAdhere) on medication adherence and accuracy among patients with schizophrenia and to measure their psychiatric symptoms and cognitive functions. Methods: In this 12-week experimental study, participants were provided interventions with the MedAdhere app, and data were collected between June 2021 and September 2022. A total of 105 participants were randomly assigned to either the experimental or control groups. We used the Positive and Negative Syndrome Scale and Mini-Mental State Examination to measure the participants’ psychiatric symptoms and cognitive functions. Generalized estimating equations were used for data analysis. Results: A total of 94 participants met the inclusion criteria and completed the protocol, and the medication adherence rate of the experimental group was 94.72% (2785/2940) during the intervention. Psychotic symptoms (positive, negative, and general psychopathology symptoms) and cognitive functions (memory, language, and executive function) were significantly improved in the experimental group compared to the control group after the intervention. Conclusions: The MedAdhere app effectively and significantly improved medication adherence and, thereby, the psychiatric symptoms of patients with schizophrenia. This artificial intelligence assisted app could be extended to all patients who need to be reminded to take medication on schedule. Trial Registration: ClinicalTrials.gov NCT05892120; https://clinicaltrials.gov/study/NCT05892120 %M 38096017 %R 10.2196/50806 %U https://mental.jmir.org/2023/1/e50806 %U https://doi.org/10.2196/50806 %U http://www.ncbi.nlm.nih.gov/pubmed/38096017 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e37102 %T Prevalence of COVID-19 Mitigation Behaviors in US Adults (August-December 2020): Nationwide Household Probability Survey %A Sanchez,Travis %A Hall,Eric %A Siegler,Aaron J %A Prakash-Asrani,Radhika %A Bradley,Heather %A Fahimi,Mansour %A Lopman,Benjamin %A Luisi,Nicole %A Nelson,Kristin N %A Sailey,Charles %A Shioda,Kayoko %A Valentine-Graves,Mariah %A Sullivan,Patrick S %+ Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 727 8403, Travis.Sanchez@emory.edu %K COVID-19 %K mask %K social distancing %K handwashing %K hand sanitizer %K public health %K pandemic %K mitigation behavior %K risk factor %K disease prevention %K health policy %K latent class analysis %K hygiene %D 2023 %7 6.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 mitigation behaviors, such as wearing masks, maintaining social distancing, and practicing hand hygiene, have been and will remain vital to slowing the pandemic. Objective: This study aims to describe the period prevalence of consistent mask-wearing, social distancing, and hand hygiene practices during the peak of COVID-19 incidence (August-December 2020) and just before COVID-19 vaccine availability, overall and in demographic subgroups. Methods: We used baseline survey data from a nationwide household probability sample to generate weighted estimates of mitigation behaviors: wearing masks, maintaining social distancing, and practicing hand hygiene. Weighted logistic regression explored differences in mitigation behaviors by demographics. Latent class analysis (LCA) identified patterns in mitigation behaviors. Results: Among 4654 participants, most (n=2727, 58.6%) were female, were non-Hispanic White (n=3063, 65.8%), were aged 55 years or older (n=2099, 45.1%), lived in the South (n=2275, 48.9%), lived in metropolitan areas (n=4186, 89.9%), had at least a bachelor’s degree (n=2547, 54.7%), had an income of US $50,000-$99,000 (n=1445, 31%), and were privately insured (n=2734, 58.7%). The period prevalence of consistent mask wearing was 71.1% (sample-weighted 95% CI 68.8-73.3); consistent social distancing, 42.9% (95% CI 40.5-45.3); frequent handwashing, 55.0% (95% CI 52.3-57.7); and frequent hand sanitizing, 21.5% (95% CI 19.4-23.8). Mitigation behaviors were more prevalent among women, older persons, Black or Hispanic persons, those who were not college graduates, and service-oriented workers. LCA identified an optimal-mitigation class that consistently practiced all behaviors (n=2656, 67% of US adults), a low-mitigation class that inconsistently practiced all behaviors (n=771, 20.6%), and a class that had optimal masking and social distancing but a high frequency of hand hygiene (n=463, 12.4%). Conclusions: Despite a high prevalence of COVID-19 mitigation behaviors, there were likely millions who did not consistently practice these behaviors during the time of the highest COVID-19 incidence. In future infectious disease outbreak responses, public health authorities should also consider addressing disparities in mitigation practices through more targeted prevention messaging. %M 38055314 %R 10.2196/37102 %U https://publichealth.jmir.org/2023/1/e37102 %U https://doi.org/10.2196/37102 %U http://www.ncbi.nlm.nih.gov/pubmed/38055314 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44299 %T Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics %A Nazarov,Anthony %A Fikretoglu,Deniz %A Liu,Aihua %A Born,Jennifer %A Michaud,Kathy %A Hendriks,Tonya %A Bélanger,Stéphanie AH %A Do,Minh T %A Lam,Quan %A Brooks,Brenda %A King,Kristen %A Sudom,Kerry %A Jetly,Rakesh %A Garber,Bryan %A Thompson,Megan %+ MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, 550 Wellington Road, London, ON, N6C 0A7, Canada, 1 6474044924, anthony.nazarov@proton.me %K mental health %K military %K Canadian Armed Forces %K operational organization %K logistics support %K health care %K moral distress %K moral injury %K deployment %K risk factors %K COVID-19 %K quarantine %K readiness %K well-being %K resilience %K long-term care facility %K centre de soins de longue durée %K survey %K older adult %K qualitative interviews %K quantitative %D 2023 %7 6.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19–related deaths among residents of long-term care facilities (LTCFs). As part of Canada’s response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes. Objective: This study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics. Methods: A multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment. Results: CAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93%), 582 (22.43%), and 497 (19.15%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted. Conclusions: The data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF–specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature. International Registered Report Identifier (IRRID): DERR1-10.2196/44299 %M 37676877 %R 10.2196/44299 %U https://www.researchprotocols.org/2023/1/e44299 %U https://doi.org/10.2196/44299 %U http://www.ncbi.nlm.nih.gov/pubmed/37676877 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46518 %T Psychological Resilience Factors and Their Association With Weekly Stressor Reactivity During the COVID-19 Outbreak in Europe: Prospective Longitudinal Study %A Bögemann,Sophie A %A Puhlmann,Lara M C %A Wackerhagen,Carolin %A Zerban,Matthias %A Riepenhausen,Antje %A Köber,Göran %A Yuen,Kenneth S L %A Pooseh,Shakoor %A Marciniak,Marta A %A Reppmann,Zala %A Uściƚko,Aleksandra %A Weermeijer,Jeroen %A Lenferink,Dionne B %A Mituniewicz,Julian %A Robak,Natalia %A Donner,Nina C %A Mestdagh,Merijn %A Verdonck,Stijn %A van Dick,Rolf %A Kleim,Birgit %A Lieb,Klaus %A van Leeuwen,Judith M C %A Kobylińska,Dorota %A Myin-Germeys,Inez %A Walter,Henrik %A Tüscher,Oliver %A Hermans,Erno J %A Veer,Ilya M %A Kalisch,Raffael %+ Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, Nijmegen, 6525 EN, Netherlands, 31 024 3614305, Sophie.Bogemann@donders.ru.nl %K resilience %K stressor reactivity %K positive appraisal %K pandemic %K mental health %K COVID-19 %D 2023 %7 17.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Cross-sectional relationships between psychosocial resilience factors (RFs) and resilience, operationalized as the outcome of low mental health reactivity to stressor exposure (low “stressor reactivity” [SR]), were reported during the first wave of the COVID-19 pandemic in 2020. Objective: Extending these findings, we here examined prospective relationships and weekly dynamics between the same RFs and SR in a longitudinal sample during the aftermath of the first wave in several European countries. Methods: Over 5 weeks of app-based assessments, participants reported weekly stressor exposure, mental health problems, RFs, and demographic data in 1 of 6 different languages. As (partly) preregistered, hypotheses were tested cross-sectionally at baseline (N=558), and longitudinally (n=200), using mixed effects models and mediation analyses. Results: RFs at baseline, including positive appraisal style (PAS), optimism (OPT), general self-efficacy (GSE), perceived good stress recovery (REC), and perceived social support (PSS), were negatively associated with SR scores, not only cross-sectionally (baseline SR scores; all P<.001) but also prospectively (average SR scores across subsequent weeks; positive appraisal (PA), P=.008; OPT, P<.001; GSE, P=.01; REC, P<.001; and PSS, P=.002). In both associations, PAS mediated the effects of PSS on SR (cross-sectionally: 95% CI –0.064 to –0.013; prospectively: 95% CI –0.074 to –0.0008). In the analyses of weekly RF-SR dynamics, the RFs PA of stressors generally and specifically related to the COVID-19 pandemic, and GSE were negatively associated with SR in a contemporaneous fashion (PA, P<.001; PAC,P=.03; and GSE, P<.001), but not in a lagged fashion (PA, P=.36; PAC, P=.52; and GSE, P=.06). Conclusions: We identified psychological RFs that prospectively predict resilience and cofluctuate with weekly SR within individuals. These prospective results endorse that the previously reported RF-SR associations do not exclusively reflect mood congruency or other temporal bias effects. We further confirm the important role of PA in resilience. %M 37847551 %R 10.2196/46518 %U https://mental.jmir.org/2023/1/e46518 %U https://doi.org/10.2196/46518 %U http://www.ncbi.nlm.nih.gov/pubmed/37847551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44887 %T Acceptability and Feasibility of Online Support Groups for Mental Health Promotion in Brazilian Graduate Students During the COVID-19 Pandemic: Longitudinal Observational Study %A Prado,Aneliana da Silva %A Kohls,Elisabeth %A Baldofski,Sabrina %A Rummel-Kluge,Christine %A Freitas,Joanneliese de Lucas %+ Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Semmelweisstraße 10, Haus 13, Leipzig, 04103, Germany, 49 3419724464, Aneliana.daSilvaPrado@medizin.uni-leipzig.de %K support group %K online group %K COVID-19 pandemic %K higher education %K graduate students %K university students %K mental health %K online intervention %K internet intervention %K e–mental health %K mental health promotion %K feasibility %K students %K acceptability %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The outbreak of the COVID-19 pandemic in 2020 aggravated already existing difficulties and added new challenges for students. Owing to the gap between needed and available psychological services, group interventions may offer a helpful strategy for student mental health promotion. Objective: This study aimed to investigate the acceptability and feasibility of a 4-week online support group program designed for mental health promotion tailored to graduate students at a Brazilian public university in the context of the COVID-19 pandemic (May 2022 to June 2022). Methods: Participants in the program took part in online support groups based on a pilot group facilitated by a trained clinical psychologist. Self-administered, standardized web-based questionnaires were assessed at the baseline (T0; before the intervention), postintervention (T2), and follow-up (T3; after 4-6 weeks) time points. We measured sociodemographic variables, treatment credibility and expectancy (Credibility and Expectancy Questionnaire), satisfaction (Client Satisfaction Questionnaire), negative effects of the intervention (Negative Effects Questionnaire), depressive symptoms (Patient Health Questionnaire–9 [PHQ-9]), and participants’ quality of life (abbreviated World Health Organization Quality of Life assessment). A 9–answer option questionnaire and open-ended questions also assessed the group’s perceived positive and negative outcomes. Results: The total sample comprised 32 participants. Most (23/32, 72%) were doctoral students. Credibility and expectancy scores were high. Participants’ satisfaction (Client Satisfaction Questionnaire) with the program was high at the postintervention (T2) and follow-up (T3) evaluations (T2: mean 28.66, SD 3.02; T3: mean 27.91, SD 3.02). Most participants reported that they could learn from other participants’ experiences (T2: 29/32, 91%; T3: 27/32, 84%) and felt encouraged to take better care of themselves (T2: 22/32, 69%; T3: 24/32, 75%). None of the participants reported that they had no benefits from the program. The PHQ-9 scores showed mild to moderate depressive symptoms (mean 9.59, SD 6.34), whereas the answers of 9% (3/32) of the participants to the PHQ-9 item 9 indicated suicidality at baseline (T0). Finally, the 4 domains of quality of life (physical: P=.01; psychological: P=.004; social: P=.02; and environmental: P<.001) showed a slight and statistically significant improvement at the postintervention evaluation (T0: mean 57.03, SD 15.39 to 59.64, SD 17.21; T2: mean 64.32, SD 11.97 to 68.75, SD 8.87). Conclusions: Online support groups for the mental health promotion of graduate students are feasible and can be especially useful for universities with students allocated to different cities. They are also satisfactory and may positively influence participants’ quality of life. Therefore, they can be considered a helpful mental health promotion strategy in the educational context. Further studies could evaluate these (or similar) programs under nonpandemic circumstances. %M 37831483 %R 10.2196/44887 %U https://formative.jmir.org/2023/1/e44887 %U https://doi.org/10.2196/44887 %U http://www.ncbi.nlm.nih.gov/pubmed/37831483 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47239 %T Structural Equation Model for Social Support and Quality of Life Among Individuals With Mental Health Disorders During the COVID-19 Pandemic %A Tran,Bach Xuan %A Dam,Vu Anh Trong %A Auquier,Pascal %A Boyer,Laurent %A Fond,Guillaume %A Nguyen,Hung Manh %A Nguyen,Hung Tuan %A Le,Huong Thi %A Tran,Ha Nhi Thi %A Vu,Giang Thu %A Nguyen,Manh Duc %A Nguyen,Duong Anh Thi %A Ly,Bang Viet %A Latkin,Carl A %A Zhang,Melvyn WB %A Ho,Roger CM %A Ho,Cyrus SH %+ Institute for Preventive Medicine and Public Health, Hanoi Medical University, 1 Ton That Tung Street, Dong Da district, Hanoi, 100000, Vietnam, 84 888288770, bach.ipmph2@gmail.com %K contextual %K social support %K quality of life %K mental health disorders %K Vietnam %K mental health %K mental illness %K cross-sectional %K association %D 2023 %7 11.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In light of the COVID-19 pandemic, the distribution of social support for mental health problems has likely become unequal. Family- and community-based social support has been recognized as a promising approach for mental disorders; however, limited global frameworks have been applied to developing countries such as Vietnam. Objective: The aim of this study was to evaluate the quality of life and social support among patients with mental health disorders in Vietnam and to investigate the factors associated with quality of life among these patients. Methods: A cross-sectional study was conducted on 222 psychiatric patients in Hanoi from 2020 to 2022. A structured questionnaire was developed based on four standardized scales: Mental Well-Being-5 scale, Multidimensional Scale of Perceived Social Support, EuroQoL-visual analog scale (EQ-VAS), and EuroQoL-5 dimensions-5 levels (EQ-5D-5L) scale. Tobit regression was used to identify factors associated with the EQ-5D-5L and EQ-VAS scores. Structural equation modeling was applied to verify the relationship between quality of life and social support. Results: The results showed that perceived support from family scored the highest compared to support from friends and significant others. Patients with depression reported the lowest quality of life and perceived social support. Structural equation modeling showed a root mean square error of approximation of 0.055 (90% CI 0.006-0.090), comparative fit index of 0.954, Tucker-Lewis index of 0.892, and standardized root mean squared error of 0.036 (P<.001). The hypothetical model indicated statistically significant correlations between EQ-VAS score and social support (P=.004), EQ-5D-5L and mental well-being (P<.001), and social support and mental well-being (P<.001). Critical deterioration of quality of life and inconsistency in social support for patients with mental illness were also recorded. Conclusions: There is a need to enhance social support and service delivery in Vietnam, focusing on occupation and quality of life. The correlations between social support, quality of life, and mental health issues suggest the potential of a clinical-social integrated intervention model of care. %M 37819706 %R 10.2196/47239 %U https://publichealth.jmir.org/2023/1/e47239 %U https://doi.org/10.2196/47239 %U http://www.ncbi.nlm.nih.gov/pubmed/37819706 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50486 %T Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study %A Werkmeister,Benjamin %A Haase,Anne M %A Fleming,Theresa %A Officer,Tara N %+ School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn Parade, Kelburn, PO Box 600, Wellington, 6140, New Zealand, 64 44636575, benjamin.werkmeister@vuw.ac.nz %K telehealth %K mental health services %K Aotearoa New Zealand %K mixed methods research %K clinician %K COVID-19 %D 2023 %7 22.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic accelerated the adoption of telehealth services for remote mental health care provision. Although studies indicate that telehealth can enhance the efficiency of service delivery and might be favored or even preferred by certain clients, its use varied after the pandemic. Once the pandemic-related restrictions eased, some regions curtailed their telehealth offerings, whereas others sustained them. Understanding the factors that influenced these decisions can offer valuable insights for evidence-based decision-making concerning the future of telehealth in mental health services. Objective: This study explored the factors associated with the uptake of and retreat from telehealth across a multiregional outpatient mental health service in Aotearoa New Zealand. We aimed to contribute to the understanding of the factors influencing clinicians’ use of telehealth services to inform policy and practice. Methods: Applying an interpretive description methodology, this sequential mixed methods study involved semistructured interviews with 33 mental health clinicians, followed by a time-series analysis of population-level quantitative data on clinician appointment activities before and throughout the COVID-19 pandemic. The interviews were thematically analyzed, and select themes were reframed for quantitative testing. The time-series analysis was conducted using administrative data to explore the extent to which these data supported the themes. In total, 4,117,035 observations were analyzed between September 2, 2019, and August 1, 2022. The findings were then synthesized through the rereview of qualitative themes. Results: The rise and recession of telehealth in the study regions were related to 3 overarching themes: clinician preparedness and role suitability, population determinants, and service capability. Participants spoke about the importance of familiarity and training but noted differences between specialist roles. Quantitative data further suggested differences based on the form of telehealth services offered (eg, audiovisual or telephone). In addition, differences were noted based on age, gender, and ethnicity; however, clinicians recognized that effective telehealth use enabled clinicians’ flexibility and client choice. In turn, clinicians spoke about system factors such as telehealth usability and digital exclusion that underpinned the daily functionality of telehealth. Conclusions: For telehealth services to thrive when they are not required by circumstances such as pandemic, investment is needed in telehealth training for clinicians, digital infrastructure, and resources for mental health teams. The strength of this study lies in its use of population-level data and consideration of a telehealth service operating across a range of teams. In turn, these findings reflect the voice of a variety of mental health clinicians, including teams operating from within specific cultural perspectives. %M 37738075 %R 10.2196/50486 %U https://formative.jmir.org/2023/1/e50486 %U https://doi.org/10.2196/50486 %U http://www.ncbi.nlm.nih.gov/pubmed/37738075 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47047 %T Telehealth and In-Person Behavioral Health Services in Rural Communities Before and During the COVID-19 Pandemic: Multisite Prospective Cohort Study %A Ward,Marcia M %A Ullrich,Fred %A Bhagianadh,Divya %A Nelson,Eve-Lynn %A Marcin,James P %A Carter,Knute D %A Law,Kari Beth %A McCord,Carly %A Neufeld,Jonathan %A Merchant,Kimberly A S %+ Department of Health Management and Policy, University of Iowa, College of Public Health Building S236, 145 Riverside Dr, Iowa City, IA, 52242, United States, 1 319 384 3815, marcia-m-ward@uiowa.edu %K anxiety %K behavior %K behavioral health %K COVID-19 %K depression %K digital health %K eHealth %K mental health %K mHealth %K pandemic %K rural health services %K rural %K telehealth %K telemedicine %D 2023 %7 18.9.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic triggered widespread adjustments across the US health care system. Telehealth use showed a substantial increase in mental health conditions and services due to acute public health emergency (PHE) behavioral health needs on top of long-standing gaps in access to behavioral health services. How health systems that were already providing behavioral telehealth services adjusted services and staffing during this period has not been well documented, particularly in rural areas with chronic shortages of behavioral health providers and services. Objective: This study investigates patient and treatment characteristic changes from before the COVID-19 PHE to during the PHE within both telehealth and in-person behavioral health services provided in 95 rural communities across the United States. Methods: We used a nonrandomized, prospective, multisite research design involving 2 active treatment groups. The telehealth cohort included all patients who initiated telehealth treatment regimens during the data collection period. A comparison group included a cohort of patients who initiated in-person treatment regimen. Patient enrollment occurred on a rolling basis, and data collection was extended for 3 months after treatment initiation for each patient. Chi-square tests compared changes from pre-PHE to PHE time periods within telehealth and in-person treatment cohorts. The dependent measures included patient diagnosis, clinicians providing treatment services, and type of treatment services provided at each encounter. The 4780 patients in the telehealth cohort and the 6457 patients in the in-person cohort had an average of 3.5 encounters during the 3-month follow-up period. Results: The encounters involving anxiety, dissociative, and stress-related disorders in the telehealth cohort increased from 30% (698/2352) in the pre-PHE period to 35% (4632/12,853) in the PHE period (P<.001), and encounters involving substance use disorders in the in-person cohort increased from 11% (468/4249) in the pre-PHE period to 18% (3048/17,047) in the PHE period (P<.001). The encounters involving treatment service codes for alcohol, drug, and medication-assisted therapy in the telehealth cohort increased from 1% (22/2352) in the pre-PHE period to 11% (1470/13,387) in the PHE period (P<.001); likewise, encounters for this type of service in the in-person cohort increased from 0% (0/4249) in the pre-PHE period to 16% (2687/17,047) in the PHE period (P<.001). From the pre-PHE to the PHE period, encounters involving 60-minute psychotherapy in the telehealth cohort increased from 8% (190/2352) to 14% (1802/13,387; P<.001), while encounters involving group therapy in the in-person cohort decreased from 12% (502/4249) to 4% (739/17,047; P<.001). Conclusions: The COVID-19 pandemic challenged health service providers, and they adjusted the way both telehealth and in-person behavioral therapy services were delivered. Looking forward, future research is needed to explicate the interaction of patient, provider, setting, and intervention factors that influenced the patterns observed as a result of the COVID-19 pandemic. %M 37721793 %R 10.2196/47047 %U https://mental.jmir.org/2023/1/e47047 %U https://doi.org/10.2196/47047 %U http://www.ncbi.nlm.nih.gov/pubmed/37721793 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e47702 %T Coping Strategies Used by Health Care Workers in Ecuador During the COVID-19 Pandemic: Observational Study to Enhance Resilience and Develop Training Tools %A Vicente,María Asunción %A Gil Hernández,Eva %A Carrillo,Irene %A Fernández,César %A López-Pineda,Adriana %A Guilabert,Mercedes %A Martín-Delgado,Jimmy %A Solis,Carlos %A Camba,Karla %A Cañizares Fuentes,Wilson Ricardo %A Mira,José Joaquín %+ Health Psychology Department, Miguel Hernandez University, Avda de la Universidad s/n, Edificio Altamira, Elche, 03202, Spain, 34 966658385, suni@umh.es %K COVID-19 %K coping %K mental health %K social support %K health professionals %K psychological well-being %K resilience %K coping strategy %K used %K health care worker %K pandemic %K well-being %K professional %K intervention %D 2023 %7 6.9.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has generated immense health care pressure, forcing critical decisions to be made in a socially alarmed environment. Adverse conditions have led to acute stress reactions, affective pathologies, and psychosomatic reactions among health personnel, which have been exacerbated by the successive waves of the pandemic. The recovery of the entire health system and its professionals has been hindered, making it essential to increase their resilience. Objective: This study aimed to achieve 2 primary objectives. First, it sought to identify coping strategies, both individual and organizational, used by health care workers in Ecuador to navigate the acute stress during the early waves of the pandemic. Second, it aimed to develop training materials to enhance team leaders' capabilities in effectively managing high-stress situations. Methods: The study used qualitative research techniques to collect information on institutional and personal coping strategies, as well as consensus-building techniques to develop a multimedia psychological tool that reinforces the resilience of professionals and teams in facing future crises. Results: The findings from the actions taken by health care workers in Ecuador were categorized into 4 types of coping strategies based on Lazarus' theories on coping strategies. As a result of this study, a new audiovisual tool was created, comprising a series of podcasts, designed to disseminate these strategies globally within the Spanish-speaking world. The tool features testimonials from health care professionals in Ecuador, narrating their experiences under the pressures of providing care during the pandemic, with a particular emphasis on the coping strategies used. Conclusions: Ensuring the preparedness of health professionals for potential future outbreaks is imperative to maintain quality and patient safety. Interventions such as this one offer valuable insights and generate new tools for health professionals, serving as a case study approach to train leaders and improve the resilience capacity and skills of their teams. %M 37672317 %R 10.2196/47702 %U https://humanfactors.jmir.org/2023/1/e47702 %U https://doi.org/10.2196/47702 %U http://www.ncbi.nlm.nih.gov/pubmed/37672317 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44000 %T Effects of Web-Based Mindfulness-Based Interventions on Anxiety, Depression, and Stress Among Frontline Health Care Workers During the COVID-19 Pandemic: Systematic Review and Meta-Analysis %A Yang,Jia-ming %A Ye,Hua %A Long,Yi %A Zhu,Qiang %A Huang,Hui %A Zhong,Yan-biao %A Luo,Yun %A Yang,Lei %A Wang,Mao-yuan %+ Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, 128 Jinling Road, Zhanggong District, Ganzhou City, Jiangxi Province, Ganzhou, 341000, China, 86 13767766152, wmy.gmu.kf@gmail.com %K web-based %K mindfulness-based intervention %K COVID-19 %K health care worker %K mental disorder %D 2023 %7 29.8.2023 %9 Review %J J Med Internet Res %G English %X Background: Since 2019, the COVID-19 outbreak has spread around the world, and health care workers, as frontline workers, have faced tremendous psychological stress. Objective: The purpose of this study is to explore whether web-based mindfulness-based interventions continue to have a positive impact on anxiety, depression, and stress among health care workers during the COVID-19 pandemic. Methods: The inclusion criteria were as follows: (1) participants were frontline health care workers during the COVID-19 pandemic; (2) the experimental group was a web-based mindfulness-based intervention; (3) the control group used either general psychological intervention or no intervention; (4) outcome indicators included scales to assess anxiety, depression, and stress; and (5) the study type was a randomized controlled study. Studies that did not meet the above requirements were excluded. We searched 9 databases, including Web of Science, Embase, PubMed, Cochrane Library, Scopus, ScienceDirect, SinoMed, China National Knowledge Infrastructure (CNKI), and Wanfang Database, for randomized controlled studies on the effects of web-based mindfulness-based interventions on common mental disorder symptoms among health care workers from January 1, 2020, to October 20, 2022. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database scale. The Cochrane risk of bias tool was used to assess the risk of bias. Subgroup analysis was used to look for sources of heterogeneity and to explore whether the results were the same for subgroups under different conditions. Sensitivity analysis was used to verify the stability of the pooled results. Results: A total of 10 randomized controlled studies with 1311 participants were included. The results showed that web-based mindfulness-based interventions were effective in reducing the symptoms of anxiety (standard mean difference [SMD]=–0.63, 95% CI –0.96 to –0.31, P<.001, I2=87%), depression (SMD=–0.52, 95% CI –0.77 to –0.26, P<.001, I2=75%), and stress (SMD=–0.20, 95% CI –0.35 to –0.05, P=.01, I2=58%) among health care workers during the COVID-19 pandemic, but with wide CIs and high heterogeneity. Conclusions: Web-based mindfulness-based interventions may be effective in reducing the symptoms of anxiety, depression, and stress among frontline health care workers during the COVID-19 pandemic. However, this effect is relatively mild and needs to be further explored by better studies in the future. Trial Registration: PROSPERO CRD42022343727; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343727 %M 37527546 %R 10.2196/44000 %U https://www.jmir.org/2023/1/e44000 %U https://doi.org/10.2196/44000 %U http://www.ncbi.nlm.nih.gov/pubmed/37527546 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46148 %T Determinants of Patient Use and Satisfaction With Synchronous Telemental Health Services During the COVID-19 Pandemic: Systematic Review %A Neumann,Ariana %A König,Hans-Helmut %A Bokermann,Josephine %A Hajek,André %+ Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 40 7410 54202, ar.neumann@uke.de %K telemedicine %K digital health %K teletherapy %K mental health %K use %K satisfaction %D 2023 %7 18.8.2023 %9 Review %J JMIR Ment Health %G English %X Background: Several recent studies examined patient use and satisfaction with synchronous telemental health services in response to the widespread implementation during the COVID-19 pandemic. However, a systematic review of recent literature on the determinants of these outcomes is missing. Objective: The aim of this systematic review was to give an extensive overview of the literature on and highlight the influential determinants of patient use and satisfaction with synchronous telemental health services during the COVID-19 pandemic. Methods: This review satisfied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO. Peer-reviewed, quantitative studies that observed the determinants of patient use or satisfaction with synchronous telemental health services during the COVID-19 pandemic were included. PubMed, PsycInfo, and Web of Science database searches were conducted in August 2022 for English and German language studies published from 2020 onward. Key steps were performed by 2 reviewers. Determinants were synthesized into major categories informed by the dimensions of the widely used and established Unified Theory of Acceptance and Use of Technology. Results: Of the 20 included studies, 10 studies examined determinants of patient use, 7 examined determinants of patient satisfaction, and 3 observed both outcomes. The quality of the studies was mainly good or fair. There was substantial heterogeneity in the study designs, methods, and findings. Sociodemographic characteristics and health-related determinants were mostly considered. Some of the major dimensions of the Unified Theory of Acceptance and Use of Technology were neglected in recent studies. Although most findings were mixed or nonsignificant, some indications for potential relationships were found (eg, for sex, age, and symptom severity). Conclusions: The findings revealed potential target groups (eg, female and young patients with mild symptoms) for future postpandemic telemental health interventions. However, they also identified patient groups that were harder to reach (eg, older patients with severe symptoms); efforts may be beneficial to address such groups. Future quantitative and qualitative research is needed to secure and expand on recent findings, which could help improve services. Trial Registration: PROSPERO CRD42022351576; https://tinyurl.com/yr6zrva5 %M 37594785 %R 10.2196/46148 %U https://mental.jmir.org/2023/1/e46148 %U https://doi.org/10.2196/46148 %U http://www.ncbi.nlm.nih.gov/pubmed/37594785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43000 %T Frontline Health Care Workers’ Mental Health and Well-Being During the First Year of the COVID-19 Pandemic: Analysis of Interviews and Social Media Data %A Vera San Juan,Norha %A Martin,Sam %A Badley,Anna %A Maio,Laura %A Gronholm,Petra C %A Buck,Caroline %A Flores,Elaine C %A Vanderslott,Samantha %A Syversen,Aron %A Symmons,Sophie Mulcahy %A Uddin,Inayah %A Karia,Amelia %A Iqbal,Syka %A Vindrola-Padros,Cecilia %+ Rapid Research Evaluation and Appraisal Lab (RREAL), Department of Targeted Intervention, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 2000, n.verasanjuan@ucl.ac.uk %K mental health %K frontline %K health care workers %K COVID-19 %K health services research %K Collaborative and Digital Analysis of Big Qualitative Data in Time Sensitive Contexts %K LISTEN method %D 2023 %7 14.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has shed light on fractures in health care systems worldwide and continues to have a significant impact, particularly in relation to the health care workforce. Frontline staff have been exposed to unprecedented strain, and delivering care during the pandemic has affected their safety, mental health, and well-being. Objective: This study aimed to explore the experiences of health care workers (HCWs) delivering care in the United Kingdom during the COVID-19 pandemic to understand their well-being needs, experiences, and strategies used to maintain well-being (at individual and organizational levels). Methods: We analyzed 94 telephone interviews with HCWs and 2000 tweets about HCWs’ mental health during the first year of the COVID-19 pandemic. Results: The results were grouped under 6 themes: redeployment, clinical work, and sense of duty; well-being support and HCW’s coping strategies; negative mental health effects; organizational support; social network and support; and public and government support. Conclusions: These findings demonstrate the need for open conversations, where staff’s well-being needs and the strategies they adopted can be shared and encouraged, rather than implementing top-down psychological interventions alone. At the macro level, the findings also highlighted the impact on HCW’s well-being of public and government support as well as the need to ensure protection through personal protective equipment, testing, and vaccines for frontline workers. %M 37402283 %R 10.2196/43000 %U https://www.jmir.org/2023/1/e43000 %U https://doi.org/10.2196/43000 %U http://www.ncbi.nlm.nih.gov/pubmed/37402283 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e46753 %T Strengthening Social Capital to Address Isolation and Loneliness in Long-Term Care Facilities During the COVID-19 Pandemic: Systematic Review of Research on Information and Communication Technologies %A Beogo,Idrissa %A Sia,Drissa %A Collin,Stephanie %A Phaelle Gedeon,Andi %A Louismé,Michaël-Christopher %A Ramdé,Jean %A Gagnon,Marie-Pierre %A Tchouaket Nguemeleu,Eric %+ University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada, 1 6135625800 ext 8148, ibeogo@uottawa.ca %K information and communication technology %K ICT %K long-term care facilities %K COVID-19 %K social isolation %K loneliness %K pandemic %K implementation sciences %K protocol %K nursing home %K mobile phone %D 2023 %7 14.8.2023 %9 Review %J JMIR Aging %G English %X Background: The COVID-19 pandemic has disproportionately and severely affected older adults, namely those living in long-term care facilities (LTCFs). Aside from experiencing high mortality rates, survivors were critically concerned by social isolation and loneliness (SIL). To address this serious public health concern and stay connected with LTCF residents, information and communication technology (ICT) platforms (eg, video calls) were used as an alternative to maintaining social interactions amid the visiting restriction policy. Objective: This paper aimed to synthesize the effects of ICT-related communication interventions using SMS text messaging or chat, video, voice mail, or photo to address SIL in LTCF residents during the COVID-19 pandemic. Methods: In total, 2793 references published in English and French in 2019 and onward were obtained from 10 relevant databases: PsycINFO-Ovid, Ovid-MEDLINE, CINAHL-EBSCO, Cochrane Library, Web of Science, Scopus, DirectScience, Communication & Mass Media Complete, IEEE Xplore, and ACM Digital Library. A 2-person screening approach was used, and the studies were screened independently and blindly. A narrative synthesis was performed to interpret the results of the included studies, and their quality was appraised. Results: In total, 4 studies were included in the review. ICT-related applications were used to ensure connectedness to address SIL. ICT interventions consisted mainly of videoconferencing, intergroup video call sessions between residents, and chatting (SMS text messages and phone calls). Roughly 3 classes of mediating ICT tools were used: video calls using software applications (eg, Skype); robot systems embedding video telephones; and ordinary telecommunication such as telephone, internet, social media platforms, and videoconferencing. This review has included the role of humanoid robots in LTCFs as an innovation avenue because of their multipurpose use (eg, communication tools and remotely operable). Conclusions: Remote social capitalization through ICT applications has become an avenue to reduce SIL among LTCF residents. This review examined a social connection approach that will remain relevant and even be fostered after the COVID-19 pandemic. As families remain the main stakeholders of LTCFs, this study’s findings could inform policy makers and frontline managers to better shape programs and initiatives to prevent or reduce SIL in LTCFs. International Registered Report Identifier (IRRID): RR2-10.2196/36269 %M 37578824 %R 10.2196/46753 %U https://aging.jmir.org/2023/1/e46753 %U https://doi.org/10.2196/46753 %U http://www.ncbi.nlm.nih.gov/pubmed/37578824 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40274 %T Examining the Utility of a Telehealth Warm Handoff in Integrated Primary Care for Improving Patient Engagement in Mental Health Treatment: Randomized Video Vignette Study %A Fountaine,Alex R %A Iyar,Megumi M %A Lutes,Lesley D %+ The Center for Obesity and Well-Being Research Excellence, Department of Psychology, University of British Columbia - Okanagan Campus, 1238 Discovery Ave, Kelowna, BC, Canada, 1 2503075045, lesley.lutes@ubc.ca %K integrated primary care %K integrated care %K patient-centered medical home %K warm handoff %K treatment engagement %K collaborative care %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A warm handoff from a physician to a mental health provider is often patients’ first contact with psychological services and provides a unique opportunity for improving treatment engagement in integrated primary care (IPC) settings. Objective: In light of the COVID-19 pandemic, this study sought to examine the impact of different types of telehealth mental health referrals on both the anticipated likelihood of accepting treatment services and anticipated likelihood of continued treatment engagement. Methods: A convenience sample of young adults (N=560) was randomized to view 1 of 3 video vignettes: warm handoff in IPC, referral as usual (RAU) in IPC, or RAU in standard primary care. Results: Logistic associations between referral type and the likelihood of referral acceptance (χ21=10.9, P=.004) and the likelihood of continued engagement (χ21=32.6, P<.001) were significant. Participants who received a warm handoff were significantly more likely to anticipate both accepting the referral (b=0.35; P=.002; odds ratio 1.42, 95% CI 1.15-1.77) and engaging in continued treatment (b=0.62; P<.001; odds ratio 1.87, 95% CI 1.49-2.34) compared with those who received RAU in the standard primary care condition. Furthermore, 77.9% (436/560) of the sample indicated that they would be at least somewhat likely to access IPC mental health services for their own mental health concerns if they were readily available in their own primary care physician’s office. Conclusions: A telehealth warm handoff resulted in the increased anticipated likelihood of both initial and continued engagement in mental health treatment. A telehealth warm handoff may have utility in fostering the uptake of mental health treatment. Nonetheless, a longitudinal assessment in a primary care clinic of the utility of a warm handoff for fostering referral acceptance and continued treatment engagement is needed to hone the adoptability of a warm handoff process and demonstrate practical evidence of effectiveness. The optimization of a warm handoff would also benefit from additional studies examining patient and provider perspectives about the factors affecting treatment engagement in IPC settings. %M 37338963 %R 10.2196/40274 %U https://formative.jmir.org/2023/1/e40274 %U https://doi.org/10.2196/40274 %U http://www.ncbi.nlm.nih.gov/pubmed/37338963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43036 %T An Entertainment-Education Video and Written Messages to Alleviate Loneliness in Germany: Pilot Randomized Controlled Study %A Liu,Shuyan %A Wegner,Luisa %A Haucke,Matthias %A Gates,Jennifer %A Adam,Maya %A Bärnighausen,Till %+ Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 622156534, till.baernighausen@uni-heidelberg.de %K entertainment media %K perceived social isolation %K health communication %K digital knowledge %D 2023 %7 7.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: More than half of adults in Germany have felt lonely during the COVID-19 pandemic. Previous studies highlight the importance of boosting positive emotions and social connectedness to combat loneliness. However, interventions targeting these protective psychosocial resources remain largely untested. Objective: In this study, we aim to test the feasibility of a short animated storytelling video, written messages boosting social connectedness, and a combination of both for alleviating loneliness. Methods: We enrolled 252 participants who were 18 years or older and spoke fluent German. Participants were recruited from a previous study on loneliness in Germany. We measured the effects of a combination of an animated video and written messages (intervention A), an animated video (intervention B), and written messages (intervention C) on loneliness, self-esteem, self-efficacy, and hope. We compared these with a control arm, which did not receive any intervention. The animated video was developed by Stanford University School of Medicine to reflect experiences of social isolation during the COVID-19 pandemic and convey messages of hope and solidarity. The written messages communicate four findings from recent studies on loneliness in Germany: (1) over a period of 6 months, 66% of respondents in Germany reported feeling lonely (feelings of loneliness are surprisingly common); (2) physical activity can ease feelings of loneliness; (3) focusing on “what really matters” in one’s life can help to ease feelings of loneliness; and (4) turning to friends for companionship and support can ease feelings of loneliness. Participants were randomized 1:1:1:1 to interventions A, B, C, and the control condition, using the randomization feature of the web-based platform “Unipark,” on which our trial takes place. Both the study investigators and analysts were blinded to the trial assignments. The primary outcome, loneliness, was measured using the short-form UCLA Loneliness Scale (ULS-8). Our secondary outcomes included the scores of the Coping with Loneliness Questionnaire, the 10-item Rosenberg Self-Esteem Scale (RSE), the 10-item General Self-Efficacy Scale, and the 12-item Adult Hope Scale (AHS). Results: We observed no statistically significant effect of the tested interventions on loneliness scores, controlling for the baseline loneliness score before an intervention (all P values >.11). However, we observed significantly greater intention to cope with loneliness after exposure to an animated video when compared with the control (β=4.14; t248=1.74; 1-tailed P=.04). Conclusions: Our results provide meaningful evidence for the feasibility of a full-scale study. Our study sheds light on the intention to cope with loneliness and explores the potential for creative digital interventions to enhance this psychological precursor, which is integral to overcoming loneliness. Trial Registration: German Clinical Trials Register DRKS00027116; https://drks.de/search/en/trial/DRKS00027116 %M 37285206 %R 10.2196/43036 %U https://formative.jmir.org/2023/1/e43036 %U https://doi.org/10.2196/43036 %U http://www.ncbi.nlm.nih.gov/pubmed/37285206 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e42707 %T COVID-19 Infodemic and Impacts on the Mental Health of Older People: Cross-sectional Multicenter Survey Study %A Braz,Patricia Rodrigues %A Moreira,Tiago Ricardo %A Ribeiro,Andréia Queiroz %A de Faria,Luciane Ribeiro %A Carbogim,Fabio da Costa %A Püschel,Vilanice Alves de Araújo %A Fhon,Jack Roberto Silva %A Freitas,Eduarda Rezende %A Pinto,Ione Carvalho %A Zacharias,Fabiana Costa Machado %A Cruz,Gylce Eloisa Cabreira Panitz %A Machado,Richardson Miranda %A Santana,Rosimere Ferreira %A de Souza,Priscilla Alfradique %A Bitencourt,Graziele Ribeiro %A Bulgarelli,Alexandre Favero %A Cavalcante,Ricardo Bezerra %+ Universidade Federal de Juiz de Fora, Campus Universitário, Rua José Lourenço Kelmer, s/n - São Pedro, Juiz de Fora - MG, 36036-900, Brazil, 55 32 85033443, ricardo.cavalcante@ufjf.br %K information dissemination %K health communication %K COVID-19 %K COVID-19 pandemic %K public health %K health of older people %K mental health %D 2023 %7 17.5.2023 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic received widespread media coverage due to its novelty, an early lack of data, and the rapid rise in deaths and cases. This excessive coverage created a secondary “infodemic” that was considered to be a serious public and mental health problem by the World Health Organization and the international scientific community. The infodemic particularly affected older individuals, specifically those who are vulnerable to misinformation due to political positions, low interpretive and critical analysis capacity, and limited technical-scientific knowledge. Thus, it is important to understand older people’s reaction to COVID-19 information disseminated by the media and the effect on their lives and mental health. Objective: We aimed to describe the profile of exposure to COVID-19 information among older Brazilian individuals and the impact on their mental health, perceived stress, and the presence of generalized anxiety disorder (GAD). Methods: This cross-sectional, exploratory study surveyed 3307 older Brazilians via the web, social networks, and email between July 2020 and March 2021. Descriptive analysis and bivariate analysis were performed to estimate associations of interest. Results: Major proportions of the 3307 participants were aged 60 to 64 years (n=1285, 38.9%), female (n=2250, 68.4%), and married (n=1835, 55.5%) and self-identified as White (n=2364, 71.5%). Only 295 (8.9%) had never started or completed a basic education. COVID-19 information was mainly accessed on television (n=2680, 81.1%) and social networks (n=1943, 58.8%). Television exposure was ≥3 hours in 1301 (39.3%) participants, social network use was 2 to 5 hours in 1084 (32.8%) participants, and radio exposure was ≥1 hour in 1223 (37%) participants. Frequency of exposure to social networks was significantly associated with perceived stress (P=.04) and GAD (P=.01). A Bonferroni post hoc test revealed significantly different perceived stress in participants who were exposed to social networks for 1 hour (P=.04) and those who had no exposure (P=.04). A crude linear regression showed that “some” social media use (P=.02) and 1 hour of exposure to social media (P<.001) were associated with perceived stress. Adjusting for sociodemographic variables revealed no associations with this outcome variable. In a crude logistic regression, some social media use (P<.001) and 2 to 5 hours of exposure to social media (P=.03) were associated with GAD. Adjusting for the indicated variables showed that some social network use (P<.001) and 1 hour (P=.04) and 2 to 5 hours (P=.03) of exposure to social media were associated with GAD. Conclusions: Older people, especially women, were often exposed to COVID-19–related information through television and social networks; this affected their mental health, specifically GAD and stress. Thus, the impact of the infodemic should be considered during anamnesis for older people, so that they can share their feelings about it and receive appropriate psychosocial care. %M 37195762 %R 10.2196/42707 %U https://aging.jmir.org/2023/1/e42707 %U https://doi.org/10.2196/42707 %U http://www.ncbi.nlm.nih.gov/pubmed/37195762 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40669 %T Handling Public Well-being During the COVID-19 Crisis: Empirical Study With Representatives From Municipalities in Sweden %A Alaqra,Ala Sarah %A Khumalo,Akhona C %+ Information Systems, Karlstad Business School, Karlstad University, Universitetsgatan 2, karlstad, 65188, Sweden, 46 547002815, as.alaqra@kau.se %K COVID-19 %K Sweden %K government %K well-being %K public health %K information and communications technology %K recreational activities %D 2023 %7 12.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 has had a significant impact on the public’s health and well-being due to infections and restrictions imposed during the crisis. Recreational activities are important for the public’s well-being; however, the public’s safety from the COVID-19 virus is the top priority. Sweden, a country with a decentralized public health and welfare system, relied on less stringent approaches for handling the crisis. The limited restrictions in Sweden allowed recreational activities to take place despite the pandemic, which could be attributed to considerations for the public’s well-being. Objective: The objective of this study was to investigate municipal approaches for handling and supporting recreational activities during the COVID-19 crisis. Methods: We conducted an empirical study (qualitative and quantitative), using an online survey for data collection, with 23 participants. They were representatives holding mostly managerial roles in 18 distinct municipalities (18 counties). A thematic analysis was conducted to analyze open-ended responses, and descriptive statistics were used to summarize the closed-ended responses. Results: In this study, we report on the status of municipalities during the COVID-19 pandemic. The highlighted results showed a significant impact on the municipalities as a result of COVID-19, where 78% (18/23) of participants stated significant changes due to the pandemic. Moreover, 91% (21/23) indicated efforts and approaches for supporting recreational activities during COVID-19. Following national guidelines for the public’s health and safety was indicated by 78% (18/23) of participants. Information and communications technology (ICT) was considered significant for dealing with COVID-19 according to 87% (20/23) of participants. Our qualitative results further showed details of the public’s health and safety considerations, the efforts to support recreational activities particularly for youth, and the role and requirements of ICT. Challenges relating to the usability of ICT were also highlighted. Conclusions: Despite the critique of Sweden’s lenient strategy for handling the COVID-19 crisis, our results showed significant considerations for the public’s safety and well-being by the municipalities (regional and local levels) in this study. The Swedish approach to handling the crisis involved trusting the public with safety guidelines in addition to efforts for the public’s safety, supporting the public’s well-being with approaches for maintaining recreational activities, and giving special care to the youth. Despite having technological solutions in place, challenges in using digital solutions and requirements for future development were noted. %M 37053098 %R 10.2196/40669 %U https://formative.jmir.org/2023/1/e40669 %U https://doi.org/10.2196/40669 %U http://www.ncbi.nlm.nih.gov/pubmed/37053098 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e39697 %T Eliciting Opinions on Health Messaging During the COVID-19 Pandemic: Qualitative Survey Study %A Ruiz,Sienna %A Okere,Uzoma Charles %A Eggers,Michelle %A O'Leary,Catina %A Politi,Mary %A Wan,Fei %A Housten,Ashley J %+ Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, 660 S Euclid Ave, MSC 8100-0094-02, St. Louis, MO, 63110, United States, 1 (314) 454 7958, ahousten@wustl.edu %K COVID-19 %K health messaging %K rural populations %K urban populations %K communication %K health information %K messaging %K dissemination %K health equity %K prevention %K implementation %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Effective public health messaging has been necessary throughout the COVID-19 pandemic, but stakeholders have struggled to communicate critical information to the public, especially in different types of locations such as urban and rural areas. Objective: This study aimed to identify opportunities to improve COVID-19 messages for community distribution in rural and urban settings and to summarize the findings to inform future messaging. Methods: We purposively sampled by region (urban or rural) and participant type (general public or health care professional) to survey participants about their opinions on 4 COVID-19 health messages. We designed open-ended survey questions and analyzed the data using pragmatic health equity implementation science approaches. Following the qualitative analysis of the survey responses, we designed refined COVID-19 messages incorporating participant feedback and redistributed them via a short survey. Results: In total, 67 participants consented and enrolled: 31 (46%) community participants from the rural Southeast Missouri Bootheel, 27 (40%) community participants from urban St Louis, and 9 (13%) health care professionals from St Louis. Overall, we found no qualitative differences between the responses of our urban and rural samples to the open-ended questions. Participants across groups wanted familiar COVID-19 protocols, personal choice in COVID-19 preventive behaviors, and clear source information. Health care professionals contextualized their suggestions within the specific needs of their patients. All groups suggested practices consistent with health-literate communications. We reached 83% (54/65) of the participants for message redistribution, and most had overwhelmingly positive responses to the refined messages. Conclusions: We suggest convenient methods for community involvement in the creation of health messages by using a brief web-based survey. We identified areas of improvement for future health messaging, such as reaffirming the preventive practices advertised early in a crisis, framing messages such that they allow for personal choice of preventive behavior, highlighting well-known source information, using plain language, and crafting messages that are applicable to the readers’ circumstances. %M 36848256 %R 10.2196/39697 %U https://humanfactors.jmir.org/2023/1/e39697 %U https://doi.org/10.2196/39697 %U http://www.ncbi.nlm.nih.gov/pubmed/36848256 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41822 %T Changes in Online Food Access During the COVID-19 Pandemic and Associations With Deprivation: Longitudinal Analysis %A Keeble,Matthew %A Adams,Jean %A Burgoine,Thomas %+ MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Level 3, Institute of Metabolic Science, Cambridge, CB2 0SL, United Kingdom, 44 1223 330315, matthew.keeble@mrc-epid.cam.ac.uk %K COVID-19 %K digital food environment %K fast foods %K online food delivery services %K public health %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Food prepared out of home is typically energy-dense and nutrient-poor. Online food delivery services have become a popular way to purchase such food. The number of accessible food outlets through these services can influence how frequently they are used. Anecdotally, food outlet access through online food delivery services increased in England between 2020 and 2022, in the context of the COVID-19 pandemic. However, the extent to which this access changed is poorly understood. Objective: We aimed to investigate monthly changes in online access to food prepared out of home in England in the context of the first 2 years of the COVID-19 pandemic compared with November 2019 and the extent to which any changes were associated with deprivation. Methods: In November 2019 and monthly between June 2020 and March 2022, we used automated data collection to construct a data set containing information about all food outlets in England registered to accept orders through the leading online food delivery service. Across postcode districts, we identified the number and percentage of food outlets registered to accept orders and the number that was accessible. We used generalized estimating equations (adjusted for population density, the number of food outlets in the physical food environment, and rural/urban classification) to investigate the change in outcomes compared with prepandemic levels (November 2019). We stratified analyses by deprivation quintile (Q). Results: Across England, the summed number of food outlets registered to accept orders online increased from 29,232 in November 2019 to 49,752 in March 2022. Across postcode districts, the median percentage of food outlets registered to accept orders online increased from 14.3 (IQR 3.8-26.0) in November 2019 to 24.0 (IQR 6.2-43.5) in March 2022. The median number of food outlets accessible online decreased from 63.5 (IQR 16.0-156.0) in November 2019 to 57.0 (IQR 11.0-163.0) in March 2022. However, we observed variation by deprivation. In March 2022, the median number of outlets accessible online was 175.0 (IQR 104.0-292.0) in the most deprived areas (Q5) compared with 27.0 (IQR 8.5-60.5) in the least deprived (Q1). In adjusted analyses, we estimated that the number of outlets accessible online in the most deprived areas was 10% higher in March 2022 compared with November 2019 (incidence rate ratios: 1.10, 95% CI 1.07-1.13). In the least deprived areas, we estimated a 19% decrease (incidence rate ratios: 0.81, 95% CI 0.79-0.83). Conclusions: The number of food outlets accessible online increased only in the most deprived areas in England. Future research might attempt to understand the extent to which changes in online food access were associated with changes in online food delivery service use and the possible implications on diet quality and health. %M 36848236 %R 10.2196/41822 %U https://publichealth.jmir.org/2023/1/e41822 %U https://doi.org/10.2196/41822 %U http://www.ncbi.nlm.nih.gov/pubmed/36848236 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45110 %T The Role of Community Cohesion in Older Adults During the COVID-19 Epidemic: Cross-sectional Study %A Li,Ying %A Ding,XiWen %A Aierken,Ayizuhere %A Pan,YiYang %A Chen,Yuan %A Hu,DongBin %+ Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, HangZhou, 310058, China, 86 0571(8820)8590, liying2012@zju.edu.cn %K community cohesion %K physical and mental health %K community services %K environmental resources %K COVID-19 epidemic %K older adults %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The community environment plays a vital role in the health of older adults. During the COVID-19 epidemic, older adults, who were considered the most impacted and most vulnerable social group, were confined to their homes during the implementation of management and control measures for the epidemic. In such situations, older adults may have to contend with a lack of resources and experience anxiety. Therefore, identifying the environmental factors that are beneficial for their physical and mental health is critical. Objective: This study aimed to assess the association between community cohesion and the physical and mental health of older adults and to identify the related community services and environmental factors that may promote community cohesion. Methods: This community-based cross-sectional study was designed during the COVID-19 epidemic. A multistage sampling method was applied to this study. A total of 2036 participants aged ≥60 years were sampled from 27 locations in China. Data were collected through face-to-face interviews. The neighborhood cohesion instrument consisting of scales on 3 dimensions was used to assess community cohesion. Self-efficacy and life satisfaction, cognitive function and depression, and community services and environmental factors were also measured using standard instruments. Statistical analyses were restricted to 99.07% (2017/2036) of the participants. Separate logistic regression analysis was conducted to assess the association among community cohesion and physical and mental health factors, related community services, and environmental factors among older adults. Results: The results showed that high levels of community cohesion were associated with good self-perceived health status and life satisfaction (odds ratio [OR] 1.27, 95% CI 1.01-1.59 and OR 1.20, 95% CI 1.15-1.27, respectively) and high levels of self-efficacy and psychological resilience (OR 1.09, 95% CI 1.05-1.13 and OR 1.05, 95% CI 1.03-1.06, respectively). The length of stay in the community and the level of physical activity were positively associated with community cohesion scores, whereas the education level was negatively associated with community cohesion scores (P=.009). Community cohesion was also associated with low levels of depression and high levels of cognitive function. Community cohesion was significantly associated with community services and environmental factors on 4 dimensions. High levels of community cohesion were associated with transportation services and rehabilitation equipment rental services as well as high levels of satisfaction with community physicians’ technical expertise and community waste disposal (OR 3.14, 95% CI 1.87-5.28; OR 3.62, 95% CI 2.38-5.52; OR 1.37, 95% CI 1.08-1.73; and OR 1.23, 95% CI 1.01-1.50, respectively). Conclusions: Community cohesion was found to be associated with the physical and mental health of older adults. Our research suggests that enhancing community services and environmental resources may be an effective strategy to increase community cohesion during major infectious disease epidemics. %M 36921236 %R 10.2196/45110 %U https://publichealth.jmir.org/2023/1/e45110 %U https://doi.org/10.2196/45110 %U http://www.ncbi.nlm.nih.gov/pubmed/36921236 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44965 %T Emotional Distress During COVID-19 by Mental Health Conditions and Economic Vulnerability: Retrospective Analysis of Survey-Linked Twitter Data With a Semisupervised Machine Learning Algorithm %A Ueda,Michiko %A Watanabe,Kohei %A Sueki,Hajime %+ Department of Public Administration and International Affairs, The Maxwell School of Citizenship and Public Affairs, Syracuse University, 426 Eggers Hall, Syracuse, NY, 13244, United States, 1 3154439046, miueda@syr.edu %K mental health %K COVID-19 %K Twitter %K social media %K depression %K suicidal ideation %K loneliness %K public health crisis %K psychological well-being %K infodemiology %K machine learning framework %K digital surveillance %K emotional distress %K online survey %D 2023 %7 16.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Monitoring the psychological conditions of social media users during rapidly developing public health crises, such as the COVID-19 pandemic, using their posts on social media has rapidly gained popularity as a relatively easy and cost-effective method. However, the characteristics of individuals who created these posts are largely unknown, making it difficult to identify groups of individuals most affected by such crises. In addition, large annotated data sets for mental health conditions are not easily available, and thus, supervised machine learning algorithms can be infeasible or too costly. Objective: This study proposes a machine learning framework for the real-time surveillance of mental health conditions that does not require extensive training data. Using survey-linked tweets, we tracked the level of emotional distress during the COVID-19 pandemic by the attributes and psychological conditions of social media users in Japan. Methods: We conducted online surveys of adults residing in Japan in May 2022 and collected their basic demographic information, socioeconomic status, and mental health conditions, along with their Twitter handles (N=2432). We computed emotional distress scores for all the tweets posted by the study participants between January 1, 2019, and May 30, 2022 (N=2,493,682) using a semisupervised algorithm called latent semantic scaling (LSS), with higher values indicating higher levels of emotional distress. After excluding users by age and other criteria, we examined 495,021 (19.85%) tweets generated by 560 (23.03%) individuals (age 18-49 years) in 2019 and 2020. We estimated fixed-effect regression models to examine their emotional distress levels in 2020 relative to the corresponding weeks in 2019 by the mental health conditions and characteristics of social media users. Results: The estimated level of emotional distress of our study participants increased in the week when school closure started (March 2020), and it peaked at the beginning of the state of emergency (estimated coefficient=0.219, 95% CI 0.162-0.276) in early April 2020. Their level of emotional distress was unrelated to the number of COVID-19 cases. We found that the government-induced restrictions disproportionately affected the psychological conditions of vulnerable individuals, including those with low income, precarious employment, depressive symptoms, and suicidal ideation. Conclusions: This study establishes a framework to implement near-real-time monitoring of the emotional distress level of social media users, highlighting a great potential to continuously monitor their well-being using survey-linked social media posts as a complement to administrative and large-scale survey data. Given its flexibility and adaptability, the proposed framework is easily extendable for other purposes, such as detecting suicidality among social media users, and can be used on streaming data for continuous measurement of the conditions and sentiment of any group of interest. %M 36809798 %R 10.2196/44965 %U https://www.jmir.org/2023/1/e44965 %U https://doi.org/10.2196/44965 %U http://www.ncbi.nlm.nih.gov/pubmed/36809798 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43762 %T Community-Level Social Support to Mitigate the Impact of Combined Frailty and Multimorbidity on Psychological Distress Among Rural Chinese Older Adults During the COVID-19 Pandemic: Multilevel Modeling Study %A Wang,Yi %A Fu,Peipei %A Li,Jie %A Gao,Tingting %A Jing,Zhengyue %A Wang,Qiong %A Zhao,Dan %A Zhou,Chengchao %+ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, China, 86 531 8838 1567, zhouchengchao@sdu.edu.cn %K psychological distress %K frailty %K multimorbidity %K community-level social support %K COVID-19 pandemic %K psychological %K rural %K older adults %K community %K support %K effectiveness %D 2023 %7 9.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Accumulating research provides evidence that the psychological health of older people deteriorated from before to during the COVID-19 pandemic. Unlike robust individuals, coexisting frailty and multimorbidity expose older adults to more complicated and wide-ranging stressors. Community-level social support (CSS) is also an important impetus for age-friendly interventions, and it is 1 of the components of social capital that is seen as an ecological-level property. To date, we have not found research that examines whether CSS buffered the adverse impacts of combined frailty and multimorbidity on psychological distress in a rural setting during COVID-19 in China. Objective: This study explores the combined effect of frailty and multimorbidity on psychological distress in rural Chinese older adults during the COVID-19 pandemic and examines whether CSS would buffer the aforementioned association. Methods: Data used in this study were extracted from 2 waves of the Shandong Rural Elderly Health Cohort (SREHC), and the final analytic sample included 2785 respondents who participated in both baseline and follow-up surveys. Multilevel linear mixed effects models were used to quantify the strength of the longitudinal association between frailty and multimorbidity combinations and psychological distress using 2 waves of data for each participant, and then, cross-level interactions between CSS and combined frailty and multimorbidity were included to test whether CSS would buffer the adverse impact of coexisting frailty and multimorbidity on psychological distress. Results: Frail older adults with multimorbidity reported the most psychological distress compared to individuals with only 1 or none of the conditions (β=.68, 95% CI 0.60-0.77, P<.001), and baseline coexisting frailty and multimorbidity predicted the most psychological distress during the COVID-19 pandemic (β=.32, 95% CI 0.22-0.43, P<.001). Further, CSS moderated the aforementioned association (β=–.16, 95% CI –0.23 to –0.09, P<.001), and increased CSS buffered the adverse effect of coexisting frailty and multimorbidity on psychological distress during the COVID-19 pandemic (β=–.11, 95% CI –0.22 to –0.01, P=.035). Conclusions: Our findings suggest that more public health and clinical attention should be paid to psychological distress among multimorbid older adults with frailty when facing public health emergencies. This research also suggests that community-level interventions prioritizing social support mechanisms, specifically improving the average levels of social support within communities, may be an effective approach to alleviate psychological distress for rural older adults who concurrently manifest frailty and multimorbidity. %M 36811848 %R 10.2196/43762 %U https://publichealth.jmir.org/2023/1/e43762 %U https://doi.org/10.2196/43762 %U http://www.ncbi.nlm.nih.gov/pubmed/36811848 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e41304 %T Digital Practices by Citizens During the COVID-19 Pandemic: Findings From an International Multisite Study %A Marston,Hannah Ramsden %A Ko,Pei-Chun %A Girishan Prabhu,Vishnunarayan %A Freeman,Shannon %A Ross,Christopher %A Sharaievska,Iryna %A Browning,Matthew HEM %A Earle,Sarah %A Ivan,Loredana %A Kanozia,Rubal %A Öztürk Çalıkoğlu,Halime %A Arslan,Hasan %A Bilir-Koca,Burcu %A Alexandra Silva,Paula %A Buttigieg,Sandra C %A Großschädl,Franziska %A Schüttengruber,Gerhilde %+ School of Health, Wellbeing and Social Care, The Open University, Horlock Building, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 7815507547, Hannah.Marston@open.ac.uk %K COVID-19 %K communication %K gerontology %K community living %K technology %K social media %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic brought digital practices and engagement to the forefront of society, which were based on behavioral changes associated with adhering to different government mandates. Further behavioral changes included transitioning from working in the office to working from home, with the use of various social media and communication platforms to maintain a level of social connectedness, especially given that many people who were living in different types of communities, such as rural, urban, and city spaces, were socially isolated from friends, family members, and community groups. Although there is a growing body of research exploring how technology is being used by people, there is limited information and insight about the digital practices employed across different age cohorts living in different physical spaces and residing in different countries. Objective: This paper presents the findings from an international multisite study exploring the impact of social media and the internet on the health and well-being of individuals in different countries during the COVID-19 pandemic. Methods: Data were collected via a series of online surveys deployed between April 4, 2020, and September 30, 2021. The age of respondents varied from 18 years to over 60 years across the 3 regions of Europe, Asia, and North America. On exploring the associations of technology use, social connectedness, and sociodemographic factors with loneliness and well-being through bivariate and multivariate analyses, significant differences were observed. Results: The levels of loneliness were higher among respondents who used social media messengers or many social media apps than among those who did not use social media messengers or used ≤1 social media app. Additionally, the levels of loneliness were higher among respondents who were not members of an online community support group than among those who were members of an online community support group. Psychological well-being was significantly lower and loneliness was significantly higher among people living in small towns and rural areas than among those living in suburban and urban communities. Younger respondents (18-29 years old), single adults, unemployed individuals, and those with lower levels of education were more likely to experience loneliness. Conclusions: From an international and interdisciplinary perspective, policymakers and stakeholders should extend and explore interventions targeting loneliness experienced by single young adults and further examine how this may vary across geographies. The study findings have implications across the fields of gerontechnology, health sciences, social sciences, media communication, computers, and information technology. International Registered Report Identifier (IRRID): RR2-10.3389/fsoc.2020.574811 %M 36877558 %R 10.2196/41304 %U https://mental.jmir.org/2023/1/e41304 %U https://doi.org/10.2196/41304 %U http://www.ncbi.nlm.nih.gov/pubmed/36877558 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e40899 %T Trends in Language Use During the COVID-19 Pandemic and Relationship Between Language Use and Mental Health: Text Analysis Based on Free Responses From a Longitudinal Study %A Weger,Rachel %A Lossio-Ventura,Juan Antonio %A Rose-McCandlish,Margaret %A Shaw,Jacob S %A Sinclair,Stephen %A Pereira,Francisco %A Chung,Joyce Y %A Atlas,Lauren Yvette %+ National Center for Complementary and Integrative Health, National Institutes of Health, 10 Center Drive, Rm 4-1741, Bethesda, MD, 20892, United States, 1 301 827 0214, lauren.atlas@nih.gov %K COVID-19 %K mental health %K natural language processing %K sentiment analysis %K free response %K qualitative %K text analysis %K mental illness %K text %K mental state %K language %K pandemic %K age %K education %D 2023 %7 1.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic and its associated restrictions have been a major stressor that has exacerbated mental health worldwide. Qualitative data play a unique role in documenting mental states through both language features and content. Text analysis methods can provide insights into the associations between language use and mental health and reveal relevant themes that emerge organically in open-ended responses. Objective: The aim of this web-based longitudinal study on mental health during the early COVID-19 pandemic was to use text analysis methods to analyze free responses to the question, “Is there anything else you would like to tell us that might be important that we did not ask about?” Our goals were to determine whether individuals who responded to the item differed from nonresponders, to determine whether there were associations between language use and psychological status, and to characterize the content of responses and how responses changed over time. Methods: A total of 3655 individuals enrolled in the study were asked to complete self-reported measures of mental health and COVID-19 pandemic–related questions every 2 weeks for 6 months. Of these 3655 participants, 2497 (68.32%) provided at least 1 free response (9741 total responses). We used various text analysis methods to measure the links between language use and mental health and to characterize response themes over the first year of the pandemic. Results: Response likelihood was influenced by demographic factors and health status: those who were male, Asian, Black, or Hispanic were less likely to respond, and the odds of responding increased with age and education as well as with a history of physical health conditions. Although mental health treatment history did not influence the overall likelihood of responding, it was associated with more negative sentiment, negative word use, and higher use of first-person singular pronouns. Responses were dynamically influenced by psychological status such that distress and loneliness were positively associated with an individual’s likelihood to respond at a given time point and were associated with more negativity. Finally, the responses were negative in valence overall and exhibited fluctuations linked with external events. The responses covered a variety of topics, with the most common being mental health and emotion, social or physical distancing, and policy and government. Conclusions: Our results identify trends in language use during the first year of the pandemic and suggest that both the content of responses and overall sentiments are linked to mental health. %M 36525362 %R 10.2196/40899 %U https://mental.jmir.org/2023/1/e40899 %U https://doi.org/10.2196/40899 %U http://www.ncbi.nlm.nih.gov/pubmed/36525362 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e37711 %T Effects of Social Media Use on Connectivity and Emotions During Pandemic-Induced School Closures: Qualitative Interview Study Among Adolescents %A Liang,Elisa %A Kutok,Emily R %A Rosen,Rochelle K %A Burke,Taylor A %A Ranney,Megan L %+ Brown-Lifespan Center for Digital Health, 139 Point St., Providence, RI, 02903, United States, 1 401 444 2557, megan_ranney@brown.edu %K social media %K adolescents %K COVID-19 %K emotions %K connectivity %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic provided a unique opportunity to examine social media and technology use during a time in which technology served as adolescents’ primary form of socialization. The literature is mixed regarding how increased screen time during this period affected adolescent mental health and well-being. The mechanisms by which screen time use affected adolescent psychosocial outcomes are also unknown. Objective: We aimed to deepen our understanding of how social media and technology use, social connectivity, and emotional well-being intersected during pandemic-related school closures. Methods: English-speaking adolescents aged 13 to 17 years were recruited on Instagram for a brief screening survey; 39 participants were purposefully selected to complete a semistructured interview regarding their social media and technology use during the pandemic. Interview summaries were abstracted from recordings, and deductive codes were created for the primary question stems. These codes were subsequently reviewed for the main themes. Results: The main themes were as follows: adolescent social media and technology use during school closures usually allowed for more and easier social connectivity, but the amount and relative ease of connectivity differed according to purpose and type of use. Emotions, particularly those of stress and happiness, were connected to whether adolescents actively or passively engaged with social media and technology. Conclusions: Our results suggest a nuanced relationship among social media and technology use, adolescent social support, and emotional well-being, including during the pandemic. Specifically, how adolescents use or engage with web-based platforms greatly influences their ability to connect with others and their feelings of stress and happiness. In the context of the COVID-19 pandemic and as technology in general remains at the core of the adolescent experience, future research should continue to examine how adolescents navigate and use web-based spaces in beneficial and harmful ways. This will inform education and interventions that foster healthy social media and technological habits. %M 36054613 %R 10.2196/37711 %U https://mental.jmir.org/2023/1/e37711 %U https://doi.org/10.2196/37711 %U http://www.ncbi.nlm.nih.gov/pubmed/36054613 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42677 %T Association of Depression With Precautionary Behavior Compliance, COVID-19 Fear, and Health Behaviors in South Korea: National Cross-sectional Study %A Shin,Hyerine %A Kim,Ji-Su %A Lee,HyunHae %+ Department of Nursing, Chung-ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea, 82 10 7117 5088, jisu80@cau.ac.kr %K COVID-19 %K precautionary behaviors %K COVID-19 fear %K health behavior deterioration %K gender differences %D 2023 %7 22.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As of January 2022, the number of people infected with COVID-19 worldwide has exceeded 350 million. As the COVID-19 pandemic continues, people are affected in a wide range of areas of life, which in turn causes numerous psychological problems. Depression is a serious problem for people who have suffered from COVID-19. Depression can worsen COVID-19 precautionary behavior compliance or the health behavior itself. In addition, these depressive symptoms may have different characteristics depending on the individual’s gender. Objective: The aim of this study was to determine whether depression is a factor that may affect COVID-19 fear, precautionary behavior compliance, and health behavior, and how these characteristic trends differ by gender. Methods: This was a secondary analysis of data from the 2020 Korea Community Health Survey (KCHS), a national cross-sectional survey conducted with complex sampling analysis. In 2020, the KCHS included COVID-19–related questions. For this study, we used the KCHS data from both the COVID-19–related questions and the Patient Health Questionnaire-9 scale. After weighting the data according to the KCHS guidelines, we calculated the distribution of men and women according to depression level. The data were collected using multiple-choice questions related to precautionary behavior compliance, COVID-19–related fears, and health behavior changes. Results: Of the 204,787 participants, those who were clinically depressed had a greater tendency to not comply with precautionary behaviors. Regarding COVID-19, “fear” showed a decreasing trend in both men (adjusted odds ratio [AOR] 0.72, 95% CI 0.61-0.83) and women (AOR 0.74, 95% CI 0.63-0.86) with clinically relevant depression. Moreover, for both men and women, health behaviors deteriorated as depression intensified; the AOR for sleep duration changes was 2.28 (95% CI 2.00-2.59) in men and was 2.15 (95% CI 1.96-2.36) in women. Notably, the responses of clinically depressed women revealed a doubled increase in both their drinking (AOR 2.25, 95% CI 1.88-2.70) and smoking (AOR 2.71, 95% CI 1.95-3.77) habits compared with those of nondepressed women. Conclusions: Both men and women with more severe depression were more likely to violate precautionary health behaviors as their depression worsened. Health behaviors also deteriorated for both genders, but women tended to show a greater change. Therefore, additional studies and interventions for vulnerable groups such as severely depressed people are needed. More research is also necessary to develop interventions based on statistical comparisons of men and women. %M 36716130 %R 10.2196/42677 %U https://publichealth.jmir.org/2023/1/e42677 %U https://doi.org/10.2196/42677 %U http://www.ncbi.nlm.nih.gov/pubmed/36716130 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e38163 %T Substance Use From Social Distancing and Isolation by US Nativity During the Time of COVID-19: Cross-sectional Study %A Montiel Ishino,Francisco Alejandro %A Villalobos,Kevin %A Williams,Faustine %+ Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, 111 TW Alexander Dr, Durham, NC, 27709, United States, 1 6143643314, francisco.montielishino@nih.gov %K substance use %K COVID-19 %K US nativity %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic had many unprecedented secondary outcomes resulting in various mental health issues leading to substance use as a coping behavior. The extent of changes in substance use in a US sample by nativity has not been previously described. Objective: This study aimed to design a web-based survey to assess the social distancing and isolation issues exacerbated by the COVID-19 pandemic to describe substance use as a coping behavior by comparing substance use changes before and during the pandemic. Methods: A comprehensive 116-item survey was designed to understand the impact of COVID-19 and social distancing on physical and psychosocial mental health and chronic diseases. Approximately 10,000 web-based surveys were distributed by Qualtrics LLC between May 13, 2021, and January 09, 2022, across the United States (ie, continental United States, Hawaii, Alaska, and territories) to adults aged ≥18 years. We oversampled low-income and rural adults among non-Hispanic White, non-Hispanic Black, Hispanic or Latino, and foreign-born participants. Of the 5938 surveys returned, 5413 (91.16%) surveys were used after proprietary expert review fraud detection (Qualtrics) and detailed assessments of the completion rate and the timing to complete the survey. Participant demographics, substance use coping behaviors, and substance use before and during the pandemic are described by the overall US resident sample, followed by US-born and foreign-born self-reports. Substance use included the use of tobacco, e-cigarettes or nicotine vapes, alcohol, marijuana, and other illicit substances. Marginal homogeneity based on the Stuart-Maxwell test was used to assess changes in self-reported substance use before and during the pandemic. Results: The sample mostly included White (2182/5413, 40.31%) and women participants (3369/5406, 62.32%) who identified as straight or heterosexual (4805/5406, 88.88%), reported making ≥US $75,000 (1405/5355, 26.23%), and had vocational or technical training (1746/5404, 32.31%). Similarities were observed between the US-born and the foreign-born participants on increased alcohol consumption: from no alcohol consumption before the pandemic to consuming alcohol once to several times a month and from once to several times per week to every day to several times per day. Although significant changes were observed from no prior alcohol use to some level of increased use, the opposite was also observed and was more pronounced among foreign-born participants. That is, there was a 5.1% overall change in some level of alcohol use before the pandemic to no alcohol use during the pandemic among foreign-born individuals, compared with a 4.3% change among US-born individuals. Conclusions: To better prepare for the inadvertent effects of public health policies meant to protect individuals, we must understand the mental health burdens that can precipitate into substance use coping mechanisms that not only have a deleterious effect on physical and mental health but also exacerbate morbidity and mortality in a disease like COVID-19. %M 36265162 %R 10.2196/38163 %U https://publichealth.jmir.org/2023/1/e38163 %U https://doi.org/10.2196/38163 %U http://www.ncbi.nlm.nih.gov/pubmed/36265162 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43730 %T The Usability, Feasibility, Acceptability, and Efficacy of Digital Mental Health Services in the COVID-19 Pandemic: Scoping Review, Systematic Review, and Meta-analysis %A Zhong,Shaoling %A Yang,Xinhu %A Pan,Zihua %A Fan,Yu %A Chen,Yanan %A Yu,Xin %A Zhou,Liang %+ The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, 510370, China, 86 81268045, liangzhou_csu@vip.163.com %K digital medicine %K COVID-19 %K mental health services %K psychological well-being %K COVID-19 pandemic %D 2023 %7 13.2.2023 %9 Review %J JMIR Public Health Surveill %G English %X Background: After the rapid spread of the novel SARS-CoV-2, the short-term and long-term mental health impacts of the pandemic on the public, in particular on susceptible individuals, have been reported worldwide. Although digital mental health services expand accessibility while removing many barriers to in-person therapy, their usability, feasibility, acceptability, and efficacy require continued monitoring during the initial phase of the pandemic and its aftermath. Objective: In this study, we aimed to understand what mental health services are offered, whether they are practical or acceptable, and to what extent digital mental health services are effective in response to the COVID-19 pandemic across high-income and low- and middle-income countries. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guideline. We implemented searches in PubMed (MEDLINE), Embase, PsycINFO, and Cochrane databases for studies that were published between December 2019 and November 2021 and that involved the use of digital mental health services. Two review authors screened, assessed, and extracted studies independently. The protocol was registered on the International Prospective Register of Systematic Reviews. Results: This review identified 7506 articles through database searching. In total, 65 (0.9%) studies from 18 countries with 67,884 participants were eligible for the scoping review. Of the 65 studies, 16 (24.6%) were included in the meta-analysis. A total of 15 (23.1%) studies measured the usability; 31 (47.7%) studies evaluated the feasibility; 29 (44.6%) studies assessed the acceptability; and 51 (78.5%) studies assessed the efficacy. Web-based programs (21/65, 32.3%), videoconferencing platforms (16/65, 24.6%), smartphone apps (14/65, 21.5%), and SMS text messaging (5/65, 7.7%) were the main techniques. Psychotherapy (44/65, 67.7%) followed by psychoeducation (6/65, 9.2%) and psychological support (5/65, 7.7%) were commonly used. The results of the meta-analysis showed that digital mental health interventions were associated with a small reduction in depressive symptoms (standardized mean difference=−0.49; 95% CI −0.74 to −0.24; P<.001) and a moderate reduction in anxiety symptoms (standardized mean difference=−0.66; 95% CI −1.23 to −1.0; P=.02) significantly. Conclusions: The findings suggest that digital mental health interventions may be practical and helpful for the general population, at-risk individuals, and patients with preexisting mental disorders across high-income and middle-income countries. An expanded research agenda is needed to apply different strategies for addressing diverse psychological needs and develop integrated mental health services in the post–COVID-19 era. Trial Registration: PROSPERO CRD42022307695; https://tinyurl.com/2jcuwjym %M 36634261 %R 10.2196/43730 %U https://publichealth.jmir.org/2023/1/e43730 %U https://doi.org/10.2196/43730 %U http://www.ncbi.nlm.nih.gov/pubmed/36634261 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e38593 %T Use of Digital Technologies to Maintain Older Adults’ Social Ties During Visitation Restrictions in Long-Term Care Facilities: Scoping Review %A Lemaire,Célia %A Humbert,Christophe %A Sueur,Cédric %A Racin,Céline %+ Magellan (EA 3713), iaelyon, Université Jean Moulin Lyon 3, 1C, avenue des Frères Lumière - CS 78242, Lyon, 69372, CEDEX 08, France, 33 0649054213, celia.lemaire@univ-lyon3.fr %K social isolation %K COVID-19 pandemic %K remote care %K nursing homes %K social ties %K digital devices %K older adults %D 2023 %7 10.2.2023 %9 Review %J JMIR Aging %G English %X Background: Digital technologies were implemented to address the disruption of long-term care facility residents’ socialization needs during the COVID-19 pandemic. A literature review regarding this topic is needed to inform public policy, facility managers, family caregivers, and nurses and allied health professionals involved in mediating the use of digital devices for residents’ social ties. Objective: Our study outlines key concepts, methodologies, results, issues, and gaps in articles published during pandemic-related visitation restrictions. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) protocol, a scoping review was conducted by searching 3 database aggregator platforms (EBSCO, ProQuest, and PubMed) for studies published in peer-reviewed journals from early 2020 to the end of June 2021, when the most stringent restrictions were in place. We included qualitative and quantitative studies, reviews, commentaries, viewpoints, and letters to the editors in French or English focusing on digital technologies aiming to support the social contact of residents in long-term care facilities during pandemic-related visitation restrictions. Results: Among 763 screened articles, 29 met our selection criteria. For each study, we characterized the (1) authors, title, and date of the publication; (2) country of the first author; (3) research fields; (4) article type; and (5) type of technology mentioned. The analysis distinguished 3 main themes emerging from the literature: (1) impact and expectations of remote social contact on the physical and mental health and well-being of the residents (n=12), (2) with whom or what the social contact took place (n=17), and (3) limitations and barriers to significant social contact related to digital technologies (n=14). The results first underlined the highly positive impact expected by the authors of the digital technologies on health and quality of life of residents of long-term care facilities. Second, they highlighted the plurality of ties to consider, since social contact takes place not only with family caregivers to maintain contact but also for other purposes (end-of-life videoconferences) and with other types of contact (eg, with staff and robots). Third, they exposed the limitations and barriers to significant contact using digital technologies and outlined the required conditions to enable them. Conclusions: The review demonstrated the opportunities and risks outlined by the literature about the implementation of digital technologies to support remote social contact. It showed the plurality of ties to consider and revealed the need to evaluate the positive impact of remote contact from the residents’ perspectives. Therefore, to go beyond the risk of digital solutionism, there is a need for studies considering the holistic impact on health regarding the implementation of digital technologies, including the meaning residents give to interpersonal exchanges and the organizational constraints. Trial Registration: OSF Registries osf.io/yhpx3; https://osf.io/yhpx3 %M 36599164 %R 10.2196/38593 %U https://aging.jmir.org/2023/1/e38593 %U https://doi.org/10.2196/38593 %U http://www.ncbi.nlm.nih.gov/pubmed/36599164 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43689 %T Caregiver Perceptions of Children’s and Adolescents’ Psychosocial Functioning During the Stringent COVID-19 Lockdown Restrictions in Shanghai: Cross-sectional Study %A Liu,Xu %A Wu,Jing %A Yang,Hongyang %A Zhao,Fangjie %A Qin,Yuchen %A Wu,Jiali %A Yan,Hongli %A Xu,Yan %A Zhang,Lulu %+ College of Health Service, Second Military Medical University, 800# Xiangyin Road, Yangpu, Shanghai, 200433, China, 86 02181871421, zllrmit@163.com %K COVID-19 exposure %K psychosocial function %K parenting %K children and adolescents %K China %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic represents a global health crisis. The Shanghai municipal government in China implemented strict and comprehensive pandemic control strategies in the first half of 2022 to eliminate a wave of COVID-19 infection. The pandemic and the resulting government responses have led to abrupt changes to families’ daily lives, including the mental health of children and adolescents. Objective: The aim of this paper is to examine the impact of COVID-19 exposure and the stringent lockdown measures on the daily life and mental health of children and adolescents and to provide suggestions on maintaining their mental health when similar public health emergencies occur in the future. Methods: In this cross-sectional study, an anonymous survey was distributed online in May 1-15, 2022, in Shanghai. Individuals were eligible to participate if they were currently the caregiver of a child or adolescent (aged 4-17 years). Outcomes were psychosocial functioning of children and adolescents, as reported by parents, using the Pediatric Symptom Checklist-17. COVID-19 exposure and life changes were also reported. Multivariate logistic regression was used to analyze risk factors for poor psychosocial functioning. Results: In total, 2493 valid questionnaires were analyzed. The rate of positive scores on the global Pediatric Symptom Checklist-17 scale was 16.5% (n=411). Internalizing, attention, and externalizing problem subscale positivity rates were 17.3% (n=431), 10.9% (n=272), and 8.9% (n=221), respectively. Caregivers reported that 64.2% (n=1601) and 20.7% (n=516) of the children’s interactions with friends or peers and parents deteriorated, respectively. Compared with male caregivers, female caregivers were less likely to report psychosocial problems in children and adolescents (adjusted odds ratio [aOR] 0.68; 95% CI 0.53-0.88). Older children and those with lower COVID-19 Exposure and Family Impact Scales scores were less likely to have psychological problems (aOR 1.15; 95% CI 1.10-1.21). Compared with children with screen times <1 hour per day for recreation, those using screens for >3 hours had higher odds of psychological distress (aOR 2.09; 95% CI 1.47-1.97). Children who spent 1-2 hours exercising and had better interactions with friends or peers and parents showed a trend toward lower odds of psychological problems. Children and adolescents with worse sleep compared with preclosure were more likely to have psychological problems. Conclusions: The prevalence of psychosocial problems among children and adolescents is relatively high. Being young, having more COVID-19 exposure, and having more screen times (>3 h/day), less exercise time (<30 min), worse sleep, and deteriorated interactions with friends or peers and parents were risk factors for poor psychosocial functioning. It is necessary for governments, communities, schools, and families to take appropriate countermeasures to reduce the negative impact of the stringent control measures on caregivers’ parenting and psychosocial functioning of children and adolescents. %M 36749625 %R 10.2196/43689 %U https://publichealth.jmir.org/2023/1/e43689 %U https://doi.org/10.2196/43689 %U http://www.ncbi.nlm.nih.gov/pubmed/36749625 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43003 %T The Association of Acute Signs and Symptoms of COVID-19 and Exacerbation of Depression and Anxiety in Patients With Clinically Mild COVID-19: Retrospective Observational Study %A Sung,Sumi %A Kim,Su Hwan %A Lee,Changwoo %A Kim,Youlim %A Bae,Ye Seul %A Chie,Eui Kyu %+ Office of Hospital Information, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 7600, ekchie93@snu.ac.kr %K COVID-19 %K depression %K anxiety %K vital signs %K symptoms %K electronic health records %D 2023 %7 30.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: To date, the association between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety in patients with clinically mild COVID-19 has not been evaluated. Objective: This study was designed to assess the correlation between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety in patients with clinically mild COVID-19 at a residential treatment center in South Korea. Methods: This retrospective study assessed 2671 patients with COVID-19 admitted to 4 residential treatment centers operated by Seoul National University Hospital, South Korea, from March 2020 to April 2022. Depression and anxiety were assessed using the 2-item Patient Health Questionnaire (PHQ-2) and 2-item Generalized Anxiety Disorder (GAD-2) scale, respectively. The exacerbation of depression and anxiety symptoms was identified from the differences in PHQ-2 and GAD-2 scores between admission and discharge, respectively. The patients’ clinical characteristics, including acute signs and symptoms of COVID-19, GAD-2 and PHQ-2 scores, were obtained from electronic health records. Demographic characteristics, a summary of vital signs, and COVID-19 symptoms were analyzed and compared between the patient groups with and those without exacerbated PHQ-2 and GAD-2 scores using the chi-square test. We applied logistic regression to identify the association between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety. Results: Sleep disorders were associated with exacerbated depression (odds ratio [OR] 1.09, 95% CI 1.05-1.13) and anxiety (OR 1.1, 95% CI 1.06-1.14), and the sore throat symptom was associated with exacerbated anxiety symptoms (OR 1.03, 95% CI 1.00-1.07). Patients with abnormal oxygen saturation during quarantine were more likely to have exacerbated depression (OR 1.27, 95% CI 1.00-1.62), and those with an abnormal body temperature during quarantine were more likely to experience anxiety (OR 1.08, 95% CI 1.01-1.16). As anticipated, patients who experienced psychological symptoms at admission were more likely to experience depression (OR 1.91, 95% CI 1.52-2.41) and anxiety (OR 1.98, 95% CI 1.54-2.53). Meanwhile, the PHQ-2 and GAD-2 scores measured at admission revealed that lower the score, higher the possibility of exacerbation of both depression (OR 0.15, 95% CI 0.11-0.22) and anxiety (OR 0.13, 95% CI 0.10-0.19). Conclusions: Results from this study suggest the importance of further interventions for patients with abnormal oxygen saturation, abnormal body temperatures, sore throat, and sleep disorder symptoms or initial psychological symptoms to mitigate the exacerbation of depression and anxiety. In addition, this study highlights the usability of short and efficient scales such as the PHQ-2 and GAD-2 in the assessment of the mental health of patients with clinically mild COVID-19 symptoms who were quarantined at home during the pandemic era. %M 36645439 %R 10.2196/43003 %U https://publichealth.jmir.org/2023/1/e43003 %U https://doi.org/10.2196/43003 %U http://www.ncbi.nlm.nih.gov/pubmed/36645439 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40940 %T Feasibility of Video Consultation for Preterm Neurodevelopmental Follow-up Care During the COVID-19 Pandemic: Cohort Study %A Albayrak,Bilge %A Cordier,Larissa Jane %A Greve,Sandra %A Teschler,Uta %A Dathe,Anne-Kathrin %A Felderhoff-Müser,Ursula %A Hüning,Britta Maria %+ Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Department of Pediatrics I, Hufelandstraße 55, Essen, 45147, Germany, 49 201723 ext 82831, larissa.cordier@uk-essen.de %K COVID-19 %K very preterm infant %K video consultation %K follow-up care %K COVID-19 pandemic %K neurodevelopmental outcome %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: During the COVID-19 pandemic, parents of infants born very preterm or at risk were exceptionally worried about being infected. The only means of protection during the onset of the pandemic was social distancing. Video consultations for neurodevelopmental follow-up care were offered as an alternative way to stay in contact with patients and their families, to provide expert support, and to monitor and assess children’s development. Objective: To assess the feasibility of and family satisfaction with video consultations, interviews were conducted after video and in-person consultations. Methods: An interview with 28 questions was created to evaluate parental satisfaction with the consultations (eg, their confidentiality and the children’s behavior). A total of 93 interviews with parents were conducted between March 2020 and February 2021 and compared (58 after video consultations and 35 after in-person consultations). The interviews were conducted at the end of the consultations by a trained professional. The video consultations were conducted using a certified platform created by Zava Sprechstunde Online, maintaining data protection with end-to-end encryption. Follow-up consultations (video or in-person) were performed at corrected ages of 3, 6, and 12 months as well as 2, 3, 4, and 5 years. The rate of total follow-up appointments attended during the survey period was evaluated and compared with the previous year. Results: There were no significant differences between the video and in-person consultation groups in satisfaction, attitudes on the confidentiality of the consultation, or discussion of private and sensitive information. Following video consultations, parents were significantly more likely to report that they were avoiding contact with medical professionals during the pandemic (P=.045; Shapiro-Wilk W=1094.5, Cohen d=–0.1782146) than the in-person consultation group. Parents in the video-consultation group stated that performing a guided examination on their child was comfortable and helped them understand their child’s development. In fact, they agreed to take advantage of future video consultations. The rate of total follow-up appointments increased compared to the previous year. Between March 2019 and February 2020, 782 of 984 (79.5%) children born at Essen University Hospital attended a follow-up appointment. During the survey period, between March 2020 and February 2021, a total of 788 of 1086 children (73%) attended a follow-up appointment, of which 117 (14.9%) were video consultations. Conclusions: The feasibility of attending video consultations for follow-up care of very preterm or at-risk infants and parental satisfaction with these consultations were as high as for in-person consultations. Parents rated video consultations as being as confidential as in-person appointments. Telemedicine can be offered as an equivalent alternative to in-person consultations and is particularly useful under certain circumstances, such as for very sick children who require assistive devices or respiratory support and oxygen or for those living a long distance away. %M 36409307 %R 10.2196/40940 %U https://pediatrics.jmir.org/2023/1/e40940 %U https://doi.org/10.2196/40940 %U http://www.ncbi.nlm.nih.gov/pubmed/36409307 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e35748 %T Social Support and Technology Use and Their Association With Mental and Physical Health During the COVID-19 Pandemic Among Asian Americans: The COMPASS Cross-sectional Study %A Park,Linda G %A Meyer,Oanh L %A Dougan,Marcelle M %A Golden,Bethany %A Ta,Kevin %A Nam,Bora %A Tsoh,Janice Y %A Tzuang,Marian %A Park,Van M Ta %+ Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, United States, 1 415 502 6616, Linda.Park@ucsf.edu %K health disparities %K mental health %K depression %K anxiety %K social support technology %K COVID-19 %K pandemic %K disparity %K support %K technology %K physical health %K race %K survey %K population %K discrimination %K outcome %K AAPI %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The global COVID-19 pandemic disproportionately affected Asian Americans and Pacific Islanders (AAPIs) and revealed significant health disparities with reports of increased discrimination and xenophobia. Among AAPIs, the pandemic exacerbated their social, linguistic, and geographic isolation. Social support may be especially important for AAPIs given the salience of collectivism as a cultural value. Another mechanism for support among AAPIs was technology use, as it is generally widespread among this population. However, older adults may not perceive the same benefits. Objective: We examined social support and technology use and their relationships with mental and physical health outcomes through the COVID-19 pandemic among AAPIs. Methods: Data were drawn from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) for the time period of October 2020 to February 2021. COMPASS was a cross-sectional, multilingual, national survey conducted online, by phone, and in person with AAPI adults who were ≥18 years of age, in collaboration with academic and community partners in the United States. Data were analyzed using multivariable linear regression using the outcome variables of mental and physical health with various predictors such as social support and technology use. We tested for interactions specific to age and ethnicity. Results: Among 4631 AAPIs (mean age 45.9, SD 16.3 years; 2992/4631, 63.1% female), we found that (1) increased social support was associated with better physical health, (2) total social support was positively associated with better mental health, (3) higher technology use was associated with poorer mental health and inversely associated with poorer physical health, (4) the association of technology use with mental health was weaker among those with low social support (vs those with high social support), (5) adults younger than 60 years old (vs ≥60 years old) were more negatively affected with social support and mental health, and (6) Korean Americans appeared to be a high-risk group for poor physical health with increased technology use. Conclusions: Our paper identified mental and physical health needs along with supportive therapies observed among AAPIs during the pandemic. Future research on how social support can be leveraged, especially among AAPIs younger than 60 years old, and how various types of technology are being utilized are important to guide the recovery efforts to address both mental and physical disparities across communities as a result of the COVID-19 pandemic. %M 36395324 %R 10.2196/35748 %U https://publichealth.jmir.org/2023/1/e35748 %U https://doi.org/10.2196/35748 %U http://www.ncbi.nlm.nih.gov/pubmed/36395324 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e42223 %T The Changes in Levels and Barriers of Physical Activity Among Community-Dwelling Older Adults During and After the Fifth Wave of COVID-19 Outbreak in Hong Kong: Repeated Random Telephone Surveys %A Wang,Zixin %A Fang,Yuan %A Chan,Paul Shing-Fong %A Yu,Fuk Yuen %A Sun,Fenghua %+ Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Ngan Shing St, Sha Tin, Hong Kong, Hong Kong, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K physical activity %K older adults %K barriers %K changes %K repeated random telephone survey %K China %K aging %K elderly population %K community-dwelling older adults %K health promotion %K telehealth %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Aging %G English %X Background: COVID-19 has had an impact on physical activity (PA) among older adults; however, it is unclear whether this effect would be long-lasting, and there is a dearth of studies assessing the changes in barriers to performing PA among older adults before and after entering the “postpandemic era.” Objective: The aim of this study was to compare the levels and barriers of PA among a random sample of community-dwelling older adults recruited during (February to April 2022) and after the fifth wave of the COVID-19 outbreak (May to July 2022) in Hong Kong. In addition, we investigated factors associated with a low PA level among participants recruited at different time points. Methods: This study involved two rounds of random telephone surveys. Participants were community-dwelling Chinese-speaking individuals aged 65 years or above and having a Hong Kong ID card. Household telephone numbers were randomly selected from the most updated telephone directories. Experienced interviewers carried out telephone interviews between 6 PM and 10 PM on weekdays and between 2 PM and 9 PM on Saturdays to avoid undersampling of working individuals. We called 3900 and 3840 households in the first and second round, respectively; for each round, 640 and 625 households had an eligible older adult and 395 and 370 completed the telephone survey, respectively. Results: As compared to participants in the first round, fewer participants indicated a low level of PA in the second round (28.6% vs 45.9%, P<.001). Participants in the second round had higher metabolic equivalent of tasks-minutes/week (median 1707.5 vs 840, P<.001) and minutes of moderate-to-vigorous PA per week (median 240 vs 105, P<.001) than those in the first round. After adjustment for significant background characteristics, participants who perceived a lack of physical capacity to perform PA (first round: adjusted odds ratio [AOR] 3.34, P=.001; second round: 2.92, P=.002) and believed that PA would cause pain and discomfort (first round: AOR 2.04, P=.02; second round: 2.82, P=.001) were more likely to have a low level of PA in both rounds. Lack of time (AOR 4.19, P=.01) and concern about COVID-19 infection during PA (AOR 1.73, P=.02) were associated with a low level of PA among participants in the first round, but not in the second round. A perceived lack of space and facility to perform PA at home (AOR 2.03, P=.02) and unable to find people to do PA with (AOR 1.80, P=.04) were associated with a low PA level in the second round, but not in the first round. Conclusions: The level of PA increased significantly among older adults after Hong Kong entered the “postpandemic era.” Different factors influenced older adults’ PA level during and after the fifth wave of the COVID-19 outbreak. Regular monitoring of the PA level and its associated factors should be conducted to guide health promotion and policy-making. %M 36599172 %R 10.2196/42223 %U https://aging.jmir.org/2023/1/e42223 %U https://doi.org/10.2196/42223 %U http://www.ncbi.nlm.nih.gov/pubmed/36599172 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37533 %T IT and the Quality and Efficiency of Mental Health Care in a Time of COVID-19: Case Study of Mental Health Providers in England %A Konteh,Frederick Hassan %A Mannion,Russell %A Jacobs,Rowena %+ Health Services Management Centre, School of Social Policy, University of Birmingham, 40 Edgbaston Park Road, Park House, Birmingham, B15 2RT, United Kingdom, 44 7401415960, f.konteh@sky.com %K COVID-19 %K mental health care %K information technology %K digital %K inequalities %K sociotechnical systems %D 2022 %7 29.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In England, COVID-19 has significantly affected mental health care and tested the resilience of health care providers. In many areas, the increased use of IT has enabled traditional modes of service delivery to be supported or even replaced by remote forms of provision. Objective: This study aimed to assess the use and impact of IT, in remote service provision, on the quality and efficiency of mental health care during the pandemic. We drew on sociotechnical systems theory as a conceptual framework to help structure the gathering, analysis, and interpretation of data. Methods: We conducted a national scoping survey that involved documentary analysis and semistructured interviews with 6 national stakeholders and case studies of 4 purposefully selected mental health providers in England involving interviews with 53 staff members. Results: Following the outbreak of COVID-19, mental health providers rapidly adjusted their traditional forms of service delivery, switching to digital and telephone consultations for most services. The informants provided nuanced perspectives on the impact on the quality and efficiency of remote service delivery during the pandemic. Notably, it has allowed providers to attend to as many patients as possible in the face of COVID-19 restrictions, to the convenience of both patients and staff. Among its negative effects are concerns about the unsuitability of remote consultation for some people with mental health conditions and the potential to widen the digital divide and exacerbate existing inequalities. Sociotechnical systems theory was found to be a suitable framework for understanding the range of systemic and sociotechnical factors that influence the use of technology in mental health care delivery in times of crisis and normalcy. Conclusions: Although the use of IT has boosted mental health care delivery during the pandemic, it has had mixed effects on quality and efficiency. In general, patients have benefited from the convenience of remote consultation when face-to-face contact was impossible. In contrast, patient choice was often compromised, and patient experience and outcomes might have been affected for some people with mental health conditions for which remote consultation is less suitable. However, the full impact of IT on the quality and efficiency of mental health care provision along with the systemic and sociotechnical determinants requires more sustained and longitudinal research. %M 36423321 %R 10.2196/37533 %U https://formative.jmir.org/2022/12/e37533 %U https://doi.org/10.2196/37533 %U http://www.ncbi.nlm.nih.gov/pubmed/36423321 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42031 %T Engagement, Use, and Impact of Digital Mental Health Resources for Diverse Populations in COVID-19: Community-Partnered Evaluation %A Wells,Kenneth %A Thames,April Denise %A Young,Alexander S %A Zhang,Lily %A Heilemann,MarySue V %A Romero,Daniela Flores %A Oliva,Adrian %A Jones,Felica %A Tang,Lingqi %A Brymer,Melissa %A Elliott,Thomas %A Arevian,Armen %A , %+ Research Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd Suite 300, Los Angeles, CA, 90024, United States, 1 310 794 3728, KWells@mednet.ucla.edu %K digital mental health %K prevention %K COVID-19 %K depression %K hotline use %K health disparity %K community health %K public health %K health resource %K mental well-being %K ethnic %K website engagement %K minority population %K digital resource %D 2022 %7 7.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic increased disparities for communities burdened by structural barriers such as reduced affordable housing, with mental health consequences. Limited data are available on digital resources for public mental health prevention during the COVID-19 pandemic. Objective: The study aim was to evaluate engagement in and impact of free digital resources on the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website during COVID-19 in California. Methods: A pilot evaluation of T4W/Juntos was performed, with partner agencies inviting providers, clients, and partners to visit the website and complete surveys at baseline (September 20, 2021, to April 4, 2022) and at 4-6–week follow-up (October 22, 2021, to May 17, 2022). Website use was assessed by three engagement items (ease of use, satisfaction, relevance), comfort in use, and use of six resource categories. Primary outcomes at follow-up were depression and anxiety (scores≥3 on Patient Health Questionnaire-2 item [PHQ2] and Generalized Anxiety Disorder-2 item [GAD2] scales). Secondary outcomes were post-pre differences in PHQ2 and GAD2 scores, and use of behavioral health hotlines and services the month before follow-up. Results: Of 366 eligible participants, 315 (86.1%) completed baseline and 193 (61.3%) completed follow-up surveys. Of baseline participants, 72.6% identified as female, and 21.3% identified as lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+). In terms of ethnicity, 44.0% identified as Hispanic, 17.8% as African American, 26.9% as non-Hispanic white, and 11.4% as other ethnicity. Overall, 32.7% had moderate anxiety or depression (GAD2/PHQ2≥3) at baseline. Predictors of baseline website engagement included being Hispanic versus other race/ethnicity (β=.27, 95% CI .10-.44; P=.002) and number of COVID-19–related behavior changes (β=.09, 95% CI .05-.13; P<.001). Predictors of comfort using the website were preferring English for website use (odds ratio [OR] 5.57, 95% CI 2.22-13.96; P<.001) and COVID-19–related behavior changes (OR 1.37, 95% CI 1.12-1.66; P=.002); receiving overnight behavioral health treatment in the prior 6 months (OR 0.15, 95% CI 0.03-0.69, P=.015) was associated with less comfort in website use. The main predictor of depression at follow-up (PHQ2≥3) was baseline depression (OR 6.24, 95% CI 2.77-14.09; P<.001). Engagement in T4W/Juntos was associated with lower likelihood of depression (OR 0.54, 95% CI 0.34-0.86; P=.01). Website use the month before follow-up was associated with a post-pre reduction in PHQ2 score (β=–.62, 95% CI –1.04 to –0.20; P=.004). The main predictor of GAD2≥3 at follow-up was baseline GAD2≥3 (OR 13.65, 95% CI 6.06-30.72; P<.001). Greater baseline website engagement predicted reduced hotline use (OR 0.36, 95% CI 0.18-0.71; P=.004). Conclusions: Ethnicity/language and COVID-19–related behavior changes were associated with website engagement; engagement and use predicted reduced follow-up depression and behavioral hotline use. Findings are based on participants recommended by community agencies with moderate follow-up rates; however, significance was similar when weighting for nonresponse. This study may inform research and policy on digital mental health prevention resources. %M 36346902 %R 10.2196/42031 %U https://formative.jmir.org/2022/12/e42031 %U https://doi.org/10.2196/42031 %U http://www.ncbi.nlm.nih.gov/pubmed/36346902 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40065 %T Certified Peer Support Specialists Training in Technology and Delivery of Digital Peer Support Services: Cross-sectional Study %A Fortuna,Karen %A Hill,Julia %A Chalker,Samantha %A Ferron,Joelle %+ Geisel School of Medicine, Department of Psychiatry, Dartmouth College, 2 Pillsbury Street, Suite 401, Concord, NH, 03301, United States, 1 603 722 5727, karen.l.fortuna@dartmouth.edu %K digital peer support %K mHealth %K COVID-19 %K mental health %K remote service %K remote mental health %K telehealth %K peer support %K psychological health %D 2022 %7 7.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: When the COVID-19 pandemic lockdown measures were instituted, the wide-scale necessity for remote mental health care increased among professional clinicians, such as psychiatrists, psychologists, social workers, and certified peer support (CPS) specialists. Factors contributing to increased demand include concern for the safety of loved ones, the safety of oneself, overall well-being, unemployment, and loneliness for older individuals. While demand continues to increase and a shortage of mental health professionals persists, understanding the training, technology, media, and delivery of digital peer support services can facilitate community-based support services to assist patients in coping with mental health symptoms between clinical encounters with licensed professionals. Digital peer support consists of asynchronous and synchronous, live or automated, peer support services such as applications, social media, and phone calls. Objective: The purpose of this cross-sectional study is to determine how digital peer support is delivered, by which technologies it is delivered, and how certified digital peer supporters are trained within the United States to inform future delivery of digital peer support. Methods: We used an online cross-sectional self-report survey developed alongside certified peer specialists. The study included questions regarding the types of peer support training and the delivery methods used within their practices. We advertised the survey through a certified peer support specialist listserve, Facebook, and Twitter. Results: Certified peer specialists provide mutual social emotional support to those with a similar mental health condition. Of certified peer specialists trained in CPS, the majority of CPS specialists were trained in peer support (418/426, 98.1%). Peer support specialists deliver services via telephone calls (182/293, 62.1%), via videoconference-based services (160/293, 54.6%), via SMS text messages (123/293, 42%), via smartphone apps (68/293, 23.2%), and via social media (65/293, 22.2%). Certified peer specialists deliver services through virtual reality (11/293, 3.8%) and through video games (6/293, 2%). Virtual reality and video games may represent emerging technologies to develop and deliver community-based support. Conclusions: This study examined the modes of digital peer support intervention as well as the training and demographic background of peer supporters. Given the demand for mental health care, digital peer support emerges as one option to increase access. These results suggest that CPS specialists commonly use SMS text messaging, phone calls, and videoconferences to engage in peer support. Less frequently, they may use diverse modes such as apps, social media, and video games. It is important to consider the backgrounds of peer supporters and the mediums of communication to best accommodate areas where access to peer support is emerging. Larger longitudinal studies and a variety of experimental designs may be considered to understand the efficacy of digital interventions and digital peer support training to direct optimal care. %M 36476983 %R 10.2196/40065 %U https://formative.jmir.org/2022/12/e40065 %U https://doi.org/10.2196/40065 %U http://www.ncbi.nlm.nih.gov/pubmed/36476983 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e40713 %T A Smartphone-Based Intervention for Anxiety and Depression in Racially and Ethnically Diverse Adults (EASE): Protocol for a Randomized Controlled Trial %A Garey,Lorra %A Zvolensky,Michael J %A Gallagher,Matthew W %A Vujanovic,Anka %A Kendzor,Darla E %A Stephens,Lancer %A Cheney,Marshall K %A Cole,Ashley B %A Kezbers,Krista %A Matoska,Cameron T %A Robison,Jillian %A Montgomery,Audrey %A Zappi,Christopher V %A Businelle,Michael S %+ Department of Psychology, University of Houston, Fred J. Heyne Building, Suite 104, 3695 Cullen Blvd, Houston, TX, 77204, United States, 1 713 743 8056, llgarey@uh.edu %K COVID-19 %K just-in-time adaptive intervention %K anxiety %K depression %K mHealth %K minority populations %K death %K behavioral %K care %K mobile application %K app %K public health %K symptoms %K risk %D 2022 %7 5.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Clear health disparities have emerged in the rates of COVID-19 exposure, hospitalization, and death among Black, Hispanic, and American Indian (BHAI) individuals, relative to non-Hispanic White (NHW) individuals. BHAI populations have been disproportionately affected by lower behavioral health access and heightened negative mental health outcomes during the pandemic. Objective: This project directly addresses health disparities in access to behavioral health care during the COVID-19 pandemic among BHAI populations via an adaptation of the established, initially validated, low-cost, mobile app Easing Anxiety Sensitivity for Everyone (EASE) among individuals with symptoms of elevated anxiety or depression or both. Methods: The EASE trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. Participants (N=800; n=200, 25%, Black; n=200, 25%, Hispanic; n=200, 25%, American Indian; and n=200, 25%, NHW) are randomized to receive either EASE or an active comparison condition for anxiety and depression. Participants compete an online prescreener, an enrollment call to provide informed consent, a baseline survey, a 6-month intervention period, and 3- and 6-month postbaseline assessments. Select participants also complete a 3- and 6-month postbaseline qualitative interview via phone or an online platform (eg, Zoom). Participants complete 2 scheduled daily ecological momentary assessments (EMAs) during the 6-month study period. These twice-daily EMAs guide a just-in-time approach to immediate, personalized behavioral health care. Results: Outcomes include reductions in anxiety and depressive symptoms and functional impairment at 3 and 6 months postrandomization. We also will examine putative mechanisms (eg, anxiety sensitivity [AS] and COVID-19–specific stress and fear) of the intervention effects. Further, as treatment effects may differ across sociocultural factors, perceived discrimination, social support, and socioeconomic status (SES) will be evaluated as potential moderators of treatment effects on the primary outcomes. Process evaluation using data collected during the study, as well as individual interviews with participants, will complement quantitative data. Conclusions: Data from this efficacy trial will determine whether EASE successfully improves symptoms of anxiety and depression and whether these improvements outperform an active comparison control app. If successful, findings from this study have the potential to decrease anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae. Data from this study may be used to support an implementation and dissemination trial of EASE within real-world behavioral health and social service settings. Trial Registration: ClinicalTrials.gov NCT05074693; https://clinicaltrials.gov/ct2/show/NCT05074693 International Registered Report Identifier (IRRID): DERR1-10.2196/40713 %M 36409958 %R 10.2196/40713 %U https://www.researchprotocols.org/2022/12/e40713 %U https://doi.org/10.2196/40713 %U http://www.ncbi.nlm.nih.gov/pubmed/36409958 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e39312 %T Reinterpretation of Health Information in the Context of an Emerging Infectious Disease: A Digital Focus Group Study %A Tan,Rayner Kay Jin %A Lim,Jane Mingjie %A Neo,Pearlyn Hui Min %A Ong,Suan Ee %+ University of North Carolina Project-China, 2 Lujing Road, Guangzhou, 510095, China, 65 91878576, rayner.tan@nus.edu.sg %K health communication %K infodemic %K SARS-CoV-2 %K coronavirus %K Singapore %K WhatsApp %K COVID-19 %K health information %K misinformation %K mobile health %K smartphone %K information quality %K online health information %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Misinformation related to the COVID-19 pandemic has accelerated global public concern and panic. The glut of information, or “infodemic,” has caused concern for authorities due to its negative impacts on COVID-19 prevention and control, spurring calls for a greater scholarly focus on health literacy during the pandemic. Nevertheless, few studies have sought to qualitatively examine how individuals interpreted and assimilated health information at the initial wave of COVID-19 restrictions. Objective: We developed this qualitative study adopting chat-based focus group discussions to investigate how individuals interpreted COVID-19 health information during the first wave of COVID-19 restrictions. Methods: We conducted a qualitative study in Singapore to investigate how individuals perceive and interpret information that they receive on COVID-19. Data were generated through online focus group discussions conducted on the mobile messaging smartphone app WhatsApp. From March 28 to April 13, 2020, we held eight WhatsApp-based focus groups (N=60) with participants stratified by age groups, namely 21-30 years, 31-40 years, 41-50 years, and 51 years and above. Data were thematically analyzed. Results: A total of four types of COVID-19 health information were generated from the thematic analysis, labeled as formal health information, informal health information, suspicious health information, and fake health information, respectively. How participants interpreted these categories of information depended largely on the perceived trustworthiness of the information source as well as the perceived veracity of information. Both factors were instrumental in determining individuals’ perceptions, and their subsequent treatment and assimilation of COVID-19–related information. Conclusions: Both perceived trustworthiness of the information source and perceived veracity of information were instrumental concepts in determining one’s perception, and thus subsequent treatment and assimilation of such information for one’s knowledge of COVID-19 or the onward propagation to their social networks. These findings have implications for how policymakers and health authorities communicate with the public and deal with fake health information in the context of COVID-19. %M 36099011 %R 10.2196/39312 %U https://humanfactors.jmir.org/2022/4/e39312 %U https://doi.org/10.2196/39312 %U http://www.ncbi.nlm.nih.gov/pubmed/36099011 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40242 %T Chatbot-Delivered Cognitive Behavioral Therapy in Adolescents With Depression and Anxiety During the COVID-19 Pandemic: Feasibility and Acceptability Study %A Nicol,Ginger %A Wang,Ruoyun %A Graham,Sharon %A Dodd,Sherry %A Garbutt,Jane %+ Division of Child and Adolescent Psychiatry, Department of Psychiatry, Washington University School of Medicine, 600 S Taylor Ave, Suite 121, St Louis, MO, 63110, United States, 1 3143625939, nicolg@wustl.edu %K COVID-19 %K adolescent depression %K mobile health %K cognitive behavioral therapy %K chatbot %K relational conversational agent %K depression %K anxiety %K suicide %K self-harm %K pandemic %K pediatric %K youth %K adolescent %K adolescence %K psychiatry %K conversational agent %K CBT %K clinic %K data %K acceptability %K feasibility %K usability %K primary care %K intervention %K mental health %K digital health %K technology mediated %K computer mediated %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Symptoms of depression and anxiety, suicidal ideation, and self-harm have escalated among adolescents to crisis levels during the COVID-19 pandemic. As a result, primary care providers (PCPs) are often called on to provide first-line care for these youth. Digital health interventions can extend mental health specialty care, but few are evidence based. We evaluated the feasibility of delivering an evidence-based mobile health (mHealth) app with an embedded conversational agent to deliver cognitive behavioral therapy (CBT) to symptomatic adolescents presenting in primary care settings during the pandemic. Objective: In this 12-week pilot study, we evaluated the feasibility of delivering the app-based intervention to adolescents aged 13 to 17 years with moderate depressive symptoms who were treated in a practice-based research network (PBRN) of academically affiliated primary care clinics. We also obtained preliminary estimates of app acceptability, effectiveness, and usability. Methods: This small, pilot randomized controlled trial (RCT) evaluated depressive symptom severity in adolescents randomized to the app or to a wait list control condition. The primary end point was depression severity at 4-weeks, measured by the 9-item Patient Health Questionnaire (PHQ-9). Data on acceptability, feasibility, and usability were collected from adolescents and their parent or legal guardian. Qualitative interviews were conducted with 13 PCPs from 11 PBRN clinics to identify facilitators and barriers to incorporating mental health apps in treatment planning for adolescents with depression and anxiety. Results: The pilot randomized 18 participants to the app (n=10, 56%) or to a wait list control condition (n=8, 44%); 17 participants were included in the analysis, and 1 became ineligible upon chart review due to lack of eligibility based on documented diagnosis. The overall sample was predominantly female (15/17, 88%), White (15/17, 88%), and privately insured (15/17, 88%). Mean PHQ-9 scores at 4 weeks decreased by 3.3 points in the active treatment group (representing a shift in mean depression score from moderate to mild symptom severity categories) and 2 points in the wait list control group (no shift in symptom severity category). Teen- and parent-reported usability, feasibility, and acceptability of the app was high. PCPs reported preference for introducing mHealth interventions like the one in this study early in the course of care for individuals presenting with mild or moderate symptoms. Conclusions: In this small study, we demonstrated the feasibility, acceptability, usability, and safety of using a CBT-based chatbot for adolescents presenting with moderate depressive symptoms in a network of PBRN-based primary care clinics. This pilot study could not establish effectiveness, but our results suggest that further study in a larger pediatric population is warranted. Future study inclusive of rural, socioeconomically disadvantaged, and underrepresented communities is needed to establish generalizability of effectiveness and identify implementation-related adaptations needed to promote broader uptake in pediatric primary care. Trial Registration: ClinicalTrials.gov NCT04603053; https://clinicaltrials.gov/ct2/show/NCT04603053 %M 36413390 %R 10.2196/40242 %U https://formative.jmir.org/2022/11/e40242 %U https://doi.org/10.2196/40242 %U http://www.ncbi.nlm.nih.gov/pubmed/36413390 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39662 %T Determinants of e-Mental Health Use During COVID-19: Cross-sectional Canadian Study %A Yu,Ellie %A Xu,Bowen %A Sequeira,Lydia %+ Canada Health Infoway, 150 King St W, Ste 1300, Toronto, ON, M5H 1J9, Canada, 1 4163039181, lsequeira@infoway-inforoute.ca %K digital health %K mental health %K e-Mental health %K user profile %K determinants %K health service %K use %K utilization %K COVID-19 %K pandemic %K Canada %K users %K factors %D 2022 %7 16.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Access to mental health treatment across Canada remains a challenge, with many reporting unmet care needs. National and provincial e-Mental health (eMH) programs have been developed over the past decade across Canada, with many more emerging during COVID-19 in an attempt to reduce barriers related to geography, isolation, transportation, physical disability, and availability. Objective: The aim of this study was to identify factors associated with the utilization of eMH services across Canada during the COVID-19 pandemic using Andersen and Newman’s framework of health service utilization. Methods: This study used data gathered from the 2021 Canadian Digital Health Survey, a cross-sectional, web-based survey of 12,052 Canadians aged 16 years and older with internet access. Bivariate associations between the use of eMH services and health service utilization factors (predisposing, enabling, illness level) of survey respondents were assessed using χ2 tests for categorical variables and t tests for the continuous variable. Logistic regression was used to predict the probability of using eMH services given the respondents’ predisposing, enabling, and illness-level factors while adjusting for respondents’ age and gender. Results: The proportion of eMH service users among survey respondents was small (883/12,052, 7.33%). Results from the logistic regression suggest that users of eMH services were likely to be those with regular family physician access (odds ratio [OR] 1.57, P=.02), living in nonrural communities (OR 1.08, P<.001), having undergraduate (OR 1.40, P=.001) or postgraduate (OR 1.48, P=.003) education, and being eHealth literate (OR 1.05, P<.001). Those with lower eMH usage were less likely to speak English at home (OR 0.06, P<.001). Conclusions: Our study provides empirical evidence on the impact of individual health utilization factors on the use of eMH among Canadians during the COVID-19 pandemic. Given the opportunities and promise of eMH services in increasing access to care, future digital interventions should both tailor themselves toward users of these services and consider awareness campaigns to reach nonusers. Future research should also focus on understanding the reasons behind the use and nonuse of eMH services. %M 36191173 %R 10.2196/39662 %U https://www.jmir.org/2022/11/e39662 %U https://doi.org/10.2196/39662 %U http://www.ncbi.nlm.nih.gov/pubmed/36191173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39634 %T Providers’ Perspectives on Telemental Health Usage After the COVID-19 Pandemic: Retrospective Analysis %A Wilczewski,Hattie %A Paige,Samantha R %A Ong,Triton %A Soni,Hiral %A Barrera,Janelle F %A Welch,Brandon M %A Bunnell,Brian E %+ Doxy.me Research, Doxy.me Inc, 3445 Winton Pl, Suite 114, Rochester, NY, 14623, United States, 1 8444369963, hattie.wilczewski@doxy.me %K telemedicine %K telehealth %K COVID-19 %K telemental health %K mental health %K pandemic %K perception %K use %K usefulness %K usage %K workflow %D 2022 %7 11.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health care pivoted to telemedicine during the COVID-19 pandemic, and there is uncertainty around the sustainability of this rapid shift. Objective: This study examined how intentions to continue using telemedicine after the COVID-19 pandemic are influenced by provider perceptions of usefulness, ease of use, and professional social influence, facilitating organizational conditions. Methods: We conducted a web-based, cross-sectional survey of 369 telemental health providers between February and March 2021. A hierarchical linear regression analysis was conducted to predict intentions to continue using telemedicine after the COVID-19 pandemic. Results: Most providers began using telemedicine in March 2020 or later (257/369, 69.6%) and attended to ≥50% of their clients via telemedicine (299/369, 81.0%). Intention to continue using telemedicine after the COVID-19 pandemic was predicted by the telemedicine caseload (β=.10; P=.005), perceived usefulness in general (β=.10; P=.008), ease of use (β=.08; P=.04), social influence (β=.68; P<.001), and facilitating conditions (β=.08; P=.047). Conclusions: Exploration of the predictors of telemedicine usage beyond the COVID-19 pandemic aids in surveillance of telemedicine usage, integration with future clinic workflows, and the shaping of public policy. It is important to consider telemedicine services as not only a response to a crisis but also an effective and useful solution for everyday life. Our results suggest widespread, sustainable telemedicine adoption. %M 36322787 %R 10.2196/39634 %U https://formative.jmir.org/2022/11/e39634 %U https://doi.org/10.2196/39634 %U http://www.ncbi.nlm.nih.gov/pubmed/36322787 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41689 %T Effectiveness of Mental Health Apps for Distress During COVID-19 in US Unemployed and Essential Workers: Remote Pragmatic Randomized Clinical Trial %A Comtois,Katherine Anne %A Mata-Greve,Felicia %A Johnson,Morgan %A Pullmann,Michael D %A Mosser,Brittany %A Arean,Patricia %+ Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 Pacific Stree NE, Seattle, WA, 98195, United States, 1 14152727222, parean@uw.edu %K COVID-19 %K COVID %K coronavirus %K pandemic %K SARS-CoV-2 %K essential worker %K suicide %K suicidal %K commercial app %K mental health apps %K health app %K mental health %K mHealth %K mobile health %K occupational health %K employee %K employment %K unemployed %K worker %K job %K depression %K anxiety %K stress %K distress %K mobile app %K RCT %K pragmatic trial %K randomized %K health care worker %K health care provider %K frontline staff %D 2022 %7 7.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During the COVID-19 pandemic, the general public was concerned about the mental health impacts of unemployment due to COVID-19 and the stress essential workers experienced during this time. Several reports indicated that people in distress were turning to digital technology, but there was little evidence about the impact of these tools on mitigating distress. Objective: This study seeks to determine the acceptability, feasibility, usability, and effectiveness of mobile mental health apps for decreasing mental health symptoms in essential workers and unemployed individuals with suicide risk. Methods: We recruited participants who indicated that they were unemployed because of COVID-19 or were COVID-19–designated essential workers. Participants were randomized to 1 of 4 free commercial mobile apps for managing distress that were (1) highly rated by PsyberGuide and (2) met the criteria for intervention features these participants indicated were desirable in a previous survey. Participants used the apps for 4 weeks and completed baseline and 4-week self-assessments of depression, anxiety emotional regulation, and suicide risk. Results: We found no differences between the apps in any outcome but did find significant changes in depression and anxiety over time (Patient Health Questionnaire [PHQ]-9: estimate=–1.5, SE 0.2, 95% CI –1.1 to –1.8, P<.001; Generalized Anxiety Disorder Scale [GAD]-7: estimate=–1.3, SE 0.2, 95% CI –1.0 to –1.6, P<.001). We found no significant changes in suicidal behavior (Suicide Behaviors Questionnaire-Revised [SBQ-R]) or emotional regulation (Difficulties in Emotion Regulation Scale – Short Form [DERS-SF]) for the 4 weeks. We did find a significant dose-response pattern for changes in depression and anxiety. Using the app at least once a week resulted in greater improvements in treatment conditions over time on depression (estimate=–0.6, SE 0.2, 95% CI 1.0-0.2, P=.003) and anxiety (estimate=0.1, SE 0.2, 95% CI 0.4-0.6, P=.78). There was no association between app frequency and changes in suicidal behavior (SBQ-R) or emotional regulation (DERS-SF). We further found a significant difference between the conditions with regard to app usability, with the control app being the most usable (meanBeautiful Mood 72.9, SD 16.7; meanCOVID Coach 71.2, SD 15.4; meanCalm 66.8, SD 17.3; mean7 Cups 65.2, SD 17.7). We found no significant differences for app acceptability or appropriateness. Conclusions: Few studies have evaluated prospectively the utility and usability of commercial apps for mood. This study found that free, self-guided commercial mobile mental health apps are seen as usable, but no one app is superior to the other. Although we found that regular use is indicated for effects on depression and anxiety to occur in those who are more symptomatic, regression to the mean cannot be ruled out. Trial Registration: ClinicalTrials.gov NCT04536935; https://tinyurl.com/mr36zx3s %M 36191176 %R 10.2196/41689 %U https://mhealth.jmir.org/2022/11/e41689 %U https://doi.org/10.2196/41689 %U http://www.ncbi.nlm.nih.gov/pubmed/36191176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39861 %T Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study %A Lee,Katherine %A Bolton,Shay-Lee %A Shterenberg,Ravit %A Bolton,James M %A Hensel,Jennifer M %+ Department of Psychiatry, University of Manitoba, PsycHealth Centre, 771 Bannatyne Ave, Winnipeg, MB, R3E 3N4, Canada, 1 204 787 3621, jhensel@hsc.mb.ca %K virtual ward %K mental health %K COVID-19 %K implementation %K driver diagram %K virtual care %K virtual health care %K acceptance %K psychiatric support %K crisis support %K provider perspectives %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic was accompanied by the accelerated uptake of virtual care, leading to a proliferation of virtual ward models as alternatives to facility-based care. Early in the pandemic, our program implemented a virtual mental health crisis ward (vWard) to provide options for individuals requiring intense psychiatric and/or crisis support but who preferred to remain in the community and were deemed safe to do so. Objective: The aim of this study was to identify early learnings from the vWard, which was implemented rapidly in a resource-constrained environment, to inform the future state should it be sustained beyond the pandemic. Methods: Mixed methods of data collection were used to evaluate provider perspectives on the vWard, develop archetypes for individuals who are a good fit for the vWard model, and create a driver diagram. Data sources included an anonymous survey of clinical and managerial staff involved in the vWard, a service planning workshop, and program discharge forms for all individuals admitted between March 2020 and April 2021. Survey responses were coded for themes under categories of “benefits” and “challenges.” Discharge forms where the team indicated that the vWard was a good fit for an individual were examined for characteristics common to these admissions. These findings were reviewed in the service planning workshop and refined with input from the participants into patient archetypes. A driver diagram was created for the future state. Results: Survey respondents (N=60) represented diverse roles in crisis services and the vWard team. Ten providers took part in the service planning workshop. A total of 467 discharge forms were reviewed. The vWard was felt to be a model that worked by 39 survey respondents, one respondent felt it did not work, and the remaining participants had no response. Several benefits for the individual and the system were identified alongside challenges, including certain processes and materials related to the nature of rapid implementation during the pandemic, and others due to lack of fit for certain individuals. The model was felt to be a good fit for 67.5% of admissions. Four patient archetypes representing a good fit with the model were developed. The driver diagram connected the program aim with primary drivers of (1) reduce barriers to care; (2) improve outcomes; and (3) provide collaborative, patient- and family-centered care to secondary drivers and interventions that leveraged virtual technology among other crisis care interventions. Conclusions: Despite some challenges, the vWard demonstrated high levels of provider acceptance and a range of mechanisms by which the model works for a variety of patient archetypes. These early learnings provide a foundation for growth, sustainability, and spread of this model going forward beyond the pandemic. %M 36252139 %R 10.2196/39861 %U https://formative.jmir.org/2022/11/e39861 %U https://doi.org/10.2196/39861 %U http://www.ncbi.nlm.nih.gov/pubmed/36252139 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e40614 %T An Internet-Based Parent Training With Telephone Coaching on Managing Disruptive Behavior in Children at Special Family Counseling Centers During the COVID-19 Pandemic: Feasibility Study %A Sourander,Saana %A Sourander,Andre %A Hinkka-Yli-Salomäki,Susanna %A Ristkari,Terja %A Kurki,Marjo %+ Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd floor, Turku, 20014, Finland, 358 469212562, saana.sourander@utu.fi %K parent training %K disruptive behavior %K child psychopathology %K child functioning %K internet-based %K COVID-19 pandemic %K COVID-19 %K mental health %K psychological well-being %K digital health %K parenting %K telehealth %K behavioral problem %K psychopathology %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: There is growing concern about the short- and long-term impacts that the COVID-19 pandemic will have on the mental health and psychosocial well-being of children and families. There are no existing studies about feasibility and outcomes using internet-based parent training programs with telephone coaching for disruptive behavioral problems in childhood during the COVID-19 pandemic in clinical settings. Objective: This study explored how the Strongest Families Smart Website (SFSW) parent training program, with telephone coaching, provided support during the COVID-19 pandemic at specialist family counseling centers in Helsinki, Finland, when restrictions made face-to-face counseling impossible. This study followed the success of a randomized controlled trial (RCT) and its implementation study of the SFSW parent training program by primary care child health clinics. The aim was to improve parenting skills, so that parents could tackle disruptive behavior by developing positive parent-child relationships. It started in May 2020, when the COVID-19 pandemic was at its height in Finland. Methods: In total, 8 family counseling centers in Helsinki identified 50 referrals aged 3-8 years with high levels of parent-reported disruptive behavioral problems. Child psychopathology and functioning and parental skills and well-being were measured at baseline, posttreatment, and 6 months later using a range of tools. The data were extracted from questionnaires completed by the parents. Results: We found that 44 (88%) of the 50 families completed the whole 11-session parent training program. Most of the children (n=48, 96%) had definitive or severe behavioral problems when they were initially screened by the centers, but with those assessed at the 6-month follow-up (n=45, 90%), this dropped to 58% (n=26). There were significant changes from baseline to 6-month follow-up in most of the child psychopathology measures, including the Child Behavior Checklist-Parent Report Form (CBCL) total score (mean change 16.3, SE 3.0, 95% CI 10.2-22.3; P<.001) and externalizing score (mean change 7.0, SE 1.0, 95% CI 4.9-9.0; P<.001). When parenting skills were measured with the Parenting Scale (PS), they showed significant changes from baseline to 6-month follow-up in total scores (mean change 0.5, SE 0.1, 95% CI 0.4-0.7; P<.001). Parents showed significant change in the stress subscore (mean change 3.9, SE 0.8, 95% CI 2.2-5.6; P<.001). Of the parents who filled in the satisfaction questionnaire (n=45, 90%), 42 (93%) reported high satisfaction in the skills and 44 (98%) in the professionalism of the family coaches. Conclusions: The program proved to be an effective method for improving parenting skills and child psychopathology and functioning. The parents were satisfied with the program, and the dropout rate was exceptionally low. The study shows that the training program could be implemented in specialist clinical settings and during crisis conditions, such as the COVID-19 pandemic. %M 36194895 %R 10.2196/40614 %U https://pediatrics.jmir.org/2022/4/e40614 %U https://doi.org/10.2196/40614 %U http://www.ncbi.nlm.nih.gov/pubmed/36194895 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e38153 %T The #VaccinesWork Hashtag on Twitter in the Context of the COVID-19 Pandemic: Network Analysis %A Fuster-Casanovas,Aïna %A Das,Ronnie %A Vidal-Alaball,Josep %A Lopez Segui,Francesc %A Ahmed,Wasim %+ Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Pica d'Estats 13-15, Sant Fruitós de Bages, 08272, Spain, 34 93 693 0040, jvidal.cc.ics@gencat.cat %K Twitter %K social media %K COVID-19 %K misinformation %K vaccination %K public health %K vaccine hesitancy %K infodemiology %K health campaign %K content analysis %K social network %K layout algorithm %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Vaccination is one of the most successful public health interventions for the prevention of COVID-19. Toward the end of April 2021, UNICEF (United Nations International Children’s Emergency Fund), alongside other organizations, were promoting the hashtag #VaccinesWork. Objective: The aim of this paper is to analyze the #VaccinesWork hashtag on Twitter in the context of the COVID-19 pandemic, analyzing the main messages shared and the organizations involved. Methods: The data set used in this study consists of 11,085 tweets containing the #VaccinesWork hashtag from the 29th to the 30th of April 2021. The data set includes tweets that may not have the hashtag but were replies or mentions in those tweets. The data were retrieved using NodeXL, and the network graph was laid out using the Harel-Koren fast multiscale layout algorithm. Results: The study found that organizations such as the World Health Organization, UNICEF, and Gavi were the key opinion leaders and had a big influence on the spread of information among users. Furthermore, the most shared URLs belonged to academic journals with a high impact factor. Provaccination users had other vaccination-promoting hashtags in common, not only in the COVID-19 scenario. Conclusions: This study investigated the discussions surrounding the #VaccinesWork hashtag. Social media networks containing conspiracy theories tend to contain dubious accounts leading the discussions and are often linked to unverified information. This kind of analysis can be useful to detect the optimal moment for launching health campaigns on Twitter. %M 36219832 %R 10.2196/38153 %U https://publichealth.jmir.org/2022/10/e38153 %U https://doi.org/10.2196/38153 %U http://www.ncbi.nlm.nih.gov/pubmed/36219832 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e40233 %T Effectiveness, Policy, and User Acceptance of COVID-19 Contact-Tracing Apps in the Post–COVID-19 Pandemic Era: Experience and Comparative Study %A Liu,MingXin %A Zhou,SiYu %A Jin,Qun %A Nishimura,Shoji %A Ogihara,Atsushi %+ Graduate School of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, 3591192, Japan, 81 04 2949 8111, liumingxin98@akane.waseda.jp %K COVID-19 %K contact-tracing app %K digital contact tracing %K mobile phone %D 2022 %7 27.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the post–COVID-19 pandemic era, many countries have launched apps to trace contacts of COVID-19 infections. Each contact-tracing app (CTA) faces a variety of issues owing to different national policies or technologies for tracing contacts. Objective: In this study, we aimed to investigate all the CTAs used to trace contacts in various countries worldwide, including the technology used by each CTA, the availability of knowledge about the CTA from official websites, the interoperability of CTAs in various countries, and the infection detection rates and policies of the specific country that launched the CTA, and to summarize the current problems of the apps based on the information collected. Methods: We investigated CTAs launched in all countries through Google, Google Scholar, and PubMed. We experimented with all apps that could be installed and compiled information about apps that could not be installed or used by consulting official websites and previous literature. We compared the information collected by us on CTAs with relevant previous literature to understand and analyze the data. Results: After screening 166 COVID-19 apps developed in 197 countries worldwide, we selected 98 (59%) apps from 95 (48.2%) countries, of which 63 (66.3%) apps were usable. The methods of contact tracing are divided into 3 main categories: Bluetooth, geolocation, and QR codes. At the technical level, CTAs face 3 major problems. First, the distance and time for Bluetooth- and geolocation-based CTAs to record contact are generally set to 2 meters and 15 minutes; however, this distance should be lengthened, and the time should be shortened for more infectious variants. Second, Bluetooth- or geolocation-based CTAs also face the problem of lack of accuracy. For example, individuals in 2 adjacent vehicles during traffic jams may be at a distance of ≤2 meters to make the CTA trace contact, but the 2 users may actually be separated by car doors, which could prevent transmission and infection. In addition, we investigated infection detection rates in 33 countries, 16 (48.5%) of which had significantly low infection detection rates, wherein CTAs could have lacked effectiveness in reducing virus propagation. Regarding policy, CTAs in most countries can only be used in their own countries and lack interoperability among other countries. In addition, 7 countries have already discontinued CTAs, but we believe that it was too early to discontinue them. Regarding user acceptance, 28.6% (28/98) of CTAs had no official source of information that could reduce user acceptance. Conclusions: We surveyed all CTAs worldwide, identified their technological policy and acceptance issues, and provided solutions for each of the issues we identified. This study aimed to provide useful guidance and suggestions for updating the existing CTAs and the subsequent development of new CTAs. %M 36190741 %R 10.2196/40233 %U https://publichealth.jmir.org/2022/10/e40233 %U https://doi.org/10.2196/40233 %U http://www.ncbi.nlm.nih.gov/pubmed/36190741 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e35000 %T Virtual Reality Applications in Medicine During the COVID-19 Pandemic: Systematic Review %A Pallavicini,Federica %A Pepe,Alessandro %A Clerici,Massimo %A Mantovani,Fabrizia %+ Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, 20126, Italy, 39 0264484931, federica.pallavicini@unimib.it %K virtual reality %K medicine %K mental health %K physical health %K education %K training %K COVID-19 %D 2022 %7 25.10.2022 %9 Review %J JMIR Serious Games %G English %X Background: Virtual reality can play an important role during the COVID-19 pandemic in the health care sector. This technology has the potential to supplement the traditional in-hospital medical training and treatment, and may increase access to training and therapies in various health care settings. Objective: This systematic review aimed to describe the literature on health care–targeted virtual reality applications during the COVID-19 crisis. Methods: We conducted a systematic search of the literature on the PsycINFO, Web of Science, and MEDLINE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search string was as follows: “[(virtual reality)] AND [(COVID-19) OR (coronavirus) OR (SARS-CoV-2) OR (healthcare)].” Papers published in English after December 2019 in peer-reviewed journals were selected and subjected to the inclusion and exclusion criteria. We used the Mixed Methods Appraisal Tool to assess the quality of studies and the risk of bias. Results: Thirty-nine studies met the inclusion criteria. Seventeen studies showed the usefulness of virtual reality during the COVID-19 crisis for reducing stress, anxiety, depression, and pain, and promoting physical activity. Twenty-two studies revealed that virtual reality was a helpful learning and training tool during the COVID-19 crisis in several areas, including emergency medicine, nursing, and pediatrics. This technology was also used as an educational tool for increasing public understanding of the COVID-19 pandemic. Different levels of immersion (ie, immersive and desktop virtual reality), types of head-mounted displays (ie, PC-based, mobile, and standalone), and content (ie, 360° videos and photos, virtual environments, virtual reality video games, and embodied virtual agents) have been successfully used. Virtual reality was helpful in both face-to-face and remote trials. Conclusions: Virtual reality has been applied frequently in medicine during the COVID-19 pandemic, with positive effects for treating several health conditions and for medical education and training. Some barriers need to be overcome for the broader adoption of virtual reality in the health care panorama. Trial Registration: International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) INPLASY202190108; https://inplasy.com/inplasy-2021-9-0108/ %M 36282554 %R 10.2196/35000 %U https://games.jmir.org/2022/4/e35000 %U https://doi.org/10.2196/35000 %U http://www.ncbi.nlm.nih.gov/pubmed/36282554 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36656 %T Anxiety, Post–COVID-19 Syndrome-Related Depression, and Suicidal Thoughts and Behaviors in COVID-19 Survivors: Cross-sectional Study %A Woodward,Sean F %A Bari,Sumra %A Vike,Nicole %A Lalvani,Shamal %A Stetsiv,Khrystyna %A Kim,Byoung Woo %A Stefanopoulos,Leandros %A Maglaveras,Nicos %A Breiter,Hans %A Katsaggelos,Aggelos K %+ Department of Electrical and Computer Engineering, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208, United States, 1 847 491 3451, a-katsaggelos@northwestern.edu %K COVID-19 %K post–COVID-19 syndrome %K suicidality %K depression %K Patient Health Questionnaire-9 %K PHQ-9 %K State Trait Anxiety Index %K STAI %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although the mental health impacts of COVID-19 on the general population have been well studied, studies of the long-term impacts of COVID-19 on infected individuals are relatively new. To date, depression, anxiety, and neurological symptoms associated with post–COVID-19 syndrome (PCS) have been observed in the months following COVID-19 recovery. Suicidal thoughts and behavior (STB) have also been preliminarily proposed as sequelae of COVID-19. Objective: We asked 3 questions. First, do participants reporting a history of COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher on depression (Patient Health Questionnaire-9 [PHQ-9]) or state anxiety (State Trait Anxiety Index) screens than those who do not? Second, do participants reporting a COVID-19 diagnosis score higher on PCS-related PHQ-9 items? Third, do participants reporting a COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher in STB before, during, or after the first year of the pandemic? Methods: This preliminary study analyzed responses to a COVID-19 and mental health questionnaire obtained from a US population sample, whose data were collected between February 2021 and March 2021. We used the Mann-Whitney U test to detect differences in the medians of the total PHQ-9 scores, PHQ-9 component scores, and several STB scores between participants claiming a past clinician diagnosis of COVID-19 and those denying one, as well as between participants claiming severe COVID-19 symptoms in a close relative and those denying them. Where significant differences existed, we created linear regression models to predict the scores based on COVID-19 response as well as demographics to identify potential confounding factors in the Mann-Whitney relationships. Moreover, for STB scores, which corresponded to 5 questions asking about 3 different time intervals (i.e., past 1 year or more, past 1 month to 1 year, and past 1 month), we developed repeated-measures ANOVAs to determine whether scores tended to vary over time. Results: We found greater total depression (PHQ-9) and state anxiety (State Trait Anxiety Index) scores in those with COVID-19 history than those without (Bonferroni P=.001 and Bonferroni P=.004) despite a similar history of diagnosed depression and anxiety. Greater scores were noted for a subset of depression symptoms (PHQ-9 items) that overlapped with the symptoms of PCS (all Bonferroni Ps<.05). Moreover, we found greater overall STB scores in those with COVID-19 history, equally in time windows preceding, during, and proceeding infection (all Bonferroni Ps<.05). Conclusions: We confirm previous studies linking depression and anxiety diagnoses to COVID-19 recovery. Moreover, our findings suggest that depression diagnoses associated with COVID-19 history relate to PCS symptoms, and that STB associated with COVID-19 in some cases precede infection. %M 35763757 %R 10.2196/36656 %U https://formative.jmir.org/2022/10/e36656 %U https://doi.org/10.2196/36656 %U http://www.ncbi.nlm.nih.gov/pubmed/35763757 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e37939 %T Teaching Telepsychiatry Skills: Building on the Lessons of the COVID-19 Pandemic to Enhance Mental Health Care in the Future %A Smith,Katharine %A Torous,John %A Cipriani,Andrea %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom, 44 01865618200, andrea.cipriani@psych.ox.ac.uk %K mHealth %K mental health %K smartphones %K telehealth %K telepsychiatry %K COVID-19 %D 2022 %7 14.10.2022 %9 Editorial %J JMIR Ment Health %G English %X COVID-19 has accelerated the use of telehealth and technology in mental health care, creating new avenues to increase both access to and quality of care. As video visits and synchronous telehealth become more routine, the field is now on the verge of embracing asynchronous telehealth, with the potential to radically transform mental health. However, sustaining the use of basic synchronous telehealth, let alone embracing asynchronous telehealth, requires new and immediate effort. Programs to increase digital literacy and competencies among both clinicians and patients are now critical to ensure all parties have the knowledge, confidence, and ability to equitably benefit from emerging innovations. This editorial outlines the immediate potential as well as concrete steps toward realizing the potential of a new, more personalized, scalable mental health system. %M 35358948 %R 10.2196/37939 %U https://mental.jmir.org/2022/10/e37939 %U https://doi.org/10.2196/37939 %U http://www.ncbi.nlm.nih.gov/pubmed/35358948 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e41356 %T Women’s Satisfaction With Telehealth Services During The COVID-19 Pandemic: Cross-sectional Survey Study %A Mittone,Diletta F %A Bailey,Caitlin P %A Eddy,Ebony L %A Napolitano,Melissa A %A Vyas,Amita %+ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, Washington, DC, DC, 20052, United States, 1 202 994 3695, avyas@gwu.edu %K telehealth %K COVID-19 %K maternal-child health %K Perinatal %K pediatrics %K telemedicine %K pregnancy %K women's health %K patient outcome %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Since March 2020, the need to reduce patients’ exposure to COVID-19 has resulted in a large-scale pivot to telehealth service delivery. Although studies report that pregnant women have been generally satisfied with their prenatal telehealth experiences during the pandemic, less is known about telehealth satisfaction among postpartum women. Objective: This study examined telehealth satisfaction among both pregnant and recently pregnant women during the COVID-19 pandemic, to determine whether demographic factors (ie, race, age, marital status, education level, household income, and employment status) are associated with telehealth satisfaction in this population. Methods: A web-based cross-sectional survey designed to capture data on health-related behaviors and health care experiences of pregnant and recently pregnant women in the United States was disseminated in Spring 2022. Eligible participants were at least 18 years old, identified as a woman, and were currently pregnant or had been pregnant in the last 3 years. Results: In the final analytic sample of N=403, the mean telehealth satisfaction score was 3.97 (SD 0.66; score range 1-5). In adjusted linear regression models, being aged 35-44 years (vs 18-24 years), having an annual income of ≥ US $100,000 (vs < US $50,000), and being recently (vs currently) pregnant were associated with greater telehealth satisfaction (P≤.049). Conclusions: Although perinatal women are generally satisfied with telehealth, disparities exist. Specifically, being aged 18-24 years, having an annual income of < US $50,000, and being currently pregnant were associated with lower telehealth satisfaction. It is critical that public health policies or programs consider these factors, especially if the expanded use of telehealth is to persist beyond the pandemic. %M 36125862 %R 10.2196/41356 %U https://pediatrics.jmir.org/2022/4/e41356 %U https://doi.org/10.2196/41356 %U http://www.ncbi.nlm.nih.gov/pubmed/36125862 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e37968 %T A Digital Mental Health Intervention (Inuka) for Common Mental Health Disorders in Zimbabwean Adults in Response to the COVID-19 Pandemic: Feasibility and Acceptability Pilot Study %A Dambi,Jermaine %A Norman,Clara %A Doukani,Asmae %A Potgieter,Stephan %A Turner,Jean %A Musesengwa,Rosemary %A Verhey,Ruth %A Chibanda,Dixon %+ Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Mt Pleasant, Harare, Zimbabwe, 263 773444911, jermainedambi@gmail.com %K acceptability %K COVID-19 %K feasibility %K Friendship Bench %K Inuka %K pilot %K task-shifting %K Zimbabwe %D 2022 %7 7.10.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Common mental health disorders (CMDs) are leading causes of disability globally. The ongoing COVID-19 pandemic has further exacerbated the burden of CMDs. COVID-19 containment measures, including lockdowns, have disrupted access to in-person mental health care. It is therefore imperative to explore the utility of digital mental health interventions to bridge the treatment gap. Mobile health technologies are effective tools for increasing access to treatment at a lower cost. This study explores the utility of Inuka, a chat-based app hinged on the Friendship Bench problem-solving therapy intervention. The Inuka app offers double anonymity, and clients can book or cancel a session at their convenience. Inuka services can be accessed either through a mobile app or the web. Objective: We aimed to explore the feasibility of conducting a future clinical trial. Additionally, we evaluated the feasibility, acceptability, appropriateness, scalability, and preliminary effectiveness of Inuka. Methods: Data were collected using concurrent mixed methods. We used a pragmatic quasiexperimental design to compare the feasibility, acceptability, and preliminary clinical effectiveness of Inuka (experimental group) and WhatsApp chat-based counseling (control). Participants received 6 problem-solving therapy sessions delivered by lay counselors. A reduction in CMDs was the primary clinical outcome. The secondary outcomes were health-related quality of life (HRQoL), disability and functioning, and social support. Quantitative outcomes were analyzed using descriptive and bivariate statistics. Finally, we used administrative data and semistructured interviews to gather data on acceptability and feasibility; this was analyzed using thematic analysis. Results: Altogether, 258 participants were screened over 6 months, with 202 assessed for eligibility, and 176 participants were included in the study (recruitment ratio of 29 participants/month). The participants’ mean age was 24.4 (SD 5.3) years, and most participants were female and had tertiary education. The mean daily smartphone usage was 8 (SD 3.5) hours. Eighty-three users signed up and completed at least one session. The average completion rate was 3 out of 4 sessions. Inuka was deemed feasible and acceptable in the local context, with connectivity challenges, app instability, expensive mobile data, and power outages cited as potential barriers to scale up. Generally, there was a decline in CMDs (F2,73=2.63; P=.08), depression (F2,73=7.67; P<.001), and anxiety (F2,73=2.95; P=.06) and a corresponding increase in HRQoL (F2,73=7.287; P<.001) in both groups. Conclusions: Study outcomes showed that it is feasible to run a future large-scale randomized clinical trial (RCT) and lend support to the feasibility and acceptability of Inuka, including evidence of preliminary effectiveness. The app’s double anonymity and structured support were the most salient features. There is a great need for iterative app updates before scaling up. Finally, a large-scale hybrid RCT with a longer follow-up to evaluate the clinical implementation and cost-effectiveness of the app is needed. %M 35960595 %R 10.2196/37968 %U https://mental.jmir.org/2022/10/e37968 %U https://doi.org/10.2196/37968 %U http://www.ncbi.nlm.nih.gov/pubmed/35960595 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38589 %T The Impacts of Social Media Use and Online Racial Discrimination on Asian American Mental Health: Cross-sectional Survey in the United States During COVID-19 %A Layug,Alyan %A Krishnamurthy,Samiksha %A McKenzie,Rachel %A Feng,Bo %+ Department of Asian American Studies, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States, 1 530 752 1880, alayug@ucdavis.edu %K Asian Americans %K mental health %K COVID-19 pandemic %K racial discrimination %K social media %K anxiety %K depression %K secondary traumatic stress %K negative affect %K racial/ethnic identification %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, increased social media usage has led to worsened mental health outcomes for many people. Moreover, due to the sociopolitical climate during the pandemic, the prevalence of online racial discrimination has contributed to worsening psychological well-being. With increases in anti-Asian hate, Asian and Asian American social media users may experience the negative effects of online racial discrimination in addition to the reduced psychological well-being resulting from exposure to online COVID-19 content. Objective: This study aims to investigate the impact of COVID-19–related social media use and exposure to online racial discrimination during the pandemic on the mental health outcomes (ie, anxiety, depression, and secondary traumatic stress [STS]) of Asian Americans compared with those of non-Asian Americans. In addition, this study explores the mediating role of negative affect and the moderating role of racial/ethnic identification. Methods: An online survey was conducted through Amazon Mechanical Turk and a university-wide research portal from March 3 to March 15, 2021. A total of 1147 participants took the survey. Participants’ social media usage related to COVID-19 and exposure to 2 online forms of racial discrimination (individual and vicarious), mental health outcomes (anxiety, depression, and STS), racial/ethnic identification, negative affect, and demographics were assessed. Results: Our results showed that COVID-19–related social media use, individual discrimination, and vicarious discrimination were predictors of negative mental health outcomes (anxiety, depression, and STS). Asian Americans reported higher vicarious discrimination than Latinx and White Americans, but Asian Americans’ mental health outcomes did not differ substantially from those of the other racial/ethnic groups. Racial/ethnic identification moderated the relationship between both types of discrimination and STS, and negative affect served as a mediator between both types of discrimination and all 3 mental health outcomes. Conclusions: These results suggest that social media exposure continues to have a dire effect on mental health during the COVID-19 pandemic. This study helps to contextualize the rise of anti-Asian American hate and its impact on mental health outcomes in the United States. %M 36121698 %R 10.2196/38589 %U https://formative.jmir.org/2022/9/e38589 %U https://doi.org/10.2196/38589 %U http://www.ncbi.nlm.nih.gov/pubmed/36121698 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 9 %P e34675 %T Psychometric Properties of the COVID-19 Pandemic Fatigue Scale: Cross-sectional Online Survey Study %A Rodriguez-Blazquez,Carmen %A Romay-Barja,Maria %A Falcon,Maria %A Ayala,Alba %A Forjaz,Maria João %+ School of Medicine, University of Murcia, Campus de Espinardo, Murcia, 31000, Spain, 34 868887583, falcon@um.es %K COVID-19 %K pandemic fatigue %K psychometric properties %K Rasch analysis %K validation %K online survey %K pandemic %K fatigue %K mental health %K information seeking %K health information %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Pandemic fatigue is defined as feelings of demotivation to follow preventive measures against COVID-19, together with decreased trust in government and frequency of information-seeking behaviors. Objective: This study aims to analyze the psychometric properties of the COVID-19–specific pandemic fatigue scale according to classical test theory (CTT) and Rasch model approaches in the general Spanish population. Methods: This was a cross-sectional study in a representative sample of 1018 adults who completed an online survey in November 2020 in the framework of the COVID-19 Snapshot Monitoring (COSMO)-Spain project. The assessments included the 6-item COVID-19 Pandemic Fatigue Scale (CPFS) and other COVID-19–related variables: COVID-19 infection, adherence to preventive behaviors, information-seeking behavior, self-efficacy, worry, and cognitive and affective risk perception. Data quality, acceptability, reliability, and validity were analyzed according to CTT, and the fit to the Rasch model, unidimensionality, appropriateness of the response scale, item local independency, reliability (person-separation index [PSI]), and item-person distribution were also calculated. Results: The mean CPFS score was 17.06 (SD 5.04, range 6-30), with higher scores for women, younger participants, participants who never seek information on COVID-19, those who think they would contract a mild disease in case of infection, those with higher level of worry about coronavirus/COVID-19, and those who felt depressed or felt the coronavirus/COVID-19 is spreading slowly (all P<.01). The Cronbach alpha for the CPFS was 0.74. In the confirmatory factor analysis, one factor was identified (root mean square error of approximation [RMSEA]=.02; comparative fit index [CFI]=.99; χ25=8.06, P=.15). The CPFS showed good fit to the Rasch model (χ 224=42.025, P=.01, PSI=.642), unidimensionality (binomial 95% CI –.005 to .045), and item local independency. Conclusions: Our results suggest that the CPFS has moderate reliability and internal consistency and it is composed of a single dimension. It is a useful tool to ascertain the level of pandemic fatigue in the general population, which may help to guide the communication and information strategies to face the COVID-19 pandemic. %M 35785547 %R 10.2196/34675 %U https://publichealth.jmir.org/2022/9/e34675 %U https://doi.org/10.2196/34675 %U http://www.ncbi.nlm.nih.gov/pubmed/35785547 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e39885 %T An e–Mental Health Resource for COVID-19–Associated Stress Reduction: Mixed Methods Study of Reach, Usability, and User Perceptions %A Minian,Nadia %A Gayapersad,Allison %A Saiva,Anika %A Dragonetti,Rosa %A Kidd,Sean A %A Strudwick,Gillian %A Selby,Peter %+ Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6H 1H4, Canada, 1 416 535 8501, peter_selby@camh.net %K COVID-19 %K website %K stress %K mental health %K eHealth %K internet-based intervention %K mixed methods evaluation %K usability %K digital health %K health informatics %D 2022 %7 26.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: COVID-19 and its public health response are having a profound effect on people’s mental health. To provide support during these times, Canada’s largest mental health and addiction teaching hospital (Centre for Addiction and Mental Health [CAMH]) launched the Mental Health and COVID-19 Pandemic website on March 18, 2020. This website was designed to be a nonstigmatizing psychoeducational resource for people experiencing mild to moderate distress due to COVID-19 and the public health response to the pandemic. Objective: The aim of this study was to examine the reach, usability, and user perceptions of the CAMH Mental Health and COVID-19 Pandemic website. Methods: This study used a mixed methods sequential explanatory design approach, which consisted of the following 2 distinct phases: (1) quantitative data collection and analysis and (2) qualitative semistructured interviews. In phase 1, we analyzed Google Analytics data to understand how many people visited the website and which were the most visited pages. We conducted a survey to identify users’ sociodemographic backgrounds, and assess the usability of the website using the System Usability Scale and users’ subjective stress levels using the Perceived Stress Scale (PSS-10). For phase 2, we conducted semistructured interviews to explore user experiences; user motivation, engagement, satisfaction, and perception of the stress reduction strategies; reflections of the website’s functionality, ease of use, navigation, and design; and recommendations for improvement. Results: Google Analytics results showed 146,978 unique users from June 2020 to March 2021. Most users were from Canada (130,066, 88.5%). Between February 20, 2021, and June 4, 2021, 152 users completed the survey. Most users identified as white, female, and having at least a college degree. Based on the PSS-10 scores, most participants were experiencing moderate to high stress when they visited the website. Users rated the usability of the website as acceptable. Ten users completed in-depth interviews between May 2021 and June 2021. Positive feedback related to the content was that the website was a trustworthy source of mental health information with helpful evidence-based stress reduction strategies. Areas for improvement included the text heavy design of the website, wider dissemination/marketing, and greater accessibility of the website to meet the needs of diverse populations. Conclusions: Adding stress reduction resources to a website from a well-respected institution may be a practical method to increase awareness and access to evidence-based stress reduction resources during times of crisis, where there is severe disruption to usual health care contacts. Efforts to ensure that these resources are more widely accessed, especially by diverse populations, are needed. %M 35960596 %R 10.2196/39885 %U https://mental.jmir.org/2022/8/e39885 %U https://doi.org/10.2196/39885 %U http://www.ncbi.nlm.nih.gov/pubmed/35960596 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e38495 %T Predicting Multiple Sclerosis Outcomes During the COVID-19 Stay-at-home Period: Observational Study Using Passively Sensed Behaviors and Digital Phenotyping %A Chikersal,Prerna %A Venkatesh,Shruthi %A Masown,Karman %A Walker,Elizabeth %A Quraishi,Danyal %A Dey,Anind %A Goel,Mayank %A Xia,Zongqi %+ Department of Neurology, University of Pittsburgh, 3501 Fifth Avenue,, BST3, Suite 7014, Pittsburgh, PA, 15260, United States, 1 412 383 5377, zxia1@pitt.edu %K mobile sensing %K sensor %K sensing %K mobile health %K mHealth %K algorithm %K multiple sclerosis %K disability %K mental health %K depression %K sleep %K fatigue %K tiredness %K predict %K machine learning %K feature selection %K neurological disorder %K COVID-19 %K isolation %K behavior change %K health outcome %K fitness %K movement %K physical activity %K exercise %K tracker %K digital phenotyping %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has broad negative impact on the physical and mental health of people with chronic neurological disorders such as multiple sclerosis (MS). Objective: We presented a machine learning approach leveraging passive sensor data from smartphones and fitness trackers of people with MS to predict their health outcomes in a natural experiment during a state-mandated stay-at-home period due to a global pandemic. Methods: First, we extracted features that capture behavior changes due to the stay-at-home order. Then, we adapted and applied an existing algorithm to these behavior-change features to predict the presence of depression, high global MS symptom burden, severe fatigue, and poor sleep quality during the stay-at-home period. Results: Using data collected between November 2019 and May 2020, the algorithm detected depression with an accuracy of 82.5% (65% improvement over baseline; F1-score: 0.84), high global MS symptom burden with an accuracy of 90% (39% improvement over baseline; F1-score: 0.93), severe fatigue with an accuracy of 75.5% (22% improvement over baseline; F1-score: 0.80), and poor sleep quality with an accuracy of 84% (28% improvement over baseline; F1-score: 0.84). Conclusions: Our approach could help clinicians better triage patients with MS and potentially other chronic neurological disorders for interventions and aid patient self-monitoring in their own environment, particularly during extraordinarily stressful circumstances such as pandemics, which would cause drastic behavior changes. %M 35849686 %R 10.2196/38495 %U https://mental.jmir.org/2022/8/e38495 %U https://doi.org/10.2196/38495 %U http://www.ncbi.nlm.nih.gov/pubmed/35849686 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38370 %T An Observational Report of Screen Time Use Among Young Adults (Ages 18-28 Years) During the COVID-19 Pandemic and Correlations With Mental Health and Wellness: International, Online, Cross-sectional Study %A Wiciak,Michelle Teresa %A Shazley,Omar %A Santhosh,Daphne %+ Department of Microbiology, Saint James School of Medicine, Saint Vincent and the Grenadines Campus, Cane Hall Road, Arnos Vale, VC0280, Saint Vincent and the Grenadines, 1 784 456 7576, mwiciak@mail.sjsm.org %K coronavirus %K COVID-19 %K pandemic %K mental health %K depression %K anxiety %K screen-time usage %K young adults %K students %K international study %K observational study %K cross-sectional study %K smoking %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Screen time (ST) drastically increased during the COVID-19 pandemic, but there is little research on the specific type of ST use, degree of change from before COVID-19, and possible associations with other factors. Young adults are a particular interest since previous studies have shown the detriment ST has on a young person’s health. With the combination of a life-changing pandemic, there are unreached depths regarding ST and young adults. This study aims to provide insight into these unknowns. Objective: This study aims to assess ST in 3 domains (entertainment, social media [SM], and educational/professional) in young adults early in the COVID-19 pandemic; identify trends; and identify any correlations with demographics, mental health, substance abuse, and overall wellness. Methods: An online, cross-sectional observational study was performed from September 2020 to January 2021 with 183 eligible respondents. Data were collected on ST, trauma from COVID-19, anxiety, depression, substance use, BMI, and sleep. Results: The average total ST during COVID-19 was 23.26 hours/week, entertainment ST was 7.98 hours/week, SM ST was 6.79 hours/week, and ST for educational or professional purposes was 8.49 hours/week. For all categories, the average ST during COVID-19 was higher than before COVID-19 (P<.001). We found ST differences between genders, student status, and continent of location. Increased well-being scores during COVID-19 were correlated with greater change in total ST (P=.01). Poorer sleep quality (P=.01) and longer sleep duration (P=.03) were associated with a greater change in entertainment ST (P=.01). More severe depression and more severe anxiety was associated with the amount of entertainment ST (P=.047, P=.03, respectively) and greater percent change in SM (P=.007, P=.002, respectively). Greater stress from COVID-19 was associated with the amount of ST for educational/professional purposes (P=.05), change in total ST (P=.006), change in entertainment ST (P=.01), and change in ST for educational/professional purposes (P=.02). Higher Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) tobacco scores were associated with greater change in total ST (P=.004), and higher pack-years were associated with greater change in SM ST (P=.003). Higher alcohol scores (P=.004) and servings of alcohol per week (P=.003) were associated with greater change in entertainment ST. Quarantining did not negatively impact these variables. Conclusions: There is no doubt ST and worsening mental health increased during COVID-19 in young adults. However, these findings indicate there are many significant associations between ST use and mental health. These associations are more complex than originally thought, especially since we found quarantining is not associated with mental health. Although other factors need to be further investigated, this study emphasizes different types of ST and degree of change in ST affect various groups of people in discrete ways. Acknowledging these findings can help young adults optimize their mental health during pandemics. %M 35878157 %R 10.2196/38370 %U https://formative.jmir.org/2022/8/e38370 %U https://doi.org/10.2196/38370 %U http://www.ncbi.nlm.nih.gov/pubmed/35878157 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e38600 %T Impact of the COVID-19 Pandemic on the Global Delivery of Mental Health Services and Telemental Health: Systematic Review %A Zangani,Caroline %A Ostinelli,Edoardo G %A Smith,Katharine A %A Hong,James S W %A Macdonald,Orla %A Reen,Gurpreet %A Reid,Katherine %A Vincent,Charles %A Syed Sheriff,Rebecca %A Harrison,Paul J %A Hawton,Keith %A Pitman,Alexandra %A Bale,Rob %A Fazel,Seena %A Geddes,John R %A Cipriani,Andrea %+ Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom, 44 1865 618228, andrea.cipriani@psych.ox.ac.uk %K COVID-19 %K coronavirus %K mental health services %K telemental health %K telepsychiatry %K face-to-face %D 2022 %7 22.8.2022 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic required mental health services around the world to adapt quickly to the new restrictions and regulations put in place to reduce the risk of transmission. As face-to-face contact became difficult, virtual methods were implemented to continue to safely provide mental health care. However, it is unclear to what extent service provision transitioned to telemental health worldwide. Objective: We aimed to systematically review the global research literature on how mental health service provision adapted during the first year of the pandemic. Methods: We searched systematically for quantitative papers focusing on the impact of the COVID-19 pandemic on mental health services published until April 13, 2021, in the PubMed, Embase, medRxiv, and bioXriv electronic bibliographic databases, using the COVID-19 Open Access Project online platform. The screening process and data extraction were independently completed by at least two authors, and any disagreement was resolved by discussion with a senior member of the team. The findings were summarized narratively in the context of each country’s COVID-19 Stringency Index, which reflects the stringency of a government’s response to COVID-19 restrictions at a specific time. Results: Of the identified 24,339 records, 101 papers were included after the screening process. Reports on general services (n=72) showed that several countries’ face-to-face services reduced their activities at the start of the pandemic, with reductions in the total number of delivered visits and with some services forced to close. In contrast, telemental health use rapidly increased in many countries across the world at the beginning of the pandemic (n=55), with almost complete virtualization of general and specialistic care services by the end of the first year. Considering the reported COVID-19 Stringency Index values, the increased use of virtual means seems to correspond to periods when the Stringency Index values were at their highest in several countries. However, due to specific care requirements, telemental health could not be used in certain subgroups of patients, such as those on clozapine or depot treatments and those who continued to need face-to-face visits. Conclusions: During the pandemic, mental health services had to adapt quickly in the short term, implementing or increasing the use of telemental health services across the globe. Limited access to digital means, poor digital skills, and patients’ preferences and individual needs may have contributed to differences in implementing and accessing telemental health services during the pandemic. In the long term, a blended approach, combining in-person and virtual modalities, that takes into consideration the needs, preferences, and digital skills of patients may better support the future development of mental health services. It will be required to improve confidence with digital device use, training, and experience in all modalities for both clinicians and service users. %M 35994310 %R 10.2196/38600 %U https://mental.jmir.org/2022/8/e38600 %U https://doi.org/10.2196/38600 %U http://www.ncbi.nlm.nih.gov/pubmed/35994310 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e38172 %T Objectively Measured Physical Activity Levels and Associated Factors in Older US Women During the COVID-19 Pandemic: Cross-sectional Study %A Choudhury,Renoa %A Park,Joon-Hyuk %A Thiamwong,Ladda %A Xie,Rui %A Stout,Jeffrey R %+ Department of Mechanical and Aerospace Engineering, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL, 32816, United States, 1 407 823 1227, Joonpark@ucf.edu %K physical activity %K older women %K COVID-19 %K sedentary behavior %K wrist-worn accelerometers %K ActiGraph %K aging %K elderly population %K women's health %K digital health %K frail %K healthy lifestyle %D 2022 %7 22.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity (PA) is vital for attenuating the aging-related physiological and functional declines in women aged 60 years or above. However, little is known about the objectively assessed PA behavior in older women during the COVID-19 pandemic and its association with sociodemographics, health and physical function, and COVID-19 related factors. Objective: This study aims to examine the objectively measured PA levels and associated factors among older US women who were living under the physical distancing guidelines during the second year of the pandemic. Methods: In this cross-sectional study, we collected free-living PA data from 94 community-dwelling older women aged between 60 and 96 years (mean age 75.1 years, SD 7.3) using wrist-worn ActiGraph GT9X accelerometers between February and August 2021. We examined whether their daily duration spent in sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) varied by sociodemographic characteristics, health and physical function, and COVID-19 related factors. Results: On average, participants accumulated 12.4 (SD 1.9) hours/day in SB, 218.6 (SD 64.3) minutes/day in LPA, and 42.4 (SD 31.0) minutes/day in MVPA, exhibiting overall reduced PA levels than previously published pre–COVID-19 norms of older US women. Among participants aged ≥80 years, sedentary time was 7.5% (P=.003) higher and the time spent in LPA and MVPA was, respectively, 13.3% (P=.03) and 44.9% (P<.001) lower than those aged 60-79 years. More MVPA participation and a less sedentary lifestyle were observed in those who had a higher self-rated health score (MVPA: P=.001, SB: P=.04) and lower fear of falling (FOF; MVPA: P=.003, SB: P=.04). Poorer performance in the 30-second sit-to-stand (STS) test was independently associated with more SB (P=.01) and less LPA (P=.04) and MVPA (P=.001) time among participants. In addition, sedentary time was 5.0% higher (P=.03) in frail and prefrail participants than their healthy counterparts. Conclusions: During the pandemic, older women spent the majority of their waking time being sedentary, while LPA accounted for a larger portion of their daily PA. Therefore, replacing SB with LPA (rather than MVPA) might provide a more feasible PA target for older women, particularly those aged ≥80 years or who have reduced physical function. In addition, targeted interventions might be beneficial in promoting an active lifestyle for those who live alone, are prefrail or frail, and have a high FOF in older age. International Registered Report Identifier (IRRID): RR2-10.2196/27381 %M 35994346 %R 10.2196/38172 %U https://aging.jmir.org/2022/3/e38172 %U https://doi.org/10.2196/38172 %U http://www.ncbi.nlm.nih.gov/pubmed/35994346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36444 %T The Prevalence of Psychotic Symptoms, Violent Ideation, and Disruptive Behavior in a Population With SARS-CoV-2 Infection: Preliminary Study %A Bari,Sumra %A Vike,Nicole L %A Stetsiv,Khrystyna %A Woodward,Sean %A Lalvani,Shamal %A Stefanopoulos,Leandros %A Kim,Byoung Woo %A Maglaveras,Nicos %A Breiter,Hans C %A Katsaggelos,Aggelos K %+ Laboratory of Neuroimaging and Genetics, Division of Psychiatric Neuroscience, Massachusetts General Hospital, 120 2nd Avenue, Charlestown, MA, 02129-2060, United States, 1 312 503 0527, hbreiter@mgh.harvard.edu %K COVID-19 %K paranoia %K delusions %K disruptive behavior %K violent ideation %K psychotic symptoms %K pandemic %K mental health %K distress %K stress %K psychological health %K psychosis %K risk %K machine learning %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 disease results from infection by the SARS-CoV-2 virus to produce a range of mild to severe physical, neurological, and mental health symptoms. The COVID-19 pandemic has indirectly caused significant emotional distress, triggering the emergence of mental health symptoms in individuals who were not previously affected or exacerbating symptoms in those with existing mental health conditions. Emotional distress and certain mental health conditions can lead to violent ideation and disruptive behavior, including aggression, threatening acts, deliberate harm toward other people or animals, and inattention to or noncompliance with education or workplace rules. Of the many mental health conditions that can be associated with violent ideation and disruptive behavior, psychosis can evidence greater vulnerability to unpredictable changes and being at a greater risk for them. Individuals with psychosis can also be more susceptible to contracting COVID-19 disease. Objective: This study aimed to investigate whether violent ideation, disruptive behavior, or psychotic symptoms were more prevalent in a population with COVID-19 and did not precede the pandemic. Methods: In this preliminary study, we analyzed questionnaire responses from a population sample (N=366), received between the end of February 2021 and the start of March 2021 (1 year into the COVID-19 pandemic), regarding COVID-19 illness, violent ideation, disruptive behavior, and psychotic symptoms. Using the Wilcoxon rank sum test followed by multiple comparisons correction, we compared the self-reported frequency of these variables for 3 time windows related to the past 1 month, past 1 month to 1 year, and >1 year ago among the distributions of people who answered whether they tested positive or were diagnosed with COVID-19 by a clinician. We also used multivariable logistic regression with iterative resampling to investigate the relationship between these variables occurring >1 year ago (ie, before the pandemic) and the likelihood of contracting COVID-19. Results: We observed a significantly higher frequency of self-reported violent ideation, disruptive behavior, and psychotic symptoms, for all 3 time windows of people who tested positive or were diagnosed with COVID-19 by a clinician. Using multivariable logistic regression, we observed 72% to 94% model accuracy for an increased incidence of COVID-19 in participants who reported violent ideation, disruptive behavior, or psychotic symptoms >1 year ago. Conclusions: This preliminary study found that people who reported a test or clinician diagnosis of COVID-19 also reported higher frequencies of violent ideation, disruptive behavior, or psychotic symptoms across multiple time windows, indicating that they were not likely to be the result of COVID-19. In parallel, participants who reported these behaviors >1 year ago (ie, before the pandemic) were more likely to be diagnosed with COVID-19, suggesting that violent ideation, disruptive behavior, in addition to psychotic symptoms, were associated with COVID-19 with an approximately 70% to 90% likelihood. %M 35763758 %R 10.2196/36444 %U https://formative.jmir.org/2022/8/e36444 %U https://doi.org/10.2196/36444 %U http://www.ncbi.nlm.nih.gov/pubmed/35763758 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e36989 %T Developing a Long COVID Phenotype for Postacute COVID-19 in a National Primary Care Sentinel Cohort: Observational Retrospective Database Analysis %A Mayor,Nikhil %A Meza-Torres,Bernardo %A Okusi,Cecilia %A Delanerolle,Gayathri %A Chapman,Martin %A Wang,Wenjuan %A Anand,Sneha %A Feher,Michael %A Macartney,Jack %A Byford,Rachel %A Joy,Mark %A Gatenby,Piers %A Curcin,Vasa %A Greenhalgh,Trisha %A Delaney,Brendan %A de Lusignan,Simon %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, 7 Walton Well Road, Oxford, OX2 6ED, United Kingdom, 44 01865 616600, simon.delusignan@phc.ox.ac.uk %K medical record systems %K computerized %K Systematized Nomenclature of Medicine %K postacute COVID-19 syndrome %K phenotype %K COVID-19 %K long COVID %K ethnicity %K social class %K general practitioners %K data accuracy %K data extracts %K biomedical ontologies %K SARS-CoV-2 %K hospitalization %K epidemiology %K surveillance %K public health %K BioPortal %K electronic health record %K disease management %K digital tool %D 2022 %7 11.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Following COVID-19, up to 40% of people have ongoing health problems, referred to as postacute COVID-19 or long COVID (LC). LC varies from a single persisting symptom to a complex multisystem disease. Research has flagged that this condition is underrecorded in primary care records, and seeks to better define its clinical characteristics and management. Phenotypes provide a standard method for case definition and identification from routine data and are usually machine-processable. An LC phenotype can underpin research into this condition. Objective: This study aims to develop a phenotype for LC to inform the epidemiology and future research into this condition. We compared clinical symptoms in people with LC before and after their index infection, recorded from March 1, 2020, to April 1, 2021. We also compared people recorded as having acute infection with those with LC who were hospitalized and those who were not. Methods: We used data from the Primary Care Sentinel Cohort (PCSC) of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database. This network was recruited to be nationally representative of the English population. We developed an LC phenotype using our established 3-step ontological method: (1) ontological step (defining the reasoning process underpinning the phenotype, (2) coding step (exploring what clinical terms are available, and (3) logical extract model (testing performance). We created a version of this phenotype using Protégé in the ontology web language for BioPortal and using PhenoFlow. Next, we used the phenotype to compare people with LC (1) with regard to their symptoms in the year prior to acquiring COVID-19 and (2) with people with acute COVID-19. We also compared hospitalized people with LC with those not hospitalized. We compared sociodemographic details, comorbidities, and Office of National Statistics–defined LC symptoms between groups. We used descriptive statistics and logistic regression. Results: The long-COVID phenotype differentiated people hospitalized with LC from people who were not and where no index infection was identified. The PCSC (N=7.4 million) includes 428,479 patients with acute COVID-19 diagnosis confirmed by a laboratory test and 10,772 patients with clinically diagnosed COVID-19. A total of 7471 (1.74%, 95% CI 1.70-1.78) people were coded as having LC, 1009 (13.5%, 95% CI 12.7-14.3) had a hospital admission related to acute COVID-19, and 6462 (86.5%, 95% CI 85.7-87.3) were not hospitalized, of whom 2728 (42.2%) had no COVID-19 index date recorded. In addition, 1009 (13.5%, 95% CI 12.73-14.28) people with LC were hospitalized compared to 17,993 (4.5%, 95% CI 4.48-4.61; P<.001) with uncomplicated COVID-19. Conclusions: Our LC phenotype enables the identification of individuals with the condition in routine data sets, facilitating their comparison with unaffected people through retrospective research. This phenotype and study protocol to explore its face validity contributes to a better understanding of LC. %M 35861678 %R 10.2196/36989 %U https://publichealth.jmir.org/2022/8/e36989 %U https://doi.org/10.2196/36989 %U http://www.ncbi.nlm.nih.gov/pubmed/35861678 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e32347 %T Mental Health Presentations Across Health Care Settings During the First 9 Months of the COVID-19 Pandemic in England: Retrospective Observational Study %A Smith,Gillian E %A Harcourt,Sally E %A Hoang,Uy %A Lemanska,Agnieszka %A Elliot,Alex J %A Morbey,Roger A %A Hughes,Helen E %A Lake,Iain %A Edeghere,Obaghe %A Oliver,Isabel %A Sherlock,Julian %A Amlôt,Richard %A de Lusignan,Simon %+ Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, 2nd Floor 23 Stephenson Street, Birmingham, B2 4BH, United Kingdom, 44 77407 40944, alex.elliot@ukhsa.gov.uk %K pandemic %K public health %K syndromic surveillance %K mental health %K anxiety %K sleep problems %K COVID-19 %K health care %K health surveillance %K health care service %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has resulted in an unprecedented impact on the day-to-day lives of people, with several features potentially adversely affecting mental health. There is growing evidence of the size of the impact of COVID-19 on mental health, but much of this is from ongoing population surveys using validated mental health scores. Objective: This study investigated the impact of the pandemic and control measures on mental health conditions presenting to a spectrum of national health care services monitored using real-time syndromic surveillance in England. Methods: We conducted a retrospective observational descriptive study of mental health presentations (those calling the national medical helpline, National Health Service [NHS] 111; consulting general practitioners [GPs] in and out-of-hours; calling ambulance services; and attending emergency departments) from January 1, 2019, to September 30, 2020. Estimates for the impact of lockdown measures were provided using an interrupted time series analysis. Results: Mental health presentations showed a marked decrease during the early stages of the pandemic. Postlockdown, attendances for mental health conditions reached higher than prepandemic levels across most systems—a rise of 10% compared to that expected for NHS 111 and 21% for GP out-of-hours service—while the number of consultations to GP in-hours service was 13% lower compared to the same time previous year. Increases were observed in calls to NHS 111 for sleep problems. Conclusions: These analyses showed marked changes in the health care attendances and prescribing for common mental health conditions across a spectrum of health care provision, with some of these changes persisting. The reasons for such changes are likely to be complex and multifactorial. The impact of the pandemic on mental health may not be fully understood for some time, and therefore, these syndromic indicators should continue to be monitored. %M 35486809 %R 10.2196/32347 %U https://publichealth.jmir.org/2022/8/e32347 %U https://doi.org/10.2196/32347 %U http://www.ncbi.nlm.nih.gov/pubmed/35486809 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 7 %P e34168 %T Peer-Presented Versus Mental Health Service Provider–Presented Mental Health Outreach Programs for University Students: Randomized Controlled Trial %A Bastien,Laurianne %A Boke,Bilun Naz %A Mettler,Jessica %A Zito,Stephanie %A Di Genova,Lina %A Romano,Vera %A Lewis,Stephen P %A Whitley,Rob %A Iyer,Srividya N %A Heath,Nancy L %+ Department of Educational and Counselling Psychology, McGill University, 3700 McTavish, Montreal, QC, H3A 1Y9, Canada, 1 5143981232, laurianne.bastien@mail.mcgill.ca %K web-based mental health outreach %K resilience building %K university student %K peer-presented %K mental health service provider–presented %K mental health %K outreach %K resilience %K student %K service provider %K randomized controlled trial %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: University students are reporting concerning levels of mental health distress and challenges. University mental health service provider initiatives have been shown to be effective in supporting students’ mental health, but these services are often resource-intensive. Consequently, new approaches to service delivery, such as web-based and peer support initiatives, have emerged as cost-effective and efficient approaches to support university students. However, these approaches have not been sufficiently evaluated for effectiveness or acceptability in university student populations. Objective: Thus, the overarching goal of this study was to evaluate a mental health service provider–presented versus peer-presented web-based mental health resilience–building video outreach program against a wait-list comparison group. Methods: Participants were 217 undergraduate students (mean age 20.44, SD 1.98 years; 171/217, 78.8% women) who were randomly assigned to one of the intervention groups (mental health service provider–presented: 69/217, 31.8%; peer-presented: 73/217, 33.6%) or the wait-list comparison group (75/217, 34.6%). Participants in the intervention groups were asked to watch 3 brief skill-building videos addressing strategies for building mental health resilience, whereas the comparison group was wait-listed. The mental health service provider–presented and peer-presented video series were identical in content, with presenters using a script to ensure consistency across delivery methods, but the videos differed in that they were either presented by mental health service providers or university students (peers). All participants were asked to complete web-based self-report measures of stress, coping self-efficacy, social support, social connectedness, mindfulness, and quality of life at baseline (time 1), 6 weeks later (time 2, after the intervention), and 1-month follow-up (time 3). Results: Results from a series of 2-way ANOVAs found no significant differences in outcomes among any of the 3 groups. Surprisingly, a main effect of time revealed that all students improved on several well-being outcomes. In addition, results for program satisfaction revealed that both the mental health service provider–presented and peer-presented programs were rated very highly and at comparable levels. Conclusions: Thus, findings suggest that a web-based mental health resilience–building video outreach program may be acceptable for university students regardless of it being mental health service provider–presented or peer-presented. Furthermore, the overall increases in well-being across groups, which coincided with the onset and early weeks of the COVID-19 pandemic, suggest an unexpected pattern of response among university students to the early period of the pandemic. Limitations and barriers as well as research implications are discussed. Trial Registration: ClinicalTrials.gov NCT05454592; https://clinicaltrials.gov/ct2/show/NCT05454592 %M 35762935 %R 10.2196/34168 %U https://mental.jmir.org/2022/7/e34168 %U https://doi.org/10.2196/34168 %U http://www.ncbi.nlm.nih.gov/pubmed/35762935 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 7 %P e37901 %T Telehealth Autism Diagnostic Assessments With Children, Young People, and Adults: Qualitative Interview Study With England-Wide Multidisciplinary Health Professionals %A Spain,Debbie %A Stewart,Gavin R %A Mason,David %A Milner,Victoria %A Fairhurst,Bryony %A Robinson,Janine %A Gillan,Nicola %A Ensum,Ian %A Stark,Eloise %A Happe,Francesca %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom, 44 207 848 5388, debbie.spain@kcl.ac.uk %K autism %K COVID-19 pandemic %K autism diagnostic assessment %K telehealth %K health professionals %K clinical supervision %K training %K COVID-19 %D 2022 %7 20.7.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe and fluctuate depending on context. Individuals can present for diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person to doing these fully via telehealth (defined as the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. Objective: This study explored health professionals’ experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. Methods: A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. Results: Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and health professionals’ experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible, and efficient for some patients, families, and health professionals. However, not all patients could be assessed in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. Conclusions: A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility, and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods. %M 35857358 %R 10.2196/37901 %U https://mental.jmir.org/2022/7/e37901 %U https://doi.org/10.2196/37901 %U http://www.ncbi.nlm.nih.gov/pubmed/35857358 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e37454 %T Role of Trusted Sources and Behavioral Beliefs in Promoting Mitigation Behaviors During the COVID-19 Pandemic: Survey Study %A Hanson,Bridget L %A Finley,Kari %A Otto,Jay %A Ward,Nicholas J %+ Center for Health and Safety Culture, Montana State University, PO Box 170548, Bozeman, MT, 59717, United States, 1 406 994 7873, bridget.hanson@montana.edu %K behavioral beliefs %K health literacy %K vaccination %K trusted sources %K social media %K vaccine hesitancy %K health information %K masking %K healthcare %K public health %K health beliefs %D 2022 %7 13.7.2022 %9 Short Paper %J JMIR Hum Factors %G English %X Background: During the ongoing COVID-19 pandemic and in preparation for future public health crises, it is important to understand the relationship between individuals’ health beliefs, including their trust in various sources of health information, and their engagement in mitigation behaviors. Objective: We sought to identify relationships between trust in various sources of health information and the behavioral beliefs related to vaccination and mask wearing as well as to understand how behavioral beliefs related to vaccination differ by willingness to be vaccinated. Methods: We conducted an online survey of 1034 adults in the United States and assessed their trust in federal, local, and media sources of health information; their beliefs about vaccination; and their masking intention and vaccination willingness. Results: Using regression, masking intention was predicted by trust in the World Health Organization (P<.05) and participants’ state public health offices (P<.05), while vaccine willingness was predicted by trust in participants’ own health care providers (P<.05) and pharmaceutical companies (P<.001). Compared to individuals with low willingness to be vaccinated, individuals with high willingness indicated greater endorsement of beliefs that vaccines would support a return to normalcy, are safe, and are a social responsibility (P<.001 for all). Conclusions: Results can be used to inform ongoing public health messaging campaigns to manage the COVID-19 pandemic and increase readiness for the next pandemic. Additionally, results support the need to bolster the public’s trust in health care agencies as well as to enhance trust and respect in health care providers to increase people’s adoption of mitigation behaviors. %M 35830238 %R 10.2196/37454 %U https://humanfactors.jmir.org/2022/3/e37454 %U https://doi.org/10.2196/37454 %U http://www.ncbi.nlm.nih.gov/pubmed/35830238 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e37026 %T Effect of the “Art Coloring” Online Coloring Game on Subjective Well-Being Increase and Anxiety Reduction During the COVID-19 Pandemic: Development and Evaluation %A Xi,JuZhe %A Gao,YuHan %A Lyu,Na %A She,Zhuang %A Wang,XinYue %A Zhang,Xin-An %A Yu,XiaoYu %A Ji,WeiDong %A Wei,MengSheng %A Dai,WeiHui %A Qian,Xuesheng %+ School of Management, Fudan University, Room 722, Siyuan Building, 670 Guoshun Road, Shanghai, 200433, China, 86 13916208229, qianxuesheng@fudan.edu.cn %K coloring game %K online intervention %K mental health %K COVID-19 pandemic %K gamification %K game-based intervention %K commercially released game %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: COVID-19 has spread worldwide and generated tremendous stress on human beings. Unfortunately, it is often hard for distressed individuals to access mental health services under conditions of restricted movement or even lockdown. Objective: The study first aims to develop an online digital intervention package based on a commercially released coloring game. The second aim is to test the effectiveness of difference intervention packages for players to increase subjective well-being (SWB) and reduce anxiety during the pandemic. Methods: An evidence-based coloring intervention package was developed and uploaded to an online coloring game covering almost 1.5 million players worldwide in January 2021. Players worldwide participated to color either 4 rounds of images characterized by awe, pink, nature, and blue or 4 rounds of irrelevant images. Participants' SWB and anxiety and the perceived effectiveness of the game in reducing anxiety (subjective effectiveness [SE]) were assessed 1 week before the intervention (T1), after the participants completed pictures in each round (T2-T5), and after the intervention (T6). Independent 2-tailed t tests were conducted to examine the general intervention (GI) effect and the intervention effect of each round. Univariate analysis was used to examine whether these outcome variables were influenced by the number of rounds completed. Results: In total, 1390 players worldwide responded and completed at least 1 assessment. Overall, the GI group showed a statistical significantly greater increase in SWB than the general control (GC) group (N=164, t162=3.59, Cohen d=0.59, 95% CI 0.36-1.24, P<.001). Compared to the control group, the best effectiveness of the intervention group was seen in the awe round, in which the increase in SWB was significant (N=171, t169=2.51, Cohen d=0.39, 95% CI 0.10-0.82, P=.01), and players who colored all 4 pictures had nearly significant improvements in SWB (N=171, F4,170=2.34, partial ŋ2=0.053, P=.06) and a significant decrease in anxiety (N=171, F4,170=3.39, partial ŋ2=0.075, P=.01). Conclusions: These data indicate the effectiveness of online psychological interventions, such as coloring games, for mental health in the specific period. They also show the feasibility of applying existing commercial games embedded with scientific psychological interventions that can fill the gap in mental crises and services for a wider group of people during the pandemic. The results would inspire innovations to prevent the psychological problems caused by public emergencies and encourage more games, especially the most popular ones, to take more positive action for the common crises of humankind. %M 35575761 %R 10.2196/37026 %U https://games.jmir.org/2022/3/e37026 %U https://doi.org/10.2196/37026 %U http://www.ncbi.nlm.nih.gov/pubmed/35575761 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e30976 %T The Efficacy of “Foundations,” a Digital Mental Health App to Improve Mental Well-being During COVID-19: Proof-of-Principle Randomized Controlled Trial %A Catuara-Solarz,Silvina %A Skorulski,Bartlomiej %A Estella-Aguerri,Iñaki %A Avella-Garcia,Claudia Bibiana %A Shepherd,Sarah %A Stott,Emily %A Hemmings,Nicola R %A Ruiz de Villa,Aleix %A Schulze,Laura %A Dix,Sophie %+ Koa Health, Carrer de la Ciutat de Granada 121, Barcelona, 08018, Spain, 44 7702 500882, sophie.dix@koahealth.com %K mental well-being %K digital health %K cognitive behavioral therapy %K positive psychology %K insomnia %K COVID-19 %K mental health %K mobile app %K anxiety %K health app %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Against a long-term trend of increasing demand, the COVID-19 pandemic has led to a global rise in common mental disorders. Now more than ever, there is an urgent need for scalable, evidence-based interventions to support mental well-being. Objective: The aim of this proof-of-principle study was to evaluate the efficacy of a mobile-based app in adults with self-reported symptoms of anxiety and stress in a randomized control trial that took place during the first wave of the COVID-19 pandemic in the United Kingdom. Methods: Adults with mild to severe anxiety and moderate to high levels of perceived stress were randomized to either the intervention or control arm. Participants in the intervention arm were given access to the Foundations app for the duration of the 4-week study. All participants were required to self-report a range of validated measures of mental well-being (10-item Connor-Davidson Resilience scale [CD-RISC-10], 7-item Generalized Anxiety Disorder scale [GAD-7], Office of National Statistics Four Subjective Well-being Questions [ONS-4], World Health Organization-5 Well-Being Index [WHO-5]) and sleep (Minimal Insomnia Scale [MISS]) at baseline and at weeks 2 and 4. The self-reported measures of perceived stress (10-item Perceived Stress Score [PSS-10]) were obtained weekly. Results: A total of 136 participants completed the study and were included in the final analysis. The intervention group (n=62) showed significant improvements compared to the control group (n=74) on measures of anxiety, with a mean GAD-7 score change from baseline of –1.35 (SD 4.43) and –0.23 (SD 3.24), respectively (t134=1.71, P=.04); resilience, with a mean change in CD-RISC score of 1.79 (SD 4.08) and –0.31 (SD 3.16), respectively (t134=–3.37, P<.001); sleep, with a mean MISS score change of –1.16 (SD 2.67) and –0.26 (SD 2.29), respectively (t134=2.13, P=.01); and mental well-being, with a mean WHO-5 score change of 1.53 (SD 5.30) and –0.23 (SD 4.20), respectively (t134=–2.16, P=.02), within 2 weeks of using Foundations, with further improvements emerging at week 4. Perceived stress was also reduced within the intervention group, although the difference did not reach statistical significance relative to the control group, with a PSS score change from baseline to week 2 of –2.94 (SD 6.84) and –2.05 (SD 5.34), respectively (t134= 0.84, P=.20). Conclusions: This study provides a proof of principle that the digital mental health app Foundations can improve measures of mental well-being, anxiety, resilience, and sleep within 2 weeks of use, with greater effects after 4 weeks. Foundations therefore offers potential as a scalable, cost-effective, and accessible solution to enhance mental well-being, even during times of crisis such as the COVID-19 pandemic. Trial Registration: OSF Registries osf.io/f6djb; https://osf.io/vm3xq %M 34978535 %R 10.2196/30976 %U https://mhealth.jmir.org/2022/7/e30976 %U https://doi.org/10.2196/30976 %U http://www.ncbi.nlm.nih.gov/pubmed/34978535 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 6 %P e36050 %T Impact of a Long Lockdown on Mental Health and the Role of Media Use: Web-Based Survey Study %A Grygarová,Dominika %A Adámek,Petr %A Juríčková,Veronika %A Horáček,Jiří %A Bakštein,Eduard %A Fajnerová,Iveta %A Kesner,Ladislav %+ Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany, 250 67, Czech Republic, 420 283 088 264, dominika.grygarova@nudz.cz %K mental health %K COVID-19 %K lockdown %K media use %K anxiety %K depression %K nationally representative data %K survey %K longitudinal study %K pandemic %K social isolation %K social media %K psychological trauma %K mental stress %K media news %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Due to the COVID-19 pandemic, the Czech population experienced a second lockdown lasting for about half a year, restricting free movement and imposing social isolation. However, it is not known whether the impact of this long lockdown resulted in habituation to the adverse situation or in the traumatization of the Czech population, and whether the media and specific media use contributed to these effects. Objective: The aim of this study was to elucidate the effect of the long lockdown on the mental health of the Czech population, and the role of exposure to COVID-19 news reports and specific forms of media news use in mental health. Methods: We conducted two consecutive surveys in the early (November 2020) and late (March/April 2021) phases of the nationwide lockdown on the same nationally representative group of Czech adults (N=1777) participating in a longitudinal panel study. Results: Our findings showed that the self-reported symptoms of anxiety and depression increased in the second observation period, confirming the negative effect of the pandemic lockdown as it unfolded, suggesting that restrictive measures and continuous exposure to a collective stressor did not result in the strengthening of resilience but rather in ongoing traumatization. The results also suggest a negative role of the media’s coverage of the COVID-19 pandemic in mental health during the early, and particularly late, phases of the lockdown. Furthermore, we found several risk and protective factors of specific media news use. The media practice in news consumption connected to social media use was the strongest predictor of exacerbated mental health symptoms, particularly in the late phase of the lockdown. Moreover, news media use characterized by internalization of information learned from the news, as well as negative attitudes toward media news, were associated with higher levels of anxiety and depression. Conversely, the use of infotainment, together with an in-depth and contextual style of reading news articles, were related to improvement of mental health. Conclusions: Our study showed that the long lockdown resulted in traumatization rather than habituation, and in more pronounced effects (both negative and positive) of media use in mental health. %M 35605112 %R 10.2196/36050 %U https://mental.jmir.org/2022/6/e36050 %U https://doi.org/10.2196/36050 %U http://www.ncbi.nlm.nih.gov/pubmed/35605112 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35091 %T Implementation and Evaluation of COVIDCare@Home, a Family Medicine–Led Remote Monitoring Program for Patients With COVID-19: Multimethod Cross-sectional Study %A Laur,Celia %A Agarwal,Payal %A Thai,Kelly %A Kishimoto,Vanessa %A Kelly,Shawna %A Liang,Kyle %A Bhatia,R Sacha %A Bhattacharyya,Onil %A Martin,Danielle %A Mukerji,Geetha %+ Women’s College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400, Geetha.Mukerji@wchospital.ca %K virtual care %K COVID-19 pandemic %K remote monitoring programs %K social determinants of health %K digital health %K COVID-19 %K pandemic %K health care %K remote monitoring %K clinical outcome %K patient %K health care cost %K patient experience %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: COVIDCare@Home (CC@H) is a multifaceted, interprofessional team-based remote monitoring program led by family medicine for patients diagnosed with COVID-19, based at Women’s College Hospital (WCH), an ambulatory academic center in Toronto, Canada. CC@H offers virtual visits (phone and video) to address the clinical needs and broader social determinants of the health of patients during the acute phase of COVID-19 infection, including finding a primary care provider (PCP) and support for food insecurity. Objective: The objective of this evaluation is to understand the implementation and quality outcomes of CC@H within the Quadruple Aim framework of patient experience, provider experience, cost, and population health. Methods: This multimethod cross-sectional evaluation follows the Quadruple Aim framework to focus on implementation and service quality outcomes, including feasibility, adoption, safety, effectiveness, equity, and patient centeredness. These measures were explored using clinical and service utilization data, patient experience data (an online survey and a postdischarge questionnaire), provider experience data (surveys, interviews, and focus groups), and stakeholder interviews. Descriptive analysis was conducted for surveys and utilization data. Deductive analysis was conducted for interviews and focus groups, mapping to implementation and quality domains. The Ontario Marginalization Index (ON-Marg) measured the proportion of underserved patients accessing CC@H. Results: In total, 3412 visits were conducted in the first 8 months of the program (April 8-December 8, 2020) for 616 discrete patients, including 2114 (62.0%) visits with family physician staff/residents and 149 (4.4%) visits with social workers/mental health professionals. There was a median of 5 (IQR 4) visits per patient, with a median follow-up of 7 days (IQR 27). The net promoter score was 77. In addition, 144 (23.3%) of the patients were in the most marginalized populations based on the residential postal code (as per ON-Marg). Interviews with providers and stakeholders indicated that the program continued to adapt to meet the needs of patients and the health care system. Conclusions: Future remote monitoring should integrate support for addressing the social determinants of health and ensure patient-centered care through comprehensive care teams. %M 35499974 %R 10.2196/35091 %U https://humanfactors.jmir.org/2022/2/e35091 %U https://doi.org/10.2196/35091 %U http://www.ncbi.nlm.nih.gov/pubmed/35499974 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35173 %T Self-care Behaviors and Technology Used During COVID-19: Systematic Review %A Sakur,Fareeya %A Ward,Kanesha %A Khatri,Neha Nafees %A Lau,Annie Y S %+ Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, NSW 2113, Australia, 61 (02) 9850 2400, fareeya.sakur@hdr.mq.edu.au %K self-care %K self-management %K chronic conditions %K COVID-19 %K pandemic %K technology %K digital health %K telehealth %K health technology %D 2022 %7 21.6.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Self-care behaviors are essential for people living with chronic conditions; however, the outbreak of the COVID-19 pandemic has imposed additional complications on their daily routines. Few studies have analyzed how self-care behaviors have changed during COVID-19 and the role of digital technology, especially among people with chronic conditions. Objective: This study aims to review how self-care behaviors have changed for people with chronic conditions during the COVID-19 pandemic, and what technology they have adopted to manage their conditions during that period. Methods: A systematic review was conducted using narrative synthesis. Data were extracted from PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, and Google Scholar, including articles from December 2019 onward. Eligible studies focused on adults diagnosed with chronic conditions undertaking any self-care tasks in line with the middle-range theory of self-care of chronic illness (ie, self-care maintenance, monitoring, and management). The methodological quality of the included articles was assessed with the McMaster Critical Review Forms for Quantitative or Qualitative Studies. Results: In total, 36 primary research articles were included. Changes to self-care behaviors during COVID-19 among people with chronic conditions were organized according to the middle-range theory of self-care of chronic illness focusing on self-care maintenance (ie, medication adherence, physical activity, and diet control), self-care monitoring (ie, monitoring signs and symptoms), and self-care management (ie, consultations with health care providers). Positive self-care behaviors observed include the following: individuals trying to maintain good glycemic control during COVID-19 increased their medication adherence in 27% (10/36) of studies; and diet control improved in 50% (18/36) of studies. Negative self-care behaviors observed include the following: decline in physical activities and increased sedentariness were observed in 65% (23/36) of studies; poor diet control was observed in 57% (21/36) of studies; and self-monitoring of health status dropped in 43% (15/36) of studies. The use of technology to support self-care of chronic conditions during COVID-19 was reported in 72% (26/36) of studies. The actual use of telehealth in place of physical consultations during COVID-19 was observed in 50% (18/36) of studies, and other digital technologies (eg, social media apps, smartphone apps, web-based platforms, and web browsing) were used in 50% (18/36) of studies. Telehealth was discussed and recommended as the default technology in delivering future health care services during COVID-19 and beyond in 77% (28/36) of studies. Conclusions: This review highlighted the necessity to rethink how models of self-care should continue to address the demands of chronic conditions while being responsive to the imminent threats of infectious diseases. Perhaps the silver lining of COVID-19 is that adoption of digital technology (especially telehealth) among a vast cross-section of people with chronic conditions is possible. Future research should investigate effective ways to incorporate evidence-based digital health tools into these new models of self-care that address the challenges of chronic and infectious conditions. %M 35442904 %R 10.2196/35173 %U https://humanfactors.jmir.org/2022/2/e35173 %U https://doi.org/10.2196/35173 %U http://www.ncbi.nlm.nih.gov/pubmed/35442904 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34115 %T Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study %A McCrady,Emma %A Strychowsky,Julie E %A Woolfson,Jessica P %+ Department of Pediatrics, London Health Sciences Centre Children's Hospital, Office B3-444, London, ON, N6A 5W9, Canada, 1 5198789608, emccrad@uwo.ca %K virtual care %K web-based care %K COVID-19 %K pediatrics %K pandemic %K physicians %K digital health %K pediatricians %K telehealth %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for pediatric physicians and surgeons at our center. At the pandemic onset, web-based care was adopted at an unprecedented scale and pace. Objective: This descriptive study explores the web-based care experience of pediatric physicians and surgeons during the pandemic by determining factors that supported and challenged web-based care adoption. Methods: This study took place at the Children’s Hospital at London Health Sciences Centre, a children’s hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. The Donabedian model was used to structure a web-based survey evaluating web-based care experience, which was distributed to 121 department-affiliated pediatric physicians (including generalists and subspecialists in surgery and medicine). Recruitment occurred via department listserv email. Qualitative data were collected through discrete and free-text survey responses. Results: Survey response rate was 52.1% (63/121). Before the pandemic, few physicians within the Department of Paediatrics used web-based care, and physicians saw <10% of patients digitally. During March-May 2020, the majority transitioned to web-based care, seeing >50% of patients digitally. Web-based care use in our sample fell from June to September 2020, with the majority seeing <50% of patients digitally. Telephone and Ontario Telemedicine Network were the platforms most used from March to September 2020. Web-based care was rated to be convenient for most providers and their patients, despite the presence of technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient digital care etiquette. Regardless of demographics, 96.4% (116/121) would continue web-based care, ideally for patients who live far away and for follow-ups or established diagnoses. Conclusions: Transition to web-based care during COVID-19 was associated with challenges but also positive experiences. Willingness among pediatricians and pediatric surgeons to continue web-based care was high. Web-based care experiences at our center could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for web-based care. %M 35666938 %R 10.2196/34115 %U https://pediatrics.jmir.org/2022/2/e34115 %U https://doi.org/10.2196/34115 %U http://www.ncbi.nlm.nih.gov/pubmed/35666938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36289 %T General Practitioners’ Experiences of Professional Uncertainties Emerging from the Introduction of Video Consultations in General Practice: Qualitative Study %A Nordtug,Maja %A Assing Hvidt,Elisabeth %A Lüchau,Elle Christine %A Grønning,Anette %+ Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Stensberggata 26, Oslo, 0170, Norway, 47 67236935, majanord@oslomet.no %K video consultation technology %K general practice, COVID-19, doctor-patient communication %K uncertainties %K general practitioners %K video consultation %K virtual health %K physician %K digital health %K pandemic %D 2022 %7 14.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Uncertainties are omnipresent in health care, but little is known about general practitioners’ (GPs) professional uncertainties concerning digital consultations. This is problematic, as many countries have undergone an extensive digital transformation. Objective: The aim of this study was to explore the professional uncertainties that emerged among Danish GPs with the introduction of video consultations. Methods: We conducted qualitative interviews with 15 Danish GPs during the beginning of the COVID-19 pandemic in 2020. The interviews were analyzed using an abductive approach. Results: We identified 3 categories of uncertainty: integrity, setting, and interaction. Respectively, these 3 categories of uncertainty refer to (1) uncertainties related to how technology may impede the provision of health care; (2) uncertainties related to the potentials of video technology; and (3) uncertainties related to how the video consultation technology affects interactions with patients. Conclusions: The uncertainties experienced by Danish GPs appear to be a typical reaction to the introduction of new technology. Embedding video consultation technology into GPs’ working routines will take time, and GPs do not necessarily feel intuitively capable of transferring their abilities, such as being good and socially present for video-mediated consultations. The heterogeneity of professional uncertainties experienced among the GPs suggests that they are the product of individual GP-technology relationships—not of the technology in itself. Consequently, we cannot expect that uncertainties can be remedied by changing or precluding new technology. %M 35653607 %R 10.2196/36289 %U https://formative.jmir.org/2022/6/e36289 %U https://doi.org/10.2196/36289 %U http://www.ncbi.nlm.nih.gov/pubmed/35653607 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e37327 %T COVID-19 Surveillance in the Biobank at the Colorado Center for Personalized Medicine: Observational Study %A Johnson,Randi K %A Marker,Katie M %A Mayer,David %A Shortt,Jonathan %A Kao,David %A Barnes,Kathleen C %A Lowery,Jan T %A Gignoux,Christopher R %+ Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Place, Mail Stop 563, Aurora, CO, 80045, United States, 1 3037245375, randi.johnson@cuanschutz.edu %K COVID-19 %K surveillance %K pandemic %K biobank %K EHR %K public health %K integrated data %K population health %K health monitoring %K electronic health record %K eHealth %K health record %K emergency response %K vaccination status %K vaccination %K testing %K symptom %K disease impact %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Characterizing the experience and impact of the COVID-19 pandemic among various populations remains challenging due to the limitations inherent in common data sources, such as electronic health records (EHRs) or cross-sectional surveys. Objective: This study aims to describe testing behaviors, symptoms, impact, vaccination status, and case ascertainment during the COVID-19 pandemic using integrated data sources. Methods: In summer 2020 and 2021, we surveyed participants enrolled in the Biobank at the Colorado Center for Personalized Medicine (CCPM; N=180,599) about their experience with COVID-19. The prevalence of testing, symptoms, and impacts of COVID-19 on employment, family life, and physical and mental health were calculated overall and by demographic categories. Survey respondents who reported receiving a positive COVID-19 test result were considered a “confirmed case” of COVID-19. Using EHRs, we compared COVID-19 case ascertainment and characteristics in EHRs versus the survey. Positive cases were identified in EHRs using the International Statistical Classification of Diseases, 10th revision (ICD-10) diagnosis codes, health care encounter types, and encounter primary diagnoses. Results: Of the 25,063 (13.9%) survey respondents, 10,661 (42.5%) had been tested for COVID-19, and of those, 1366 (12.8%) tested positive. Nearly half of those tested had symptoms or had been exposed to someone who was infected. Young adults (18-29 years) and Hispanics were more likely to have positive tests compared to older adults and persons of other racial/ethnic groups. Mental health (n=13,688, 54.6%) and family life (n=12,233, 48.8%) were most negatively affected by the pandemic and more so among younger groups and women; negative impacts on employment were more commonly reported among Black respondents. Of the 10,249 individuals who responded to vaccination questions from version 2 of the survey (summer 2021), 9770 (95.3%) had received the vaccine. After integration with EHR data up to the time of the survey completion, 1006 (4%) of the survey respondents had a discordant COVID-19 case status between EHRs and the survey. Using all longitudinal EHR and survey data, we identified 11,472 (6.4%) COVID-19-positive cases among Biobank participants. In comparison to COVID-19 cases identified through the survey, EHR-identified cases were younger and more likely to be Hispanic. Conclusions: We found that the COVID-19 pandemic has had far-reaching and varying effects among our Biobank participants. Integrated data assets, such as the Biobank at the CCPM, are key resources for population health monitoring in response to public health emergencies, such as the COVID-19 pandemic. %M 35486493 %R 10.2196/37327 %U https://publichealth.jmir.org/2022/6/e37327 %U https://doi.org/10.2196/37327 %U http://www.ncbi.nlm.nih.gov/pubmed/35486493 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33484 %T Attitudes Toward the Global Allocation of Chinese COVID-19 Vaccines: Cross-sectional Online Survey of Adults Living in China %A Yu,Hanzhi %A Du,Runming %A Wang,Minmin %A Yu,Fengyun %A Yang,Juntao %A Jiao,Lirui %A Wang,Zhuoran %A Liu,Haitao %A Wu,Peixin %A Bärnighausen,Till %A Xue,Lan %A Wang,Chen %A McMahon,Shannon %A Geldsetzer,Pascal %A Chen,Simiao %+ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Postfach 10 57 60 69047, Heidelberg, 69047, Germany, 49 6221 54 0, simiao.chen@uni-heidelberg.de %K COVID-19 vaccines %K China %K global allocation %K public attitudes %K cross-sectional %K survey %K vaccines %K COVID-19 %K pandemic %K public health %K health policy %K epidemiology %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 vaccines are in short supply worldwide. China was among the first countries to pledge supplies of the COVID-19 vaccine as a global public product, and to date, the country has provided more than 600 million vaccines to more than 200 countries and regions with low COVID-19 vaccination rates. Understanding the public’s attitude in China toward the global distribution of COVID-19 vaccines could inform global and national decisions, policies, and debates. Objective: The aim of this study was to determine the attitudes of adults living in China regarding the global allocation of COVID-19 vaccines developed in China and how these attitudes vary across provinces and by sociodemographic characteristics. Methods: We conducted a cross-sectional online survey among adults registered with the survey company KuRunData. The survey asked participants 31 questions about their attitudes regarding the global allocation of COVID-19 vaccines developed in China. We disaggregated responses by province and sociodemographic characteristics. All analyses used survey sampling weights. Results: A total of 10,000 participants completed the questionnaire. Participants generally favored providing COVID-19 vaccines to foreign countries before fulfilling domestic needs (75.6%, 95% CI 74.6%-76.5%). Women (3778/4921, 76.8%; odds ratio 1.18, 95% CI 1.07-1.32; P=.002) and those living in rural areas (3123/4065, 76.8%; odds ratio 1.13, 95% CI 1.01-1.27; P=.03) were especially likely to hold this opinion. Most respondents preferred providing financial support through international platforms rather than directly offering support to individual countries (72.1%, 95% CI 71%-73.1%), while for vaccine products they preferred direct provision to relevant countries instead of via a delivery platform such as COVAX (77.3%, 95% CI 76.3%-78.2%). Conclusions: Among our survey sample, we found that adults are generally supportive of the international distribution of COVID-19 vaccines, which may encourage policy makers to support and implement the distribution of COVID-19 vaccines developed in China worldwide. Conducting similar surveys in other countries could help align policy makers’ actions on COVID-19 vaccine distribution with the preferences of their constituencies. %M 35483084 %R 10.2196/33484 %U https://publichealth.jmir.org/2022/6/e33484 %U https://doi.org/10.2196/33484 %U http://www.ncbi.nlm.nih.gov/pubmed/35483084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e33011 %T Media Use During the COVID-19 Pandemic: Cross-sectional Study %A Rivest-Beauregard,Marjolaine %A Fortin,Justine %A Guo,Connie %A Cipolletta,Sabrina %A Sapkota,Ram P %A Lonergan,Michelle %A Brunet,Alain %+ Division of Psychosocial Research, Douglas Mental Health University Institute, Perry Building, Third Floor, 6875 bd LaSalle, Montréal, QC, H4H 1R3, Canada, 1 514 761 6131 ext 3473, marjolaine.rivest-beauregard@mail.mcgill.ca %K media use %K support %K information-seeking behaviors %K trauma- and stressor-related symptoms %K COVID-19 %K media %K information-seeking %K behavior %K trauma %K stress %K symptom %K frequency %K risk %K distress %D 2022 %7 7.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Throughout the pandemic, the general population was encouraged to use media to be kept informed about sanitary measures while staying connected with others to obtain social support. However, due to mixed findings in the literature, it is not clear whether media use in such a context would be pathogenic or salutogenic. Objective: Therefore, the associations between COVID-19–related stressors and frequency of media use for information-seeking on trauma- and stressor-related (TSR) symptoms were examined while also investigating how social media use for support-seeking and peritraumatic distress interact with those variables. Methods: A path model was tested in a sample of 5913 adults who completed an online survey. Results: The number of COVID-19–related stressors (β=.25; P<.001) and extent of information-seeking through media (β=.24; P=.006) were significantly associated with the severity of TSR symptoms in bivariate comparisons. Associations between levels of peritraumatic distress and both COVID-19–related stressors and information-seeking through media, and social media use for support- and information-seeking through media were found (βCOVID-19 stressors: Peritraumatic Distress Inventory=.49, P<.001; βseeking information: Peritraumatic Distress Inventory=.70, P<.001; βseeking information–seeking support=.04, P<.001). Conclusions: Results suggest that exposure to COVID-19–related stressors and seeking COVID-19–related information through the media are associated with higher levels of peritraumatic distress that, in turn, lead to higher levels of TSR symptoms. Although exposure to the stress of the COVID-19 pandemic may be unavoidable, the frequency of COVID-19–related information consumption through various media should be approached with caution. %M 3553703 %R 10.2196/33011 %U https://www.jmir.org/2022/6/e33011 %U https://doi.org/10.2196/33011 %U http://www.ncbi.nlm.nih.gov/pubmed/3553703 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34793 %T The Factors Associated With Nonuse of Social Media or Video Communications to Connect With Friends and Family During the COVID-19 Pandemic in Older Adults: Web-Based Survey Study %A Savage,Rachel D %A Di Nicolo,Sophia %A Wu,Wei %A Li,Joyce %A Lawson,Andrea %A Grieve,Jim %A Goel,Vivek %A Rochon,Paula A %+ Women's Age Lab, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 416 351 3732 ext 3822, rachel.savage@wchospital.ca %K digital technology %K loneliness %K older adults %K COVID-19 %K elderly %K lonely %K mental health %K factor %K usage %K social media %K video %K communication %K connection %K connect %K family %K friend %K age %K support %D 2022 %7 6.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technologies have enabled social connection during prolonged periods of physical distancing and travel restrictions throughout the COVID-19 pandemic. These solutions may exclude older adults, who are at higher risk for social isolation, loneliness, and severe outcomes if infected with SARS-CoV-2. Objective: This study investigated factors associated with nonuse of social media or video communications to connect with friends and family among older adults during the pandemic’s first wave. Methods: A web-based, cross-sectional survey was administered to members of a national retired educators’ organization based in Ontario, Canada, between May 6 and 19, 2020. Respondents (N=4879) were asked about their use of social networking websites or apps to communicate with friends and family, their internet connection and smartphone access, loneliness, and sociodemographic characteristics. Factors associated with nonuse were evaluated using multivariable logistic regression. A thematic analysis was performed on open-ended survey responses that described experiences with technology and virtual connection. Results: Overall, 15.4% (751/4868) of respondents did not use social networking websites or apps. After adjustment, male gender (odds ratio [OR] 1.60, 95% CI 1.33-1.92), advanced age (OR 1.88, 95% CI 1.38-2.55), living alone (OR 1.68, 95% CI 1.39-2.02), poorer health (OR 1.33, 95% CI 1.04-1.71), and lower social support (OR 1.44, 95% CI 1.20-1.71) increased the odds of nonuse. The reliability of internet connection and access to a smartphone also predicted nonuse. Many respondents viewed these technologies as beneficial, especially for maintaining pre–COVID-19 social contacts and routines, despite preferences for in-person connection. Conclusions: Several factors including advanced age, living alone, and low social support increased the odds of nonuse of social media in older adults to communicate with friends and family during COVID-19’s first wave. Our findings identified socially vulnerable subgroups who may benefit from intervention (eg, improved access, digital literacy, and telephone outreach) to improve social connection. %M 35344502 %R 10.2196/34793 %U https://aging.jmir.org/2022/2/e34793 %U https://doi.org/10.2196/34793 %U http://www.ncbi.nlm.nih.gov/pubmed/35344502 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32419 %T Continuation of Teletherapy After the COVID-19 Pandemic: Survey Study of Licensed Mental Health Professionals %A Gangamma,Rashmi %A Walia,Bhavneet %A Luke,Melissa %A Lucena,Claudine %+ Department of Marriage and Family Therapy, Falk College of Sport and Human Dynamics, Syracuse University, Peck Hall, 601 E Genesee Street, Syracuse, NY, 13202, United States, 1 614 325 4029, rgangamm@syr.edu %K teletherapy %K relational teletherapy %K teletherapy predictors %K postpandemic teletherapy %K mental health %K telemedicine %K COVID-19 %K telehealth %D 2022 %7 1.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of teletherapy has exponentially increased in the context of the ongoing COVID-19 pandemic. Studies on teletherapy documented substantial benefits of accessibility and convenience even before the start of the pandemic. Although recent studies show that this modality of therapy delivery is here to stay, few have studied who will most benefit from this trend. Objective: In this paper, we report predictors of continued teletherapy usage in a sample of licensed mental health professionals in the United States during a time period when pandemic-related restrictions began diminishing. As such, it is one of the first studies to examine factors related to continued benefits of teletherapy postpandemic. Methods: Participation from licensed mental health professionals was sought on listservs of national organizations of multiple mental health organizations. Data were collected via an anonymous link to a survey on Qualtrics between January 2021 and April 2021. Participants responded to questions on therapist demographics, practice setting, experiences of shifting to teletherapy, perspectives on continued use of teletherapy, and their client characteristics. Findings related to client characteristics that predicted continued teletherapy usage are presented here. Results: A total of 186 individuals consented to participate in the survey, with a final sample of 114 with complete data. A majority of participants identified as female (92/114, 80.7%), White (94/114, 82.5%), and having a master's degree (75/114, 65.5%) from a nationally accredited program (106/114, 93%). Data were analyzed using heteroskedastic regression modeling with client-related factors as predictors. Two models were run with and without distance travelled by clients as a control variable. Model estimates from both models showed that continued use of teletherapy postpandemic was predicted by the following factors: higher percentage of clients from rural areas, younger and older adult clients, clients with Medicare, and clients with marginalized gender and religious/spiritual identities. Significantly, having a higher percentage of clients from lower socioeconomic status, a higher percentage of those with Medicaid coverage, and a higher percentage of couples and families as clients predicted decreased use of teletherapy postpandemic. Conclusions: Findings from the study suggest that while some groups of clients are more likely to continue to receive benefits of teletherapy, vulnerable groups such as those in lower socioeconomic conditions, Medicaid beneficiaries, and those who seek couple and family therapy may be less likely to be served by it. These differences point to a need to address factors driving telehealth care disparities such as access to technology, housing, and childcare issues, as well as the need for continued training for licensed professionals. %M 35584317 %R 10.2196/32419 %U https://formative.jmir.org/2022/6/e32419 %U https://doi.org/10.2196/32419 %U http://www.ncbi.nlm.nih.gov/pubmed/35584317 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e34710 %T COVID-19 News and Its Association With the Mental Health of Sexual and Gender Minority Adults: Cross-sectional Study %A Clark,Kristen D %A Lunn,Mitchell R %A Sherman,Athena D F %A Bosley,Hannah G %A Lubensky,Micah E %A Obedin-Maliver,Juno %A Dastur,Zubin %A Flentje,Annesa %+ Department of Nursing, University of New Hampshire, 4 Library Way, Durham, NH, 03824, United States, 1 603 862 2271, kristen.clark@unh.edu %K PTSD %K posttraumatic stress disorder %K anxiety %K minority populations %K vicarious trauma %K tertiary trauma %K COVID-19 %K pandemic %K public health %K sexual orientation %K gender identity %K mental health %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Sexual and gender minority (SGM; people whose sexual orientation is not heterosexual or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and substantial disparities in anxiety and posttraumatic stress disorder (PTSD). Exposure to traumatic stressors such as news related to COVID-19 may be associated with symptoms of anxiety and PTSD. Objective: This study aims to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States. Methods: Data were collected between March 23 and August 2, 2020, from The PRIDE Study, a national longitudinal cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and symptoms of anxiety using the Generalized Anxiety Disorder-7 and symptoms of COVID-19–related PTSD using the Impact of Events Scale-Revised. Results: Our sample included a total of 3079 SGM participants. Each unit increase in COVID-19–related news exposure was associated with greater anxiety symptoms (odds ratio 1.77, 95% CI 1.63-1.93; P<.001) and 1.93 greater odds of PTSD (95% CI 1.74-2.14; P<.001). Conclusions: Our study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities. %M 35486805 %R 10.2196/34710 %U https://publichealth.jmir.org/2022/5/e34710 %U https://doi.org/10.2196/34710 %U http://www.ncbi.nlm.nih.gov/pubmed/35486805 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e37328 %T The Efficacy of a Brief, Altruism-Eliciting Video Intervention in Enhancing COVID-19 Vaccination Intentions Among a Population-Based Sample of Younger Adults: Randomized Controlled Trial %A Zhu,Patricia %A Tatar,Ovidiu %A Griffin-Mathieu,Gabrielle %A Perez,Samara %A Haward,Ben %A Zimet,Gregory %A Tunis,Matthew %A Dubé,Ève %A Rosberger,Zeev %+ Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, QC, H3T1E4, Canada, 1 514 340 8222 ext 23978, ovidiu.tatar@mail.mcgill.ca %K COVID-19 %K vaccination %K altruism %K prosocial motives %K video intervention %K randomized controlled trial %K younger adults %K vaccine hesitancy %K public health %K youth %K digital intervention %K health intervention %K health promotion %K web survey %K digital health %K online health %K health information %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: High COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance. Objective: This study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video’s efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures. Methods: Using a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention. Results: Analyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (χ21=20.55, P<.001). The between-group difference in postintervention intentions (χ23=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate. Conclusions: Although the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a “push” for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases. Trial Registration: ClinicalTrials.gov NCT04960228; https://clinicaltrials.gov/ct2/show/NCT04960228 %M 35544437 %R 10.2196/37328 %U https://publichealth.jmir.org/2022/5/e37328 %U https://doi.org/10.2196/37328 %U http://www.ncbi.nlm.nih.gov/pubmed/35544437 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e32278 %T Factors Associated With Protective Mask-Wearing Behavior to Avoid COVID-19 Infection in China: Internet-Based Cross-sectional Study %A Xu,Yue %A Wu,Qingqing %A Xu,Shuiyang %A Zhao,Yusui %A Zhang,Xuehai %+ Department of Health Education, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China, 86 87115248, xhzhang@cdc.zj.cn %K COVID-19 %K internet-based %K disease prevention %K mask %K knowledge %K behavior %D 2022 %7 26.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The novel coronavirus disease COVID-19 is likely to spread from person to person in close-contact settings. The Chinese Center for Disease Control and Prevention released a handbook on COVID-19, which introduced health information to the public, specifically related to wearing masks correctly and adopting preventive measures to avoid COVID-19 infection. Objective: The aim of this study was to assess the level of mask knowledge, behavior related to mask usage, and major information channels used for obtaining mask- and COVID-19–related information in China. Methods: An internet-based survey was conducted primarily using DingXiang Doctor WeChat public accounts. The data about mask knowledge and behavior were collected and analyzed. In addition to descriptive statistics, logistic regression was used to analyze significant risk factors contributing to protective mask behavior. Results: Data were collected from a total of 10,304 respondents to the survey. More than half of the respondents were under 30 years old and nearly three-quarters were women. Over 80% of participants had a bachelor’s degree or higher, and the largest proportion of respondents (n=4204, 40.80%) were employed as business/service workers. Over half of the study participants were married (n=5302, 51.46%). The findings revealed that 67.49% (6954/10,304) of the participants practiced protective mask behavior; 97.93% (10,091/10,304) believed that wearing masks is an effective protective measure against COVID-19; 96.85% (9979/10,304) chose a mask that has two or more layers of washable, breathable fabric; and 70.57% (7272/10,304) wore the masks correctly. Gender, age, occupation, and education level had significant effects on behavior, whereas marital status and the infection status of family members were not significantly related to mask-wearing behavior. In addition, WeChat public accounts (9227/10,304, 89.55%) were the most prominent source of obtaining health information for Chinese netizens after the outbreak of COVID-19. Conclusions: This study elucidated that Chinese netizens’ protective mask behavior is far lower than their mask-related knowledge. Improved information channels and adequate information on wearing masks are necessary to improve the public’s protective mask behavior, particularly among men, the elderly, and people with less education. %M 35486491 %R 10.2196/32278 %U https://publichealth.jmir.org/2022/5/e32278 %U https://doi.org/10.2196/32278 %U http://www.ncbi.nlm.nih.gov/pubmed/35486491 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e36966 %T The Mental Health Impact of Daily News Exposure During the COVID-19 Pandemic: Ecological Momentary Assessment Study %A Kellerman,John K %A Hamilton,Jessica L %A Selby,Edward A %A Kleiman,Evan M %+ Department of Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Rd, Piscataway, NJ, 08854, United States, 1 848 445 2576, jk1684@rutgers.edu %K news consumption %K worry %K hopelessness %K ecological momentary assessment %K news media %K COVID-19 %K pandemic %K mental health %K depression %K stress %K psychological distress %K mediation model %K digital health %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Consumption of distressing news media, which substantially increased during the COVID-19 pandemic, has demonstrable negative effects on mental health. Objective: This study examines the proximal impact of daily exposure to news about COVID-19 on mental health in the first year of the pandemic. Methods: A sample of 546 college students completed daily ecological momentary assessments (EMAs) for 8 weeks, measuring exposure to news about COVID-19, worry and optimism specifically related to COVID-19, hopelessness, and general worry. Results: Participants completed >80,000 surveys. Multilevel mediation models indicated that greater daily exposure to news about COVID-19 is associated with higher same-day and next-day worry about the pandemic. Elevations in worry specifically about COVID-19 were in turn associated with greater next-day hopelessness and general worry. Optimism about COVID-19 mediated the relationship between daily exposure to COVID-19 news and next-day general worry but was not related to hopelessness. Conclusions: This study demonstrates the mental health impact of daily exposure to COVID-19 news and highlights how worry about the pandemic contributes over time to hopelessness and general worry. %M 35377320 %R 10.2196/36966 %U https://mental.jmir.org/2022/5/e36966 %U https://doi.org/10.2196/36966 %U http://www.ncbi.nlm.nih.gov/pubmed/35377320 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35535 %T Clinicians’ Attitudes Toward Telepsychology in Addiction and Mental Health Services, and Prediction of Postpandemic Telepsychology Uptake: Cross-sectional Study %A Zentner,Kristen %A Gaine,Graham %A Ethridge,Paige %A Surood,Shireen %A Abba-Aji,Adam %+ Clinical Supports and Services, Addiction & Mental Health, Alberta Health Services, 9942 108 St NW, Edmonton, AB, T5K 2J5, Canada, 1 780 342 7726, graham.gaine@albertahealthservices.ca %K mental health %K telepsychology %K clinician attitude %K unified theory of acceptance and use of technology %K therapeutic alliance %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has resulted in unprecedented uptake of telepsychology services; however, clinicians have mixed attitudes toward virtual technologies. Objective: This study (1) explored clinicians’ experiences of and intentions to use video, telephone, and in-person services, and (2) tested the utility of the unified theory of acceptance and use of technology (UTAUT) to predict clinicians’ intentions to offer telepsychology after the COVID-19 pandemic. Methods: Clinician satisfaction and therapeutic alliance were compared across in-person, video, and telephone services, while technology attitudes and intention to use after the pandemic were compared across video and telephone services among 118 addiction and mental health clinicians during the COVID-19 pandemic. Results: Clinicians reported more positive experiences with in-person services than both virtual technologies; further, clinicians reported greater positive experiences, attitudes, and intentions to use video services than telephone services across measures. Based on the UTAUT, performance expectancy positively predicted concurrent intentions to use video services (β=0.46; P<.001) and telephone services (β=0.35; P<.001) after the pandemic. Social influence (β=0.24; P=.004) and facilitating conditions (β=0.19; P=.03) additionally predicted the intention to use telephone services. Conclusions: Clinicians rated in-person services more positively than virtual technologies, with video services perceived more positively than telephone services. Performance expectancy was the primary facilitator of the uptake of both virtual modalities. %M 35559793 %R 10.2196/35535 %U https://formative.jmir.org/2022/5/e35535 %U https://doi.org/10.2196/35535 %U http://www.ncbi.nlm.nih.gov/pubmed/35559793 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e35159 %T Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review %A Philippe,Tristan J %A Sikder,Naureen %A Jackson,Anna %A Koblanski,Maya E %A Liow,Eric %A Pilarinos,Andreas %A Vasarhelyi,Krisztina %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 604 875 4111 ext 64710, Krisztina.Vasarhelyi@vch.ca %K digital health %K telepsychology %K computer-assisted therapy %K online therapy %K mobile applications %K mobile apps %K telemedicine %K telepsychiatry %K virtual reality exposure therapy %K mental health %K COVID-19 %D 2022 %7 12.5.2022 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. Objective: To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. Methods: We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. Results: Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. Conclusions: Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions. %M 35551058 %R 10.2196/35159 %U https://mental.jmir.org/2022/5/e35159 %U https://doi.org/10.2196/35159 %U http://www.ncbi.nlm.nih.gov/pubmed/35551058 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e36673 %T Long COVID Optimal Health Program (LC-OHP) to Enhance Psychological and Physical Health: Protocol for a Feasibility Randomized Controlled Trial %A Al-Jabr,Hiyam %A Windle,Karen %A Thompson,David R %A Jenkins,Zoe M %A Castle,David J %A Ski,Chantal F %+ Integrated Care Academy, University of Suffolk, Waterfront Building, 19 Neptune Quay, Ipswich, IP4 1QJ, United Kingdom, 44 01473 338845, h.al-jabr@uos.ac.uk %K long COVID %K COVID-19 %K optimal health program %K telemedicine %K integrated care %K telehealth %K patient care %K health intervention %K mental health %K physical health %K psychological health %K pandemic %K patient support %D 2022 %7 12.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Long COVID is a collection of symptoms that develop during or following a confirmed or suspected case of COVID-19, which continue for more than 12 weeks. Despite the negative impact of long COVID on people’s lives and functioning, there is no validated treatment or even rehabilitation guidance. What has been recommended thus far is the adoption of holistic management approaches. The Optimal Health Program (OHP) is a brief 5-session, plus booster, psychosocial program designed to support mental and physical well-being that has been used effectively for a range of chronic conditions. Objective: This study examines the feasibility and acceptability of employing an especially customized version of OHP (long COVID OHP [LC-OHP]) to improve psychological and physical health of people with long COVID. Methods: This is a feasibility randomized controlled trial that will be running from November 2021 to February 2023. Eligible participants aged 18 years or older who are experiencing symptoms of long COVID will be identified through their secondary practitioners with recruitment to be undertaken by the research team. A total of 60 participants will be randomized into a control (usual care) or an intervention (LC-OHP) group. Outcomes will be feasibility and acceptability of the program (primary); and efficacy of the LC-OHP in improving anxiety, depression, fatigue, self-efficacy, and quality of life (secondary). Up to 20 participants will be interviewed at the end of the trial to explore their experience with the program. Quantitative data will be analyzed using SPSS, and differences between groups will be compared using inferential tests where appropriate. Qualitative data will be transcribed and thematically analyzed to identify common emerging themes. Results: This is an ongoing study, which began in November 2021. Conclusions: Long COVID has a significant impact on an individual’s mental and physical functioning. The LC-OHP has a potential to provide people living with long COVID with additional support and to improve self-efficacy. The findings of this study would identify the feasibility of delivering this program to this population and will provide an indication for the program’s effectiveness. Trial Registration: ISRCTN Registry ISRCTN38746119; https://www.isrctn.com/ISRCTN38746119 International Registered Report Identifier (IRRID): DERR1-10.2196/36673 %M 35468586 %R 10.2196/36673 %U https://www.researchprotocols.org/2022/5/e36673 %U https://doi.org/10.2196/36673 %U http://www.ncbi.nlm.nih.gov/pubmed/35468586 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37046 %T The Effects of the COVID-19 Pandemic on Mental Health Among Older Adults From Different Communities in Chengmai County, China: Cross-sectional Study %A Xu,Zhimin %A Ghisi,Gabriela Lima de Melo %A Cui,Lixian %A Zeng,Fang %A Zhou,Xiaohai %A Yue,Zhongtang %A Chen,Hanbei %+ University Health Network, 347 Rumsey Road, Toronto, ON, M4G 1R7, Canada, 1 4164200014, gabriela.meloghisi@uhn.ca %K mental health %K COVID-19 %K depression %K anxiety %K aged %K aging %K older adults %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Due to the strict measures employed to control the spread of SARS-CoV-2, the extent of COVID-19 goes beyond morbidity and mortality and affects individuals’ mental health in the long term. Objective: This cross-sectional study aimed to investigate the effects of the COVID-19 pandemic on mental health and its contributing factors among older people in Chengmai County, China. Methods: A web-based survey was administered through WeChat between March and April 2020. Older people (ie, >50 years) from local and foreign community groups completed the survey, which included items on sociodemographic and clinical characteristics, the 7-item Generalized Anxiety Disorder scale (GAD-7), and the 9-item Patient Health Questionnaire (PHQ-9). Independent t tests and a multiple linear regression analysis were used to investigate differences between anxiety and depression and the factors associated with these symptoms across the 2 groups. Results: Overall, 469 responses were received; 119 responses (25.4%) were from male participants and 202 (43.1%) were from those older than 65 years. Of the 469 responses, 245 (52.2%) were from the local community group and 224 (47.8%) from the foreign group. The mean GAD-7 (P=.003) scores were significantly higher in the local group. Anxiety was significantly more present in the local group (61/245, 24.9% compared to 35/224, 15.6% in the foreign group; P=.01). A total of 6 respondents presented severe anxiety and 2 presented severe depression. Conclusions: This study demonstrated that both community groups of older adults from the Chinese “Hometown of Longevity” presented anxiety or depressive disorders during the first months of the pandemic. Local community groups presented significantly more mental health disorders, which were associated with a history of previous psychological disorders. %M 35404834 %R 10.2196/37046 %U https://formative.jmir.org/2022/5/e37046 %U https://doi.org/10.2196/37046 %U http://www.ncbi.nlm.nih.gov/pubmed/35404834 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e37292 %T A Group-Facilitated, Internet-Based Intervention to Promote Mental Health and Well-Being in a Vulnerable Population of University Students: Randomized Controlled Trial of the Be Well Plan Program %A Fassnacht,Daniel B %A Ali,Kathina %A van Agteren,Joep %A Iasiello,Matthew %A Mavrangelos,Teri %A Furber,Gareth %A Kyrios,Michael %+ College of Education, Psychology and Social Work, Flinders University, Sturt Road, Bedford Park, Adelaide, 5042, Australia, 61 8 8201 2621, dan.fassnacht@flinders.edu.au %K COVID-19 %K mental health %K well-being %K depression %K anxiety %K online %K digital %K intervention %K Be Well Plan %K health outcome %K online health %K digital health %K health intervention %K primary outcome %K cognition %K randomized control trial %K resilience %K participant satisfaction %K student %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: A growing literature supports the use of internet-based interventions to improve mental health outcomes. However, most programs target specific symptoms or participant groups and are not tailored to facilitate improvements in mental health and well-being or do not allow for needs and preferences of individual participants. The Be Well Plan, a 5-week group-facilitated, internet-based mental health and well-being group intervention addresses these gaps, allowing participants to select a range of activities that they can tailor to their specific characteristics, needs, and preferences. Objective: This study aims to test whether the Be Well Plan program was effective in improving primary outcomes of mental well-being, resilience, anxiety, and depression compared to a waitlist control group during the COVID-19 pandemic; secondary outcomes included self-efficacy, a sense of control, and cognitive flexibility. The study further seeks to examine participants’ engagement and satisfaction with the program. Methods: A randomized controlled trial (RCT) was conducted with 2 parallel arms, an intervention and a waitlist control group. The intervention involved 5 weekly 2-hour sessions, which were facilitated in group format using Zoom videoconferencing software. University students were recruited via social media posts, lectures, emails, flyers, and posters. Results: Using an intentional randomization 2:1 allocation strategy, we recruited 215 participants to the trial (n=126, 58.6%, intervention group; n=89, 41.4%, waitlist control group). Of the 126 participants assigned to the intervention group, 75 (59.5%) commenced the program and were included in modified intention-to-treat (mITT) analyses. mITT intervention participants attended, on average, 3.41 sessions (SD 1.56, median 4); 55 (73.3%) attended at least 4 sessions, and 25 (33.3%) attended all 5 sessions. Of the 49 intervention group participants who completed the postintervention assessment, 47 (95.9%) were either very satisfied (n=31, 66%) or satisfied (n=16, 34%). The mITT analysis for well-being (F1,162=9.65, P=.002, Cohen d=0.48) and resilience (F1,162=7.85, P=.006, Cohen d=0.44) showed significant time × group interaction effects, suggesting that both groups improved over time, but the Be Well Plan (intervention) group showed significantly greater improvement compared to the waitlist control group. A similar pattern of results was observed for depression and anxiety (Cohen d=0.32 and 0.37, respectively), as well as the secondary outcomes (self-efficacy, Cohen d=0.50; sense of control, Cohen d=0.42; cognitive flexibility, Cohen d=0.65). Larger effect sizes were observed in the completer analyses. Reliable change analysis showed that the majority of mITT participants (58/75, 77.3%) demonstrated a significant reliable improvement in at least 1 of the primary outcomes. Conclusions: The Be Well Plan program was effective in improving mental health and well-being, including mental well-being, resilience, depression, and anxiety. Participant satisfaction scores and attendance indicated a high degree of engagement and satisfaction with the program. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12621000180819; https://tinyurl.com/2p8da5sk %M 35471196 %R 10.2196/37292 %U https://mental.jmir.org/2022/5/e37292 %U https://doi.org/10.2196/37292 %U http://www.ncbi.nlm.nih.gov/pubmed/35471196 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e26438 %T Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study %A Korpilahti-Leino,Tarja %A Luntamo,Terhi %A Ristkari,Terja %A Hinkka-Yli-Salomäki,Susanna %A Pulkki-Råback,Laura %A Waris,Otto %A Matinolli,Hanna-Maria %A Sinokki,Atte %A Mori,Yuko %A Fukaya,Mami %A Yamada,Yuko %A Sourander,Andre %+ Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Lemminkäisenkatu 3, Turku, 20520, Finland, 358 50 365 3447, andre.sourander@utu.fi %K adolescent %K anxiety %K child %K cognitive behavioral therapy %K coping %K COVID-19 %K Internet %K mental health %K parents %K web-based %D 2022 %7 13.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had a major impact on families’ daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services. Objective: The first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children’s anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention. Methods: The Let’s Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program. Results: Of the 602 participants who filled in the baseline survey, 196 (32.6%) completed the program’s 7 themes, and 189 (31.4%) completed the postintervention survey. Most (138/189, 73.0%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6%) and their children’s anxiety (157/189, 83.1%). The majority (157/189, 83.1%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0%) reported that the program improved how they planned each day with their children. Conclusions: The single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery. %M 35138265 %R 10.2196/26438 %U https://www.jmir.org/2022/4/e26438 %U https://doi.org/10.2196/26438 %U http://www.ncbi.nlm.nih.gov/pubmed/35138265 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e33473 %T Web-Based Single Session Intervention for Perceived Control Over Anxiety During COVID-19: Randomized Controlled Trial %A Mullarkey,Michael %A Dobias,Mallory %A Sung,Jenna %A Ahuvia,Isaac %A Shumake,Jason %A Beevers,Christopher %A Schleider,Jessica %+ Department of Psychology, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY, 11794, United States, 1 6316326000, Michael.Mullarkey@stonybrook.edu %K anxiety %K COVID-19 %K single-session intervention %K SSI %K perceived control %K intervention %K mental health %K control %K online intervention %K telemedicine %K telehealth %K scalable %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anxiety is rising across the United States during the COVID-19 pandemic, and social distancing mandates preclude in-person mental health care. Greater perceived control over anxiety has predicted decreased anxiety pathology, including adaptive responses to uncontrollable stressors. Evidence suggests that no-therapist, single-session interventions can strengthen perceived control over emotions like anxiety; similar programs, if designed for the COVID-19 context, could hold substantial public health value. Objective: Our registered report evaluated a no-therapist, single-session, online intervention targeting perceived control over anxiety in the COVID-19 context against a placebo intervention encouraging handwashing. We tested whether the intervention could (1) decrease generalized anxiety and increase perceived control over anxiety and (2) achieve this without decreasing social-distancing intentions. Methods: We tested these questions using a between-subjects design in a weighted-probability sample of US adults recruited via a closed online platform (ie, Prolific). All outcomes were indexed via online self-report questionnaires. Results: Of 522 randomized individuals, 500 (95.8%) completed the baseline survey and intervention. Intent-to-treat analyses using all randomized participants (N=522) found no support for therapeutic or iatrogenic effects; effects on generalized anxiety were d=–0.06 (95% CI –0.27 to 0.15; P=.48), effects on perceived control were d=0.04 (95% CI –0.08 to 0.16; P=.48), and effects on social-distancing intentions were d=–0.02 (95% CI –0.23 to 0.19; P=.83). Conclusions: Strengths of this study included a large, nationally representative sample and adherence to open science practices. Implications for scalable interventions, including the challenge of targeting perceived control over anxiety, are discussed. Trial Registration: ClinicalTrials.gov NCT04459455; https://clinicaltrials.gov/show/NCT04459455 %M 35230962 %R 10.2196/33473 %U https://mental.jmir.org/2022/4/e33473 %U https://doi.org/10.2196/33473 %U http://www.ncbi.nlm.nih.gov/pubmed/35230962 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e36217 %T Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel %A Jaworski,Beth K %A Taylor,Katherine %A Ramsey,Kelly M %A Heinz,Adrienne J %A Steinmetz,Sarah %A Owen,Jason E %A Tsai,Jack %A Pietrzak,Robert H %+ National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 18312781567, beth.jaworski@nih.gov %K COVID-19 %K coronavirus %K mobile app %K mHealth %K digital health %K mental health %K public mental health %K stress %K coping %K older adults %K veterans %D 2022 %7 5.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored. Objective: The purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. Methods: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021. Results: We found that most US veterans (81.5%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3% of eligible participants, n=34), 50% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently. Conclusions: The COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan. %M 35245204 %R 10.2196/36217 %U https://mental.jmir.org/2022/4/e36217 %U https://doi.org/10.2196/36217 %U http://www.ncbi.nlm.nih.gov/pubmed/35245204 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e34002 %T Brief Digital Interventions to Support the Psychological Well-being of NHS Staff During the COVID-19 Pandemic: 3-Arm Pilot Randomized Controlled Trial %A De Kock,Johannes H %A Latham,Helen Ann %A Cowden,Richard G %A Cullen,Breda %A Narzisi,Katia %A Jerdan,Shaun %A Munoz,Sarah-Anne %A Leslie,Stephen J %A Stamatis,Andreas %A Eze,Jude %+ Division of Rural Health and Wellbeing, Institute of Health Research and Innovation, School of Health, University of the Highlands and Islands, 12b Ness Walk, Inverness, IV3 5SQ, United Kingdom, 44 01463 255000, Hannes.De@nhs.scot %K eHealth %K public health %K depression %K anxiety %K well-being %K mobile health %K intervention studies %K staff %K occupational health %K NHS %K intervention %K support %K COVID-19 %K randomized controlled trial %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Health and social care staff are at high risk of experiencing adverse mental health (MH) outcomes during the COVID-19 pandemic. Hence, there is a need to prioritize and identify ways to effectively support their psychological well-being (PWB). Compared to traditional psychological interventions, digital psychological interventions are cost-effective treatment options that allow for large-scale dissemination and transcend social distancing, overcome rurality, and minimize clinician time. Objective: This study reports MH outcomes of a Consolidated Standards of Reporting Trials (CONSORT)-compliant parallel-arm pilot randomized controlled trial (RCT) examining the potential usefulness of an existing and a novel digital psychological intervention aimed at supporting psychological health among National Health Service (NHS) staff working through the COVID-19 pandemic. Methods: NHS Highland (NHSH) frontline staff volunteers (N=169) were randomly assigned to the newly developed NHSH Staff Wellbeing Project (NHSWBP), an established digital intervention (My Possible Self [MPS]), or a waitlist (WL) group for 4 weeks. Attempts were made to blind participants to which digital intervention they were allocated. The interventions were fully automated, without any human input or guidance. We measured 5 self-reported psychological outcomes over 3 time points: before (baseline), in the middle of (after 2 weeks), and after treatment (4 weeks). The primary outcomes were anxiety (7-item General Anxiety Disorder), depression (Patient Health Questionnaire), and mental well-being (Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes included mental toughness (Mental Toughness Index) and gratitude (Gratitude Questionnaire-6). Results: Retention rates mid- and postintervention were 77% (n=130) and 63.3% (n=107), respectively. Postintervention, small differences were noted between the WL and the 2 treatment groups on anxiety (vs MPS: Cohen d=0.07, 95% CI –0.20 to 0.33; vs NHSWBP: Cohen d=0.06, 95% CI –0.19 to 0.31), depression (vs MPS: Cohen d=0.37, 95% CI 0.07-0.66; vs NHSWBP: Cohen d=0.18, 95% CI –0.11 to 0.46), and mental well-being (vs MPS: Cohen d=–0.04, 95% CI –0.62 to –0.08; vs NHSWBP: Cohen d=–0.15, 95% CI –0.41 to 0.10). A similar pattern of between-group differences was found for the secondary outcomes. The NHSWBP group generally had larger within-group effects than the other groups and displayed a greater rate of change compared to the other groups on all outcomes, except for gratitude, where the rate of change was greatest for the MPS group. Conclusions: Our analyses provided encouraging results for the use of brief digital psychological interventions in improving PWB among health and social care workers. Future multisite RCTs, with power to reliably detect differences, are needed to determine the efficacy of contextualized interventions relative to existing digital treatments. Trial Registration: ISRCTN Registry (ISRCTN) ISRCTN18107122; https://www.isrctn.com/ISRCTN18107122 %M 35044927 %R 10.2196/34002 %U https://mental.jmir.org/2022/4/e34002 %U https://doi.org/10.2196/34002 %U http://www.ncbi.nlm.nih.gov/pubmed/35044927 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e34134 %T Application of a Web-based Self-assessment Triage Tool During the COVID-19 Pandemic: Descriptive Study %A Nowicka,Anna %A Jaszczak,Jakub %A Szymanek Pasternak,Anna %A Simon,Krzysztof %+ Provincial Specialist Hospital them. J. Gromkowski, Koszarowa 5, Wrocław, 51-149, Poland, 48 660427576, nowickanna@gmail.com %K COVID-19 %K symptom checker %K preclinical triage %K self-assessment tool %K online applications %K COVID-19 remote triage %K COVID-19 self-assessment %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has sped up the implementation of telehealth solutions in medicine. A few symptom checkers dedicated for COVID-19 have been described, but it remains unclear whether and how they can affect patients and health systems. Objective: This paper demonstrates our experiences with the COVID-19 risk assessment (CRA) tool. We tried to determine who the user of the web-based COVID-19 triage app is and compare this group with patients in the infectious diseases ward’s admission room to evaluate who could benefit from implementing the COVID-19 online symptom checker as a remote triage solution. Methods: We analyzed the answers of 248,862 people interacting with an online World Health Organization–based triage tool for assessing the probability of SARS-CoV-2 infection. These users filled in an online questionnaire between April 7 and August 6, 2020. Based on the presented symptoms, risk factors, and demographics, the tool assessed whether the user’s answers were suggestive of COVID-19 and recommended appropriate action. Subsequently, we compared the sociodemographic and clinical characteristics of tool users with patients admitted to the Infectious Diseases Admission Room of J. Gromkowski Hospital in Wrocław. Results: The CRA tool tended to be used by asymptomatic or oligosymptomatic individuals (171,226 [68.80%] of all users). Most users were young (162,432 [65.27%] were below 40 years of age) and without comorbidities. Only 77,645 (31.20%) of the self-assessment app users were suspected of COVID-19 based on their reported symptoms. On the contrary, most admission room patients were symptomatic—symptoms such as fever, cough, and dyspnea were prevalent in both COVID-19-positive and COVID-19-negative patients. COVID-19-suspected patients in the CRA tool group presented similar COVID-19 symptoms as those who presented to the admission room. These were cough (25,062/40,007 [62.64%] in the CRA tool group vs 138/232 [59.48%] in the admission room group), fever (23,123/40,007 [57.80%] in the CRA tool group vs 146/232 [62.93%] in the admission room group), and shortness of breath (15,157/40,007 [37.89%] in the CRA tool group vs 87/232 [37.50%] in the admission room group). Conclusions: The comparison between the symptomatology of the users interacting with the CRA tool and those visiting the admission room revealed 2 major patient groups who could have benefited from the implementation of the self-assessment app in preclinical triage settings. The primary users of the CRA tool were young, oligosymptomatic individuals looking for screening for COVID-19 and reassurance early in the COVID-19 pandemic. The other group were users presenting the typical symptoms suggestive of COVID-19 at that time. The CRA tool recognized these individuals as potentially COVID-19 positive and directed them to the proper level of care. These use cases fulfil the idea of preclinical triage; however, the accuracy and influence on health care must be examined in the clinical setting. %M 35168192 %R 10.2196/34134 %U https://humanfactors.jmir.org/2022/2/e34134 %U https://doi.org/10.2196/34134 %U http://www.ncbi.nlm.nih.gov/pubmed/35168192 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32387 %T Effects of COVID-19 on Physical Activity and Its Relationship With Mental Health in a US Community Sample: Cross-sectional, Convenience Sampling–based Online Survey %A Zhang,Wei %A Velez,Dominick %+ Department of Psychology, New Jersey City University, 2039 John F. Kennedy Blvd, Jersey City, NJ, 07305, United States, 1 2012002000 ext 3063, wzhang@njcu.edu %K physical activity %K COVID-19 %K mental health %K depression %K anxiety %K United States %K survey %K cross-sectional %K distress %K risk %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 restrictions may make it difficult for people to engage in the recommended amounts of physical activity (PA). Objective: The influence of the COVID-19 pandemic on PA, as well as the links between PA and mental health, was investigated in this study. Methods: Participants were recruited using convenience sampling and responded to an online survey between April 15 and July 1, 2021, with ages ranging from 18 to 24 years (n=156, 40.9% of the sample) to ≥55 years (n=28, 7.4% of the sample). To assess general psychological distress, depression, anxiety, and pandemic anxiety, a battery of mental health assessments was used. The International Physical Activity Questionnaire - Short Form was used to collect PA data from participants, who were then classified as inactive, minimally active, or highly active. Participants also indicated the locations where they performed PA before and during COVID-19. Results: A sample of 381 individuals was included in this research. The logistic regression analysis results were interpreted as odds ratios (ORs), where an OR higher than 1 indicated a greater chance of an event occurring and an OR less than 1 implied a lower likelihood of an event occurring. Logistic regression results revealed that inactive individuals were more likely to develop psychological distress (OR 2.17, 95% CI 1.27-3.69, P=.004), depression (OR 3.81, 95% CI 1.92-7.57, P<.001), and anxiety (OR 1.86, 95% CI 0.99-3.47, P=.05) as compared to highly active individuals. Furthermore, when compared to highly active people, those who were only minimally active had a higher risk of depression (OR 2.14, 95% CI 1.05-4.33, P=.04). Wilcoxon signed-rank tests revealed that COVID-19 has a greater impact on reducing the chances of less active individuals engaging in PA outside and in public spaces. Highly active people's physical exercise locations had changed less, and their exercise frequency at home increased. Conclusions: Programmatic and policy interventions geared particularly toward enhancing PA among those less active may be a helpful strategy for addressing the worldwide pandemic’s mental health crisis. %M 35302509 %R 10.2196/32387 %U https://formative.jmir.org/2022/4/e32387 %U https://doi.org/10.2196/32387 %U http://www.ncbi.nlm.nih.gov/pubmed/35302509 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32449 %T Using Natural Language Processing to Explore Mental Health Insights From UK Tweets During the COVID-19 Pandemic: Infodemiology Study %A Marshall,Christopher %A Lanyi,Kate %A Green,Rhiannon %A Wilkins,Georgina C %A Pearson,Fiona %A Craig,Dawn %+ National Institute for Health Research Innovation Observatory, Newcastle University, The Catalyst, Newcastle, NE4 5TG, United Kingdom, 44 0191 2082259, chris.marshall@io.nihr.ac.uk %K Twitter %K mental health %K COVID-19 %K sentiment %K lockdown %K soft intelligence %K artificial intelligence %K machine learning %K natural language processing %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: There is need to consider the value of soft intelligence, leveraged using accessible natural language processing (NLP) tools, as a source of analyzed evidence to support public health research outputs and decision-making. Objective: The aim of this study was to explore the value of soft intelligence analyzed using NLP. As a case study, we selected and used a commercially available NLP platform to identify, collect, and interrogate a large collection of UK tweets relating to mental health during the COVID-19 pandemic. Methods: A search strategy comprised of a list of terms related to mental health, COVID-19, and lockdown restrictions was developed to prospectively collate relevant tweets via Twitter’s advanced search application programming interface over a 24-week period. We deployed a readily and commercially available NLP platform to explore tweet frequency and sentiment across the United Kingdom and identify key topics of discussion. A series of keyword filters were used to clean the initial data retrieved and also set up to track specific mental health problems. All collated tweets were anonymized. Results: We identified and analyzed 286,902 tweets posted from UK user accounts from July 23, 2020 to January 6, 2021. The average sentiment score was 50%, suggesting overall neutral sentiment across all tweets over the study period. Major fluctuations in volume (between 12,622 and 51,340) and sentiment (between 25% and 49%) appeared to coincide with key changes to any local and/or national social distancing measures. Tweets around mental health were polarizing, discussed with both positive and negative sentiment. Key topics of consistent discussion over the study period included the impact of the pandemic on people’s mental health (both positively and negatively), fear and anxiety over lockdowns, and anger and mistrust toward the government. Conclusions: Using an NLP platform, we were able to rapidly mine and analyze emerging health-related insights from UK tweets into how the pandemic may be impacting people’s mental health and well-being. This type of real-time analyzed evidence could act as a useful intelligence source that agencies, local leaders, and health care decision makers can potentially draw from, particularly during a health crisis. %M 36406146 %R 10.2196/32449 %U https://infodemiology.jmir.org/2022/1/e32449 %U https://doi.org/10.2196/32449 %U http://www.ncbi.nlm.nih.gov/pubmed/36406146 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e35677 %T Using Twitter to Examine Stigma Against People With Dementia During COVID-19: Infodemiology Study %A Bacsu,Juanita-Dawne %A Fraser,Sarah %A Chasteen,Alison L %A Cammer,Allison %A Grewal,Karl S %A Bechard,Lauren E %A Bethell,Jennifer %A Green,Shoshana %A McGilton,Katherine S %A Morgan,Debra %A O’Rourke,Hannah M %A Poole,Lisa %A Spiteri,Raymond J %A O'Connell,Megan E %+ Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 306 250 4399, juanita.bacsu@usask.ca %K coronavirus 2019 %K social media %K stigma %K dementia %K ageism %K COVID-19 %K Twitter %K bias %K infodemiology %K attention %K risk %K impact %K misinformation %K belief %K cognition %K cognitive impairment %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: During the pandemic, there has been significant social media attention focused on the increased COVID-19 risks and impacts for people with dementia and their care partners. However, these messages can perpetuate misconceptions, false information, and stigma. Objective: This study used Twitter data to understand stigma against people with dementia propagated during the COVID-19 pandemic. Methods: We collected 1743 stigma-related tweets using the GetOldTweets application in Python from February 15 to September 7, 2020. Thematic analysis was used to analyze the tweets. Results: Based on our analysis, 4 main themes were identified: (1) ageism and devaluing the lives of people with dementia, (2) misinformation and false beliefs about dementia and COVID-19, (3) dementia used as an insult for political ridicule, and (4) challenging stigma against dementia. Social media has been used to spread stigma, but it can also be used to challenge negative beliefs, stereotypes, and false information. Conclusions: Dementia education and awareness campaigns are urgently needed on social media to address COVID-19-related stigma. When stigmatizing discourse on dementia is widely shared and consumed amongst the public, it has public health implications. How we talk about dementia shapes how policymakers, clinicians, and the public value the lives of people with dementia. Stigma perpetuates misinformation, pejorative language, and patronizing attitudes that can lead to discriminatory actions, such as the limited provision of lifesaving supports and health services for people with dementia during the pandemic. COVID-19 policies and public health messages should focus on precautions and preventive measures rather than labeling specific population groups. %M 35290197 %R 10.2196/35677 %U https://aging.jmir.org/2022/1/e35677 %U https://doi.org/10.2196/35677 %U http://www.ncbi.nlm.nih.gov/pubmed/35290197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31088 %T Stratified Impacts of the Infodemic During the COVID-19 Pandemic: Cross-sectional Survey in 6 Asian Jurisdictions %A Chen,Xi %A Lin,Fen %A Cheng,Edmund W %+ Department of Media and Communication, City University of Hong Kong, M5086, 5/F, Run Run Shaw Creative Media Centre, 18 Tat Hong Avenue, Kowloon Tong, Hong Kong, 852 34428691, fenlin@cityu.edu.hk %K infodemic %K information overload %K psychological distress %K protective behavior %K cross-national survey %K Asia %K COVID-19 %D 2022 %7 22.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although timely and accurate information during the COVID-19 pandemic is essential for containing the disease and reducing mental distress, an infodemic, which refers to an overabundance of information, may trigger unpleasant emotions and reduce compliance. Prior research has shown the negative consequences of an infodemic during the pandemic; however, we know less about which subpopulations are more exposed to the infodemic and are more vulnerable to the adverse psychological and behavioral effects. Objective: This study aimed to examine how sociodemographic factors and information-seeking behaviors affect the perceived information overload during the COVID-19 pandemic. We also investigated the effect of perceived information overload on psychological distress and protective behavior and analyzed the socioeconomic differences in the effects. Methods: The data for this study were obtained from a cross-national survey of residents in 6 jurisdictions in Asia in May 2020. The survey targeted residents aged 18 years or older. A probability-based quota sampling strategy was adopted to ensure that the selected samples matched the population’s geographical and demographic characteristics released by the latest available census in each jurisdiction. The final sample included 10,063 respondents. Information overload about COVID-19 was measured by asking the respondents to what extent they feel overwhelmed by news related to COVID-19. The measure of psychological distress was adapted from the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Protective behaviors included personal hygienic behavior and compliance with social distancing measures. Results: Younger respondents and women (b=0.20, 95% CI 0.14 to 0.26) were more likely to perceive information overload. Participants self-perceived as upper or upper-middle class (b=0.19, 95% CI 0.09 to 0.30) and those with full-time jobs (b=0.11, 95% CI 0.04 to 0.17) tended to perceive higher information overload. Respondents who more frequently sought COVID-19 information from newspapers (b=0.12, 95% CI 0.11 to 0.14), television (b=0.07, 95% CI 0.05 to 0.09), and family and friends (b=0.11, 95% CI 0.09 to 0.14) were more likely to feel overwhelmed. In contrast, obtaining COVID-19 information from online news outlets and social media was not associated with perceived information overload. There was a positive relationship between perceived information overload and psychological distress (b=2.18, 95% CI 2.09 to 2.26). Such an association was stronger among urban residents, full-time employees, and those living in privately owned housing. The effect of perceived information overload on protective behavior was not significant. Conclusions: Our findings revealed that respondents who were younger, were female, had a higher socioeconomic status (SES), and had vulnerable populations in the household were more likely to feel overwhelmed by COVID-19 information. Perceived information overload tended to increase psychological distress, and people with higher SES were more vulnerable to this adverse psychological consequence. Effective policies and interventions should be promoted to target vulnerable populations who are more susceptible to the occurrence and negative psychological influence of perceived information overload. %M 35103601 %R 10.2196/31088 %U https://www.jmir.org/2022/3/e31088 %U https://doi.org/10.2196/31088 %U http://www.ncbi.nlm.nih.gov/pubmed/35103601 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e35221 %T Socioeconomic Disparities in the Demand for and Use of Virtual Visits Among Senior Adults During the COVID-19 Pandemic: Cross-sectional Study %A Yu,Ellie %A Hagens,Simon %+ Canada Health Infoway, 150 King Street Unit 1300, Toronto, ON, M5H 1J9, Canada, 1 6476406189, ellieyuyaoyu@gmail.com %K virtual care %K virtual visit %K COVID-19 %K survey %K virtual care demand %K virtual care use %K older adults %K elderly care %K aging %K digital health %K pandemic %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic has limited the provision of in-person care and accelerated the need for virtual care. Older adults (65+ years) were 1 of the highest user groups of in-person health care services prior to the pandemic. Social distancing guidelines and high rates of mortality from coronavirus infections among older adults made receiving in-person health care services challenging for older adults. The provision of virtual care technologies can help to ensure continuity of care and provide essential health care services during the pandemic to those at high risk of contracting the COVID-19 coronavirus, including older adults. It is also essential to understand and address potential socioeconomic, demographic, and health disparities in the demand for and use of virtual care technologies among older adults. Objective: The objective of this study is to investigate socioeconomic disparities in the demand for and use of virtual visits during the COVID-19 pandemic among older adults in Canada. Methods: A cross-sectional web survey was conducted with 12,052 Canadians over the age of 16 years, selected from Leger’s Léger Opinion panel from July 14 to August 6, 2021. Associations between socioeconomic factors and the demand for and use of virtual visits were tested using χ2 tests and logistic regression models for telephone visits, video visits, and secure messaging. Weighting was applied using the 2016 census reference variables to render a representative sample of the Canadian population. Results: A total of 2303 older adults were surveyed. Older adults expressed the highest demand for and use of telephone visits, following by video visits and secure messaging. eHealth literacy was positively associated with the use of all 3 virtual care modalities. Higher income was negatively associated with the use of video visits (odds ratio [OR] 0.65, 95% CI 0.428-0.974, P=.03). Having no private insurance coverage was negatively associated with use of secure messaging (OR 0.73, 95% CI 0.539-0.983, P=.04), but living in a rural community (OR 0.172, 95% CI 1.12-2.645, P=.01) and being born outside of Canada (OR 0.150, 95% CI 1.041-2.173, P=.03) were positively associated with the use of secure messaging. Higher education (OR 0.078, 95% CI 0.633-0.97, P=.02) and being non-White (OR=0.054, 95% CI 0.312-0.92, P=.02) were negatively associated with the use of the telephone. Conclusions: This study found that compared to video visits and secure messaging, the demand for and use of telephone visits were more prevalent among older adults during the pandemic. The gaps between the demand for and use of video and secure messaging services remain substantial. Our results highlight socioeconomic disparities among older adults that could potentially explain this trend. Lower income and a lower education level may act as barriers for older adults in acquiring the skills and technologies necessary to use more complex solutions, such as video and secure messaging. In addition, higher eHealth literacy was found to be critical for older adults to successfully navigate all types of virtual visit technologies. %M 35134746 %R 10.2196/35221 %U https://aging.jmir.org/2022/1/e35221 %U https://doi.org/10.2196/35221 %U http://www.ncbi.nlm.nih.gov/pubmed/35134746 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e35280 %T COVID-19 Mental Health Stressors of Health Care Providers in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Intervention: Qualitative Study %A Sato,Christa %A Adumattah,Anita %A Abulencia,Maria Krisel %A Garcellano,Peter Dennis %A Li,Alan Tai-Wai %A Fung,Kenneth %A Poon,Maurice Kwong-Lai %A Vahabi,Mandana %A Wong,Josephine Pui-Hing %+ Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, M5B2K3, Canada, 1 416 979 5000 ext 556303, jph.wong@ryerson.ca %K COVID-19 %K COVID-19 in Canada %K health care providers %K pandemic stressors %K health impact %K caregiving roles %K situational identities %K emotional labor %K hero discourse %K social ecological framework %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the pandemic, more Canadians have reported poorer mental health. A vital group experiencing a high level of stressors consists of health care providers (HCPs) caring for COVID-19 patients, carrying out public health responses, or working with vulnerable populations. The mental health of HCPs is negatively affected by the pandemic, not only at work but also at home and in the community. Intersecting stressors at multiple levels contribute to HCPs’ experiences of fatigue, insomnia, anxiety, depression, and posttraumatic stress symptoms. Objective: The aim of this qualitative study was to explore the pandemic stressors experienced by HCPs at work, at home, and in the community before participating in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) online intervention. Methods: Informed by a social ecological approach, we used a qualitative reflective approach to engage 74 HCPs in diverse roles. Data were collected during the first 2 waves of the COVID-19 pandemic (June 2020 to February 2021) in Canada. Results: Informed by a social ecological framework, 5 overarching themes were identified in our thematic analysis: (1) personal level stressors that highlight HCPs’ identities and responsibilities beyond the workplace; (2) interpersonal level stressors from disrupted social relationships; (3) organizational stressors that contributed to unsettled workplaces and moral distress; (4) community and societal stressors attributed to vicarious trauma and emotional labor; and (5) the multilevel and cumulative impacts of COVID-19 stressors on HCPs’ health. Conclusions: COVID-19 is not merely a communicable disease but also a social and political phenomenon that intensifies the effects of social inequities. Current understanding of pandemic stressors affecting HCPs is largely partial in nature. Although workplace stressors of HCPs are real and intense, they need to be explored and understood in the context of stressors that exist in other domains of HCPs’ lives such as family and community to ensure these experiences are not being silenced by the “hero” discourses or overshadowed by professional demands. %M 35138256 %R 10.2196/35280 %U https://formative.jmir.org/2022/3/e35280 %U https://doi.org/10.2196/35280 %U http://www.ncbi.nlm.nih.gov/pubmed/35138256 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32598 %T The Impact of COVID-19 Lockdown on Daily Activities, Cognitions, and Stress in a Lonely and Distressed Population: Temporal Dynamic Network Analysis %A Haucke,Matthias %A Heinz,Andreas %A Liu,Shuyan %A Heinzel,Stephan %+ Department of Psychiatry and Neurosciences, Charité–Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, Berlin, 10117, Germany, 49 015155710318, matthias.haucke@fu-berlin.de %K COVID-19 %K mental health %K outbreak %K epidemic %K pandemic %K psychological response %K emotional well-being %K ecological momentary assessment %K risk %K protective factors %K lockdown measures %K loneliness %K mood inertia %K stressors %K mobile apps %K mHealth %K digital health %K EMA %K smartphone apps %K network model %K cognition %K stress %K temporal dynamic network %K permutation testing %K network comparison %K network characteristics %K multilevel vector autoregressive model %K mlVAR %D 2022 %7 17.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic and its associated lockdown measures impacted mental health worldwide. However, the temporal dynamics of causal factors that modulate mental health during lockdown are not well understood. Objective: We aimed to understand how a COVID-19 lockdown changes the temporal dynamics of loneliness and other factors affecting mental health. This is the first study that compares network characteristics between lockdown stages to prioritize mental health intervention targets. Methods: We combined ecological momentary assessments with wrist-worn motion tracking to investigate the mechanism and changes in network centrality of symptoms and behaviors before and during lockdown. A total of 258 participants who reported at least mild loneliness and distress were assessed 8 times a day for 7 consecutive days over a 213-day period from August 8, 2020, through March 9, 2021, in Germany, covering a “no-lockdown” and a “lockdown” stage. COVID-19–related worry, information-seeking, perceived restriction, and loneliness were assessed by digital visual analog scales ranging from 0 to 100. Social activity was assessed on a 7-point Likert scale, while physical activity was recorded from wrist-worn actigraphy devices. Results: We built a multilevel vector autoregressive model to estimate dynamic networks. To compare network characteristics between a no-lockdown stage and a lockdown stage, we performed permutation tests. During lockdown, loneliness had the highest impact within the network, as indicated by its centrality index (ie, an index to identify variables that have a strong influence on the other variables). Moreover, during lockdown, the centrality of loneliness significantly increased. Physical activity contributed to a decrease in loneliness amid the lockdown stage. Conclusions: The COVID-19 lockdown increased the central role of loneliness in triggering stress-related behaviors and cognition. Our study indicates that loneliness should be prioritized in mental health interventions during lockdown. Moreover, physical activity can serve as a buffer for loneliness amid social restrictions. %M 35191843 %R 10.2196/32598 %U https://www.jmir.org/2022/3/e32598 %U https://doi.org/10.2196/32598 %U http://www.ncbi.nlm.nih.gov/pubmed/35191843 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e31552 %T The Use of Technology Among Persons With Memory Concerns and Their Caregivers in the United States During the COVID-19 Pandemic: Qualitative Study %A Albers,Elizabeth A %A Mikal,Jude %A Millenbah,Ashley %A Finlay,Jessica %A Jutkowitz,Eric %A Mitchell,Lauren %A Horn,Brenna %A Gaugler,Joseph E %+ Division of Health Policy and Management, School of Public Health, University of Minnesota, D351 Mayo, 420 Delaware St SE, Minneapolis, MN, 55455, United States, 1 6124540415, alber304@umn.edu %K social isolation %K dementia %K caregiving - informal %K aging in place %K caregivers %K aging %K elderly %K pandemic %K COVID-19 %K mental health %K technology use %K health technology %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Stay-at-home orders and other public health measures designed to mitigate the spread of COVID-19 have increased isolation among persons with memory concerns (PWMCs: individuals diagnosed with cognitive impairment or Alzheimer disease or related dementias). The pandemic has also exacerbated challenges for family members who care for PWMCs. Although technology has demonstrated the potential to improve the social connections and mental health of PWMCs and their family caregivers (CGs), previous research shows that older adults may be reluctant to adopt new technologies. Objective: We aimed to understand why and how some PWMCs and their CGs altered their use of mainstream technology, such as smartphones and fitness trackers, and assistive technology to adapt to lifestyle changes (eg, increased isolation) during the COVID-19 pandemic. Methods: Using data collected in 20 qualitative interviews from June to August 2020 with 20 PWMCs and family CG dyads, we assessed changes in and barriers to everyday technology use following the implementation of COVID-19 mitigation strategies in the United States. Zoom videoconferencing was utilized to conduct the interviews to protect the health of the participants who were primarily older adults. Results: Using qualitative thematic analysis, we identified 3 themes that explained motivations for using technology during a pandemic: (1) maintaining social connections, (2) alleviating boredom, and (3) increasing CG respite. Results further revealed lingering barriers to PWMC and CG adoption of technologies, including: (1) PWMC dependence upon CGs, (2) low technological literacy, and (3) limitations of existing technology. Conclusions: This in-depth investigation suggests that technology can provide PWMCs with more independence and offer CGs relief from CG burden during periods of prolonged isolation. %M 35134748 %R 10.2196/31552 %U https://aging.jmir.org/2022/1/e31552 %U https://doi.org/10.2196/31552 %U http://www.ncbi.nlm.nih.gov/pubmed/35134748 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e30778 %T Influence of Forced Online Distance Education During the COVID-19 Pandemic on the Perceived Stress of Postsecondary Students: Cross-sectional Study %A Šorgo,Andrej %A Crnkovič,Nuša %A Gabrovec,Branko %A Cesar,Katarina %A Selak,Špela %+ National Institute of Public Health, Trubarjeva cesta 2, Ljubljana, 1000, Slovenia, 386 1 620 36 45, spela.selak@nijz.si %K online study %K stress %K COVID-19 %K postsecondary students %K pandemic %K epidemiology %K educational institutions %K online education %K pedagogy %K mental health %D 2022 %7 15.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the most significant changes in the majority of postsecondary educational institutions was the closure of those institutions and the shift of educational activities to online distance learning formats as a result of the COVID-19 pandemic. Closure combined with forced online distance education (FODE) was a cure with many side effects, 1 of them being the effect on students’ mental health and, more specifically, levels of stress. Due to the novelty of the situation, there have been no studies so far designed to link satisfaction with online study, feelings toward the study obligations, and stress among students. Objective: The aim of the study is to assess the perceived stress of Slovenian postsecondary students in order to identify the online study–related factors affecting or acting as a covariate during the COVID-19 lockdown. Methods: Data collection was conducted through a self-reported survey as part of a large cross-sectional study based on data collected from postsecondary students from a number of higher educational institutions. The random sample consisted of 4455 individuals. The Perceived Stress Scale (PSS-4), Satisfaction with Online Study Scale (SAT-5), and Feelings Towards Study Obligations Scale (FETSOS) were used to assess the constructs and the relations observed within the study. Results: The results indicate that more than half of all respondents reported high levels of stress. The difference in the reported levels of perceived stress between genders were statistically significant (N=4454, F2=56.719, P<.001, Cohen d=0.35). Overall, the results suggest that a decline in the motivation to study, the quality of internet and mobile connections, and the presence of distracting factors in the study space were the 3 main factors related to the students’ negative emotions as associated with the timeliness, performance, and quality of the study obligations. Furthermore, the results show that the level of satisfaction with online study affected stress such that the higher the satisfaction, the lower the stress. Moreover, the more positive feelings connected with the timeliness, performance, and quality of the study obligations that the students felt, the more satisfaction they reported with online study and, thus indirectly, lower stress and less negative feelings. Conclusions: The findings of this study call for implementing structures and measures targeted at stress reduction, working conditions, and pedagogy with regard to FODE. %M 35171098 %R 10.2196/30778 %U https://www.jmir.org/2022/3/e30778 %U https://doi.org/10.2196/30778 %U http://www.ncbi.nlm.nih.gov/pubmed/35171098 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e36263 %T Telehealth Services for Substance Use Disorders During the COVID-19 Pandemic: Longitudinal Assessment of Intensive Outpatient Programming and Data Collection Practices %A Gliske,Kate %A Welsh,Justine W %A Braughton,Jacqueline E %A Waller,Lance A %A Ngo,Quyen M %+ Butler Center for Research, Hazelden Betty Ford Foundation, 15251 Pleasant Valley Road, BC4, Center City, MN, 55012, United States, 1 6512134347, KGLISKE@hazeldenbettyford.org %K telehealth %K substance use disorder %K COVID-19 %K substance use treatment %K feasibility study %K routine outcome monitoring data %K mental health %K addiction %K digital health %K telemedicine %K outpatient program %K virtual health %K addiction treatment %K virtual care %K patient outcomes %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The onset of the COVID-19 pandemic necessitated the rapid transition of many types of substance use disorder (SUD) treatments to telehealth formats, despite limited information about what makes treatment effective in this novel format. Objective: This study aims to examine the feasibility and effectiveness of virtual intensive outpatient programming (IOP) treatment for SUD in the context of a global pandemic, while considering the unique challenges posed to data collection during an unprecedented public health crisis. Methods: The study is based on a longitudinal study with a baseline sample of 3642 patients who enrolled in intensive outpatient addiction treatment (in-person, hybrid, or virtual care) from January 2020 to March 2021 at a large substance use treatment center in the United States. The analytical sample consisted of patients who completed the 3-month postdischarge outcome survey as part of routine outcome monitoring (n=1060, 29.1% response rate). Results: No significant differences were detected by delivery format in continuous abstinence (χ22=0.4, P=.81), overall quality of life (F2,826=2.06, P=.13), financial well-being (F2,767=2.30, P=.10), psychological well-being (F2,918=0.72, P=.49), and confidence in one’s ability to stay sober (F2,941=0.21, P=.81). Individuals in hybrid programming were more likely to report a higher level of general health than those in virtual IOP (F2,917=4.19, P=.01). Conclusions: Virtual outpatient care for the treatment of SUD is a feasible alternative to in-person-only programming, leading to similar self-reported outcomes at 3 months postdischarge. Given the many obstacles presented throughout data collection during a pandemic, further research is needed to better understand under what conditions telehealth is an acceptable alternative to in-person care. %M 35285807 %R 10.2196/36263 %U https://mental.jmir.org/2022/3/e36263 %U https://doi.org/10.2196/36263 %U http://www.ncbi.nlm.nih.gov/pubmed/35285807 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33883 %T The Effect of the Imacoco Care Psychoeducation Website on Improving Psychological Distress Among Workers During the COVID-19 Pandemic: Randomized Controlled Trial %A Imamura,Kotaro %A Sasaki,Natsu %A Sekiya,Yuki %A Watanabe,Kazuhiro %A Sakuraya,Asuka %A Matsuyama,Yutaka %A Nishi,Daisuke %A Kawakami,Norito %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 3522, nkawakami@m.u-tokyo.ac.jp %K COVID-19 %K education %K internet-based intervention %K occupational groups %K psychological distress %K mental health %K digital health %K health intervention %K psychoeducation %D 2022 %7 10.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prolonged COVID-19 pandemic has affected mental health among workers. Psychoeducational intervention via a website could be effective for primary prevention of mental illness among workers in the current COVID-19 pandemic. Objective: The aim of this randomized controlled trial is to examine the effect of a newly developed online psychoeducational website named Imacoco Care on reducing psychological distress and fear about COVID-19 infection among workers. Methods: Participants in the study were recruited from registered members of a web survey company in Japan. Participants who fulfilled the eligibility criteria were randomly allocated to the intervention or control group. Participants in the intervention group were invited to access the Imacoco Care program within a month after the baseline survey. The Kessler Psychological Distress Scale (K6) and the Fear of COVID-19 Scale (FCV-19S) scores were obtained at baseline and at 1- and 3-month follow-ups. Results: A total of 1200 workers were randomly allocated to the intervention and control groups (n=600 [50%] per group). The Imacoco Care intervention group showed a significant favorable effect on K6 scores (P=.03) with a small effect size (ES; Cohen d=–0.14) and an adverse effect on FCV-19S scores (P=.01) with a small ES (Cohen d=0.16) at 3-month follow-up. In the per protocol analysis (including only participants who had read the Imacoco Care content at least 1 time), the Imacoco Care intervention group also showed a significant favorable effect on reducing K6 scores (P=.03), while an adverse effect on FCV-19S scores was not significant (P=.06) in the intervention group at 3-month follow-up. Conclusions: A web-based psychoeducation approach may be effective for improving psychological distress among workers; however, it may be important not only to distribute information but also to encourage active engagement with the content of the program to prevent adverse effects of psychoeducational intervention. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000042556; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048548 %M 35133972 %R 10.2196/33883 %U https://formative.jmir.org/2022/3/e33883 %U https://doi.org/10.2196/33883 %U http://www.ncbi.nlm.nih.gov/pubmed/35133972 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34152 %T Evaluating the Effect of Supported Systematic Work Environment Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Study %A Haraldsson,Patrik %A Ros,Axel %A Jonker,Dirk %A Areskoug Josefsson,Kristina %+ School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Gjuterigatan 5, Jönköping, 553 18, Sweden, 46 10 2447892, patrik.haraldsson@ju.se %K occupational health interventions %K implementation %K mixed methods %K COVID-19 pandemic %K COVID-19 %K pandemic %K occupational health %K health interventions %K health care %K support services %K employee health %D 2022 %7 10.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The work environment is a complex phenomenon in which many factors interact. Scientific research indicates a relation between the work environment and employee health, staff turnover, patient satisfaction, and patient safety. There is a great need for knowledge on how to conduct work environment interventions and practical work environment management to maximize benefits to the employees. Objective: The aim of this study is to explore how Occupational Health Service (OHS) support will affect the work environment, sick leave, staff turnover, patient satisfaction, and patient safety during and following the COVID-19 pandemic in a medical ward setting. Methods: A mixed methods evaluation of a concurrent work environment quality improvement project at the Department of Internal Medicine and Geriatrics in a local hospital in the south of Sweden will be performed. Results: The mixed methods evaluation of the quality improvement project received funding from Futurum–Academy for Health and Care, Jönköping County Council and Region Jönköping County, and the study protocol was approved by the Swedish Ethical Review Authority. The work environment quality improvement project will continue between May 2020 and December 2021. Conclusions: The study might contribute to increased knowledge of how work environment interventions and practical work environment management can impact the work environment, and employee health, staff turnover, patient satisfaction, and patient safety. There is a need for knowledge in this area for OHS management to provide increased benefits to employees, employers, and society as a whole. International Registered Report Identifier (IRRID): DERR1-10.2196/34152 %M 35234649 %R 10.2196/34152 %U https://www.researchprotocols.org/2022/3/e34152 %U https://doi.org/10.2196/34152 %U http://www.ncbi.nlm.nih.gov/pubmed/35234649 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e27469 %T The Mental Health Impact of the COVID-19 Pandemic Among Physicians, Nurses, and Other Health Care Providers in Alberta: Cross-sectional Survey %A El Gindi,Hany %A Shalaby,Reham %A Gusnowski,April %A Vuong,Wesley %A Surood,Shireen %A Hrabok,Marianne %A Greenshaw,Andrew J %A Agyapong,Vincent %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 780 215 7771, agyapong@ualberta.ca %K COVID-19 %K health care worker %K mobile technology %K Text4Hope %K anxiety %K depression %K stress %K pandemic %K e-mental health %K mental health %K impact %K physician %K nurse %K Canada %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, threats to mental health, psychological safety, and well-being are evident, particularly among the first responders and the health care staff. Objective: This study aims to examine the prevalence and potential predictors of the likely stress, generalized anxiety disorder, and major depressive disorder among health care workers (HCWs). Methods: A cross-sectional survey was used through a survey link sent to gather demographic information and responses on several self-report scales, including the Perceived Stress Scale, the Generalized Anxiety Disorder 7-item scale, and the Patient Health Questionnaire-9 among HCWs enrolled in the Text4Hope program. Results: The result from this study suggests that during the COVID-19 pandemic, HCWs reported a high likelihood of moderate-to-high perceived stress (n=840, 81.2%), moderate-to-severe anxiety (n=369, 38.6%), and depression (n=317, 32.7%) symptoms. Nurses and other HCWs were significantly more likely to report depressive symptoms compared to physicians (F(2, 159.47)=15.89, 95% CI –5.05 to –2.04). Younger age groups of HCWs (≤30 years) were more prone to report likely stress, anxiety, and depressive symptoms compared to HCWs 41-50 and >50 years old (odds ratio [OR] 1.82-3.03). Similarly, females and those who reported a lack of social support (separated/divorced and single) among HCWs had a higher likelihood to report likely stress and depressive symptoms, respectively (OR 1.8 and 1.6, respectively). Conclusions: This cross-sectional study explored a high level of mental health burdens during the COVID-19 pandemic among HCWs in Alberta. Levels of psychological symptoms were more noticeable in the female gender and the nursing profession. %M 34995203 %R 10.2196/27469 %U https://formative.jmir.org/2022/3/e27469 %U https://doi.org/10.2196/27469 %U http://www.ncbi.nlm.nih.gov/pubmed/34995203 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34601 %T The Essential Network (TEN): Protocol for an Implementation Study of a Digital-First Mental Health Solution for Australian Health Care Workers During COVID-19 %A Coleshill,Matthew James %A Baldwin,Peter %A Black,Melissa %A Newby,Jill %A Shrestha,Tanya %A Haffar,Sam %A Mills,Llewellyn %A Stensel,Andrew %A Cockayne,Nicole %A Tennant,Jon %A Harvey,Samuel %A Christensen,Helen %+ Black Dog Institute, Hospital Road, Randwick, New South Wales, Sydney, 2031, Australia, 61 02 9065 9149, m.coleshill@blackdog.org.au %K blended care %K mental health %K burnout %K health care workers %K COVID-19 %K health care service %K health service %D 2022 %7 9.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has placed health care workers (HCWs) under severe stress, compounded by barriers to seeking mental health support among HCWs. The Essential Network (TEN) is a blend of digital and person-to-person (blended care) mental health support services for HCWs, funded by the Australian Federal Department of Health as part of their national COVID-19 response strategy. TEN is designed as both a preventative measure and treatment for common mental health problems faced by HCWs. New blended services need to demonstrate improvements in mental health symptoms and test acceptability in their target audience, as well as review implementation strategies to improve engagement. Objective: The primary objective of this implementation study is to design and test an implementation strategy to improve uptake of TEN. The secondary objectives are examining the acceptability of TEN among HCWs, changes in mental health outcomes associated with the use of TEN, and reductions in mental health stigma among HCWs following the use of TEN. Methods: The implementation study contains 3 components: (1) a consultation study with up to 39 stakeholders or researchers with implementation experience to design an implementation strategy, (1) a longitudinal observational study of at least 105 HCWs to examine the acceptability of TEN and the effectiveness of TEN at 1 and 6 months in improving mental health (as assessed by the Distress Questionnaire [DQ-5], Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder [GAD-7], Oldenburg Burnout Inventory [OBI-16], and Work and Social Adjustment Scale [WSAS]) and reducing mental health stigma (the Endorsed and Anticipated Stigma Inventory [EASI]), and (3) an implementation study where TEN service uptake analytics will be examined for 3 months before and after the introduction of the implementation strategy. Results: The implementation strategy, designed with input from the consultation and observational studies, is expected to lead to an increased number of unique visits to the TEN website in the 3 months following the introduction of the implementation strategy. The observational study is expected to observe high service acceptability. Moderate improvements to general mental health (DQ-5, WSAS) and a reduction in workplace- and treatment-related mental health stigma (EASI) between the baseline and 1-month time points are expected. Conclusions: TEN is a first-of-a-kind blended mental health service available to Australian HCWs. The results of this project have the potential to inform the implementation and development of blended care mental health services, as well as how such services can be effectively implemented during a crisis. International Registered Report Identifier (IRRID): DERR1-10.2196/34601 %M 35148269 %R 10.2196/34601 %U https://www.researchprotocols.org/2022/3/e34601 %U https://doi.org/10.2196/34601 %U http://www.ncbi.nlm.nih.gov/pubmed/35148269 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33066 %T Effects of a National Preventive Intervention Against Potential COVID-19–Related Gambling Problems in Online Gamblers: Self-Report Survey Study %A Håkansson,Anders %A Sundvall,Andreas %A Lyckberg,Axel %+ Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Baravägen 1, Lund, 22100, Sweden, 46 46175596, anders_c.hakansson@med.lu.se %K gambling disorder %K problem gambling %K COVID-19 %K harm reduction %K behavioral addiction %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has been suspected to increase gambling problems in the population. Several governments introduced COVID-19–specific interventions early with the aim to prevent gambling problems, but their effects have not been evaluated. Objective: This study aimed to evaluate a Swedish COVID-19–related temporary legislation imposing an automated weekly deposit limit for online casino gambling. Methods: The study was an anonymous survey sent by a state-owned gambling operator to online gamblers (N=619), among whom 54.0% (n=334) were moderate-risk/problem gamblers who reached the weekly limit on online gambling during the summer of 2020. Results: Overall, 60.1% (372/619) were aware of having been limited by the COVID-19–related deposit limit, and a minority (145/619, 23.4%) perceived the intervention as fairly bad or very bad. Among those aware of the intervention, 38.7% (144/372) believed the intervention decreased their overall gambling, whereas 7.8% (29/372) believed it rather increased it. However, 82.5% (307/372) reported having gambled at more than one operator after the limit, and the most common gambling type reported to have increased at another operator was online casino (42% among moderate-risk/problem gamblers and 19% among others; P<.001). An increase in gambling following the intervention was associated with being a moderate-risk/problem gambler and having negative attitudes toward the intervention. Conclusions: The weekly deposit limit had relatively high acceptability, but the study highlights the limitations of a single-operator deposit limit, given the high number of gamblers also reporting gambling at other operators and the lower effect in clients with gambling problems. %M 34678751 %R 10.2196/33066 %U https://formative.jmir.org/2022/3/e33066 %U https://doi.org/10.2196/33066 %U http://www.ncbi.nlm.nih.gov/pubmed/34678751 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32694 %T The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study %A Sugaya,Nagisa %A Yamamoto,Tetsuya %A Suzuki,Naho %A Uchiumi,Chigusa %+ Graduate School of Technology, Industrial and Social Sciences, Tokushima University, 1-1, Minamijosanjima-cho, Tokushima, 770-8502, Japan, 81 88 656 7617, t.yamamoto@tokushima-u.ac.jp %K coronavirus disease 2019 %K mild lockdown %K social isolation %K longitudinal survey %K public health %K surveillance %K epidemiology %K COVID-19 %K pandemic %K lockdown %K psychological behavior %K social factors %K mental health %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Lockdowns and stay-at-home orders announced internationally for COVID-19 have led to physical and social distancing, with reports of many individuals experiencing social isolation (SI) and loneliness. Although the emergency declaration in Japan was declared as a “mild” lockdown requested by the government without penalties for violations, the lockdown measures, including SI, had several influences on people’s lives and mental health as in other countries. Furthermore, Japan declared a state of emergency multiple times; thus, it is necessary to examine the influence of the transition of SI caused by repeated emergency declarations and the deterioration of mental health associated with these changes. Objective: This study longitudinally investigated the transition of SI and its related factors during the mild lockdown under 2 declared states of emergency in Japan and analyzed psychosocial characteristics by extracting clusters where people with specific transition patterns of SI predominated. Methods: We collected data on 7893 inhabitants (3694 [46.8%] women, 49.6 [SD 13.7] years old) living in the 7 prefectures where the initial emergency declaration was applied. The investigations took place online in the final phase of the first and second states of emergency: phase 1 (between May 11 and 12, 2020) and phase 2 (between February 24 and 28, 2021). Nonparametric Bayesian coclustering was used to visualize the exhaustive interaction structure between the transition pattern of SI and the psychosocial variables. Results: There were no improvements in social networks and loneliness between the 2 phases, although psychological distress significantly improved and depression slightly decreased. Overall, 3868 (49%) of the 7893 participants remained socially isolated through phases 1 and 2, and 947 (12%) were socially isolated in phase 2, even though they were not socially isolated in phase 1. More participants experienced persistent SI in unmarried, childless, and low-household-income groups. The persistent-SI group had fewer cohabitants than other transition pattern groups. The nonparametric Bayesian coclustering results showed that most clusters, including participants without SI throughout phases 1 and 2, had healthy behaviors, more interactions, good relationships, and less loneliness and psychological stress. Furthermore, the cluster in which relationships deteriorated in phase 1 recovered in phase 2. Comparatively, the clusters with SI throughout phases 1 and 2 were divided into clusters with increased loneliness and psychological stress; clusters were close to participants’ average scores in this study. The clusters with increased loneliness and psychological stress were notable for deteriorating relationships and less online interaction. Conclusions: This study revealed the actual state of transition of SI and related psychological, social, and behavioral factors under repeated declarations of a state of emergency. These results should help construct intervention methods that fit individual characteristics of people in SI during a pandemic. %M 35107428 %R 10.2196/32694 %U https://publichealth.jmir.org/2022/3/e32694 %U https://doi.org/10.2196/32694 %U http://www.ncbi.nlm.nih.gov/pubmed/35107428 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e33277 %T Precision Public Health and Structural Racism in the United States: Promoting Health Equity in the COVID-19 Pandemic Response %A Geneviève,Lester Darryl %A Martani,Andrea %A Wangmo,Tenzin %A Elger,Bernice Simone %+ Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, Basel, 4056, Switzerland, 41 612071782, lester.genevieve@unibas.ch %K precision public health %K structural racism %K COVID-19 %K pandemic %K social justice %K health equity %K SARS-CoV-2 %K stigma %K discrimination %K disparity %K inequality %K precision health %K public health %K racism %K inequality %K equity %K mortality %K morbidity %D 2022 %7 4.3.2022 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic has revealed deeply entrenched structural inequalities that resulted in an excess of mortality and morbidity in certain racial and ethnic groups in the United States. Therefore, this paper examines from the US perspective how structural racism and defective data collection on racial and ethnic minorities can negatively influence the development of precision public health (PPH) approaches to tackle the ongoing COVID-19 pandemic. Importantly, the effects of structural and data racism on the development of fair and inclusive data-driven components of PPH interventions are discussed, such as with the use of machine learning algorithms to predict public health risks. The objective of this viewpoint is thus to inform public health policymaking with regard to the development of ethically sound PPH interventions against COVID-19. Particular attention is given to components of structural racism (eg, hospital segregation, implicit and organizational bias, digital divide, and sociopolitical influences) that are likely to hinder such approaches from achieving their social justice and health equity goals. %M 35089868 %R 10.2196/33277 %U https://publichealth.jmir.org/2022/3/e33277 %U https://doi.org/10.2196/33277 %U http://www.ncbi.nlm.nih.gov/pubmed/35089868 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e29250 %T Community Mental Health Clinicians’ Perspectives on Telehealth During the COVID-19 Pandemic: Mixed Methods Study %A Schriger,Simone H %A Klein,Melanie R %A Last,Briana S %A Fernandez-Marcote,Sara %A Dallard,Natalie %A Jones,Bryanna %A Beidas,Rinad S %+ Department of Psychology, University of Pennsylvania, 425 S University Ave, Stephen A Levin Building, Philadelphia, PA, 19104-6241, United States, 1 215 898 7300, schriger@sas.upenn.edu %K telehealth %K COVID-19 %K evidence-based practice %K community mental health %K trauma-focused cognitive behavioral therapy %K implementation science %K youth mental health %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In March 2020, a rapid shift to telehealth occurred in community mental health settings in response to the need for physical distancing to decrease transmission of the virus causing COVID-19. Whereas treatment delivered over telehealth was previously utilized sparingly in community settings, it quickly became the primary mode of treatment delivery for the vast majority of clinicians, many of whom had little time to prepare for this shift and limited to no experience using telehealth. Little is known about community mental health clinicians’ experiences using telehealth. Although telehealth may make mental health treatment more accessible for some clients, it may create additional barriers for others given the high rates of poverty among individuals seeking treatment from community mental health centers. Objective: We examined community mental health clinicians’ perspectives on using telehealth to deliver trauma-focused cognitive behavioral therapy to youth. We sought to better understand the acceptability of using telehealth, as well as barriers and facilitators to usage. Methods: We surveyed 45 clinicians across 15 community clinics in Philadelphia. Clinicians rated their satisfaction with telehealth using a quantitative scale and shared their perspectives on telehealth in response to open-ended questions. Therapists’ responses were coded using an open-coding approach wherein coders generated domains, themes, and subthemes. Results: Clinicians rated telehealth relatively positively on the quantitative survey, expressing overall satisfaction with their current use of telehealth during the pandemic, and endorsing telehealth as a helpful mode of connecting with clients. Responses to open-ended questions fell into five domains. Clinicians noted that (1) telehealth affects the content (ie, what is discussed) and process (ie, how it is discussed) of therapy; (2) telehealth alters engagement, retention, and attendance; (3) technology is a crucial component of utilizing telehealth; (4) training, resources, and support are needed to facilitate telehealth usage; and (5) the barriers, facilitators, and level of acceptability of telehealth differ across individual clinicians and clients. Conclusions: First, telehealth is likely a better fit for some clients and clinicians than others, and attention should be given to better understanding who is most likely to succeed using this modality. Second, although telehealth increased convenience and accessibility of treatment, clinicians noted that across the board, it was difficult to engage clients (eg, young clients were easily distracted), and further work is needed to identify better telehealth engagement strategies. Third, for many clients, the telehealth modality may actually create an additional barrier to care, as children from families living in poverty may not have the requisite devices or quality broadband connection to make telehealth workable. Better strategies to address disparities in access to and quality of digital technologies are needed to render telehealth an equitable option for all youth seeking mental health services. %M 35023839 %R 10.2196/29250 %U https://pediatrics.jmir.org/2022/1/e29250 %U https://doi.org/10.2196/29250 %U http://www.ncbi.nlm.nih.gov/pubmed/35023839 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31992 %T Psychometric Evaluation of a Fear of COVID-19 Scale in China: Cross-sectional Study %A Choi,Edmond P H %A Duan,Wenjie %A Fong,Daniel Y T %A Lok,Kris Y W %A Ho,Mandy %A Wong,Janet Y H %A Lin,Chia-Chin %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176645, dytfong@hku.hk %K Chinese %K COVID-19 %K fear %K psychometric %K validation %K scale %K mental health %K information %K cross-sectional %K validity %K reliability %K support %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: At the very beginning of the COVID-19 pandemic, information about fear of COVID-19 was very limited in Chinese populations, and there was no standardized and validated scale to measure the fear associated with the pandemic. Objective: This cross-sectional study aimed to adapt and validate a fear scale to determine the levels of fear of COVID-19 among the general population in mainland China and Hong Kong. Methods: A web-based questionnaire platform was developed for data collection; the study instruments were an adapted version of the 8-item Breast Cancer Fear Scale (“Fear Scale”) and the 4-item Patient Health Questionnaire. The internal construct validity, convergent validity, known group validity, and reliability of the adapted Fear Scale were assessed, and descriptive statistics were used to summarize the participants’ fear levels. Results: A total of 2822 study participants aged 18 years or older were included in the analysis. The reliability of the adapted scale was satisfactory, with a Cronbach α coefficient of .93. The item-total correlations corrected for overlap were >0.4, confirming their internal construct validity. Regarding convergent validity, a small-to-moderate correlation between the Fear Scale and the 4-item Patient Health Questionnaire scores was found. Regarding known group validity, we found that the study participants who were recruited from Hong Kong had a higher level of fear than the study participants from mainland China. Older adults had a higher level of fear compared with younger adults. Furthermore, having hypertension, liver disease, heart disease, cancer, anxiety, and insomnia were associated with a higher fear level. The descriptive analysis found that more than 40% of the study participants reported that the thought of COVID-19 scared them. About one-third of the study participants reported that when they thought about COVID-19, they felt nervous, uneasy, and depressed. Conclusions: The psychometric properties of the adapted Fear Scale are acceptable to measure the fear of COVID-19 among Chinese people. Our study stresses the need for more psychosocial support and care to help this population cope with their fears during the pandemic. %M 35072632 %R 10.2196/31992 %U https://formative.jmir.org/2022/3/e31992 %U https://doi.org/10.2196/31992 %U http://www.ncbi.nlm.nih.gov/pubmed/35072632 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e33704 %T The Impact of Long COVID-19 on Mental Health: Observational 6-Month Follow-Up Study %A Houben-Wilke,Sarah %A Goërtz,Yvonne MJ %A Delbressine,Jeannet M %A Vaes,Anouk W %A Meys,Roy %A Machado,Felipe VC %A van Herck,Maarten %A Burtin,Chris %A Posthuma,Rein %A Franssen,Frits ME %A Vijlbrief,Herman %A Spies,Yvonne %A van 't Hul,Alex J %A Spruit,Martijn A %A Janssen,Daisy JA %+ Department of Research and Education, Ciro, Hornerheide 1, Horn, 6085 NM, Netherlands, 31 475587602, sarahwilke@ciro-horn.nl %K SARS-CoV-2 %K corona %K COVID-19 %K post-traumatic stress disorder %K anxiety %K depression %K PASC %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The psychological impact of COVID-19 can be substantial. However, knowledge about long-term psychological outcomes in patients with COVID-19 is scarce. Objective: In this longitudinal, observational study, we aimed to reveal symptoms of posttraumatic stress disorder (PTSD) and symptoms of anxiety and depression up to 6 months after the onset of COVID-19–related symptoms in patients with confirmed COVID-19 and persistent complaints. To demonstrate the impact in nonhospitalized patients, we further aimed to compare these outcomes between nonhospitalized and hospitalized patients. Methods: Demographics, symptoms of PTSD (Trauma Screening Questionnaire [TSQ] ≥6 points) and symptoms of anxiety and depression (Hospital Anxiety and Depression Scale [HADS] ≥8 points) were assessed at 3 and 6 months after the onset of COVID-19–related symptoms in members of online long COVID-19 peer support groups. Results: Data from 239 patients with confirmed COVID-19 (198/239, 82.8% female; median age: 50 [IQR 39-56] years) were analyzed. At the 3-month follow-up, 37.2% (89/239) of the patients had symptoms of PTSD, 35.6% (85/239) had symptoms of anxiety, and 46.9% (112/239) had symptoms of depression, which remained high at the 6-month follow-up (64/239, 26.8%, P=.001; 83/239, 34.7%, P=.90; 97/239, 40.6%, P=.08, respectively; versus the 3-month follow-up). TSQ scores and HADS anxiety and depression scores were strongly correlated at the 3- and 6-month follow-ups (r=0.63-0.71, P<.001). Symptoms of PTSD, anxiety, and depression were comparable between hospitalized (n=62) and nonhospitalized (n=177) patients. Conclusions: A substantial percentage of patients with confirmed COVID-19 and persistent complaints reported symptoms of PTSD, anxiety, or depression 3 and 6 months after the onset of COVID-19–related symptoms. The prevalence rates of symptoms of PTSD, anxiety, and depression were comparable between hospitalized and nonhospitalized patients and merely improved over time. Health care professionals need to be aware of these psychological complications and intervene on time in post-COVID-19 patients with persistent complaints. Trial Registration: Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705. %M 35200155 %R 10.2196/33704 %U https://mental.jmir.org/2022/2/e33704 %U https://doi.org/10.2196/33704 %U http://www.ncbi.nlm.nih.gov/pubmed/35200155 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e31909 %T Crowdsourced Community Support Resources Among Patients Discharged From the Emergency Department During the COVID-19 Pandemic: Pilot Feasibility Study %A Agarwal,Anish K %A Southwick,Lauren %A Schneider,Rachelle %A Pelullo,Arthur %A Ortiz,Robin %A Klinger,Elissa V %A Gonzales,Rachel E %A Rosin,Roy %A Merchant,Raina M %+ Department of Emergency Medicine, University of Pennsylvania, 3600 Civic Center Boulevard, Philadelphia, PA, 19104, United States, 1 2674280125, Anish.Agarwal@pennmedicine.upenn.edu %K COVID-19 %K mHealth %K CHW %K digital health %K platform %K crowdsource %K support %K community %K health system %K monitoring %K virtual care %K text message %K model %K community health worker %K pilot study %K feasibility %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has placed strains on communities. During this public health crisis, health systems have created remote methods of monitoring symptom progression and delivering care virtually. Objective: Using an SMS text message-based system, we sought to build and test a remote model to explore community needs, connect individuals to curated resources, and facilitate community health worker intervention when needed during the pandemic. The primary aims of this pilot study were to establish the feasibility (ie, engagement with the text line) and acceptability (ie, participant ratings of resources and service) of delivering automated well-being resources via smartphone technology. Methods: Eligible patients (aged 18 years or older, having a cell phone with SMS text messaging capability, and recently visited the emergency department) were identified using the electronic health record. The patients were consented to enroll and begin receiving COVID-19–related information and links to community resources. We collected open-ended and close-ended resource and mood ratings. We calculated the frequencies and conducted a thematic review of the open-ended responses. Results: In 7 weeks, 356 participants were enrolled; 13,917 messages were exchanged including 333 resource ratings (mean 4) and 673 well-being scores (mean 6.8). We received and coded 386 open-ended responses, most of which elaborated upon their self-reported mood score (29%). Overall, 77% (n=274) of our participants rated the platform as a service they would highly recommend to a family member or friend. Conclusions: This approach is designed to broaden the reach of health systems, tailor to community needs in real time, and connect at-risk individuals with robust community health support. %M 35037886 %R 10.2196/31909 %U https://mental.jmir.org/2022/2/e31909 %U https://doi.org/10.2196/31909 %U http://www.ncbi.nlm.nih.gov/pubmed/35037886 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e27286 %T The Beneficial Effect of the First COVID-19 Lockdown on Undergraduate Students of Education: Prospective Cohort Study %A Joseph,Gili %A Schori,Hadas %+ Department of Physical Activity and Movement, Faculty of Science, Seminar Hakibbutzim College of Education, 149 Namir Drive, Tel Aviv, 6250769, Israel, 972 544577095, gilijosephphd@gmail.com %K sleep quality %K exercise %K well-being %K undergraduate students %K COVID-19 lockdown %K COVID-19 %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has been spreading consistently since the beginning of 2020. On February 27, 2020, the first patient with coronavirus was diagnosed in Israel. On March 14, 2020, the Israeli government declared a general lockdown that lasted about a month, which altered the lives of the entire population. Objective: The objective of this paper is to evaluate the change in the well-being, physical activity, and sleep quality of undergraduate students of education at 2 time points: before (November 2019) and during (April 2020) the first COVID-19 lockdown. Methods: In total, 533 undergraduate students of education submitted an online questionnaire before the lockdown and at its end. The questionnaire comprised 4 parts: a (1) sociodemographic and (2) weekly exercise questionnaire taken from the International Physical Activity Questionnaire–Short Form; (3) sleep quality, rated using the Mini Sleep Questionnaire; and (4) well-being, rated using the short version of the Mental Health Inventory. This was a pre-post prospective cohort questionnaire study. Results: It was predicted that there would be a decrease in the aforementioned parameters. Contrary to all expectations, an increase was observed in all 3. Results showed that during the lockdown, there was an increase in the level of exercise students engaged in. Overall, 102 (61.4%) of 166 students engaged in a greater amount of physical activity during the COVID-19 lockdown compared to 150 (40.9%) of 367 students who engaged in a greater amount of physical activity before COVID-19. Levels of sleep quality (mean 5.34 [SD 0.92] vs mean 5.12 [SD 0.46], P=.02) and well-being (mean 3.79 [SD 0.62] vs mean 3.67 [SD 0.59], P=.02) were also higher during the COVID-19 lockdown. Conclusions: These findings indicate that undergraduate students seem to have taken advantage of the change in lifestyle due to the lockdown, directing the free time toward improving health by engaging in more physical activity, thus improving sleep quality and well-being. %M 35072635 %R 10.2196/27286 %U https://formative.jmir.org/2022/2/e27286 %U https://doi.org/10.2196/27286 %U http://www.ncbi.nlm.nih.gov/pubmed/35072635 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30598 %T The Impact of COVID-19 Confinement on Cognition and Mental Health and Technology Use Among Socially Vulnerable Older People: Retrospective Cohort Study %A Dura-Perez,Elena %A Goodman-Casanova,Jessica Marian %A Vega-Nuñez,Amanda %A Guerrero-Pertiñez,Gloria %A Varela-Moreno,Esperanza %A Garolera,Maite %A Quintana,Maria %A Cuesta-Vargas,Antonio I %A Barnestein-Fonseca,Pilar %A Gómez Sánchez-Lafuente,Carlos %A Mayoral-Cleries,Fermin %A Guzman-Parra,Jose %+ Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital, s/n, Málaga, 29009, Spain, 34 660901966, jmariangoodman@gmail.com %K COVID-19 %K cognition %K quality of life %K social isolation %K mental health %K social support %K technology %K physical distancing %K leisure activities %K nursing %D 2022 %7 22.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 forced the implementation of restrictive measures in Spain, such as lockdown, home confinement, social distancing, and isolation. It is necessary to study whether limited access to basic services and decreased family and social support could have deleterious effects on cognition, quality of life, and mental health in vulnerable older people. Objective: This study aims to explore the impact of the COVID-19 outbreak on cognition in older adults with mild cognitive impairment or dementia as the main outcome and the quality of life, perceived health status, and depression as secondary outcomes and to analyze the association of living alone and a change in living arrangements with those outcomes and other variables related with the use of technology and health services. Likewise, this study aims to analyze the association of high and low technophilia with those variables, to explore the access and use of health care and social support services, and, finally, to explore the informative-, cognitive-, entertainment-, and socialization-related uses of information and communications technologies (ICTs) during the COVID-19 outbreak. Methods: This cohort study was conducted in Málaga (Spain). In total, 151 participants with mild cognitive impairment or mild dementia, from the SMART4MD (n=75, 49.7%) and TV-AssistDem (n=76, 50.3%) randomized clinical trials, were interviewed by telephone between May 11 and June 26, 2020. All participants had undergone 1-3 assessments (in 6-month intervals) on cognition, quality of life, and mood prior to the COVID-19 breakout. Results: The outbreak did not significantly impact the cognition, quality of life, and mood of our study population when making comparisons with baseline assessments prior to the outbreak. Perceived stress was reported as moderate during the outbreak. After correction for multiple comparisons, living alone, a change in living arrangements, and technophilia were not associated with negative mental health outcomes. However, being alone was nominally associated with self-perceived fear and depression, and higher technophilia with better quality of life, less boredom, perceived stress and depression, and also less calmness. Overall, health care and social support service access and utilization were high. The most used ICTs during the COVID-19 outbreak were the television for informative, cognitive, and entertainment-related uses and the smartphone for socialization. Conclusions: Our findings show that the first months of the outbreak did not significantly impact the cognition, quality of life, perceived health status, and depression of our study population when making comparisons with baseline assessments prior to the outbreak. Living alone and low technophilia require further research to establish whether they are risk factors of mental health problems during lockdowns in vulnerable populations. Moreover, although ICTs have proven to be useful for informative-, cognitive-, entertainment-, and socialization-related uses during the pandemic, more evidence is needed to support these interventions. Trial Registration: ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797 International Registered Report Identifier (IRRID): RR2-10.2196/26431 %M 35049505 %R 10.2196/30598 %U https://www.jmir.org/2022/2/e30598 %U https://doi.org/10.2196/30598 %U http://www.ncbi.nlm.nih.gov/pubmed/35049505 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e34645 %T Risk Factors for COVID-19 in College Students Identified by Physical, Mental, and Social Health Reported During the Fall 2020 Semester: Observational Study Using the Roadmap App and Fitbit Wearable Sensors %A Gilley,Kristen N %A Baroudi,Loubna %A Yu,Miao %A Gainsburg,Izzy %A Reddy,Niyanth %A Bradley,Christina %A Cislo,Christine %A Rozwadowski,Michelle Lois %A Clingan,Caroline Ashley %A DeMoss,Matthew Stephen %A Churay,Tracey %A Birditt,Kira %A Colabianchi,Natalie %A Chowdhury,Mosharaf %A Forger,Daniel %A Gagnier,Joel %A Zernicke,Ronald F %A Cunningham,Julia Lee %A Cain,Stephen M %A Tewari,Muneesh %A Choi,Sung Won %+ Department of Pediatrics, University of Michigan Medical School, 1200 E Hospital Dr, Medical Professional Building D4118, Ann Arbor, MI, 48109, United States, 1 734 615 2263, sungchoi@med.umich.edu %K mHealth %K mobile health %K college student %K mental health %K wearable devices %K wearable %K student %K risk factor %K risk %K COVID-19 %K physical health %K observational %K crisis %K self-report %K outcome %K physical activity %K wellbeing %K well-being %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic triggered a seismic shift in education to web-based learning. With nearly 20 million students enrolled in colleges across the United States, the long-simmering mental health crisis in college students was likely further exacerbated by the pandemic. Objective: This study leveraged mobile health (mHealth) technology and sought to (1) characterize self-reported outcomes of physical, mental, and social health by COVID-19 status; (2) assess physical activity through consumer-grade wearable sensors (Fitbit); and (3) identify risk factors associated with COVID-19 positivity in a population of college students prior to release of the vaccine. Methods: After completing a baseline assessment (ie, at Time 0 [T0]) of demographics, mental, and social health constructs through the Roadmap 2.0 app, participants were instructed to use the app freely, wear the Fitbit, and complete subsequent assessments at T1, T2, and T3, followed by a COVID-19 assessment of history and timing of COVID-19 testing and diagnosis (T4: ~14 days after T3). Continuous measures were described using mean (SD) values, while categorical measures were summarized as n (%) values. Formal comparisons were made on the basis of COVID-19 status. The multivariate model was determined by entering all statistically significant variables (P<.05) in univariable associations at once and then removing one variable at a time through backward selection until the optimal model was obtained. Results: During the fall 2020 semester, 1997 participants consented, enrolled, and met criteria for data analyses. There was a high prevalence of anxiety, as assessed by the State Trait Anxiety Index, with moderate and severe levels in 465 (24%) and 970 (49%) students, respectively. Approximately one-third of students reported having a mental health disorder (n=656, 33%). The average daily steps recorded in this student population was approximately 6500 (mean 6474, SD 3371). Neither reported mental health nor step count were significant based on COVID-19 status (P=.52). Our analyses revealed significant associations of COVID-19 positivity with the use of marijuana and alcohol (P=.02 and P=.046, respectively) and with lower belief in public health measures (P=.003). In addition, graduate students were less likely and those with ≥20 roommates were more likely to report a COVID-19 diagnosis (P=.009). Conclusions: Mental health problems were common in this student population. Several factors, including substance use, were associated with the risk of COVID-19. These data highlight important areas for further attention, such as prioritizing innovative strategies that address health and well-being, considering the potential long-term effects of COVID-19 on college students. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): RR2-10.2196/29561 %M 34992051 %R 10.2196/34645 %U https://mental.jmir.org/2022/2/e34645 %U https://doi.org/10.2196/34645 %U http://www.ncbi.nlm.nih.gov/pubmed/34992051 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e33585 %T Depressive Symptoms and Anxiety During the COVID-19 Pandemic: Large, Longitudinal, Cross-sectional Survey %A MacDonald,James J %A Baxter-King,Ryan %A Vavreck,Lynn %A Naeim,Arash %A Wenger,Neil %A Sepucha,Karen %A Stanton,Annette L %+ Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA, 90025-1563, United States, 1 7742701642, jamesjmacdonald7@gmail.com %K COVID-19 %K depression %K anxiety %K pandemic %K mental health %K public health %K psychological variables %K younger adults %K symptom monitoring %K health intervention %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has influenced the mental health of millions across the globe. Understanding factors associated with depressive symptoms and anxiety across 12 months of the pandemic can help identify groups at higher risk and psychological processes that can be targeted to mitigate the long-term mental health impact of the pandemic. Objective: This study aims to determine sociodemographic features, COVID-19-specific factors, and general psychological variables associated with depressive symptoms and anxiety over 12 months of the pandemic. Methods: Nationwide, cross-sectional electronic surveys were implemented in May (n=14,636), July (n=14,936), October (n=14,946), and December (n=15,265) 2020 and March/April 2021 (n=14,557) in the United States. Survey results were weighted to be representative of the US population. The samples were drawn from a market research platform, with a 69% cooperation rate. Surveys assessed depressive symptoms in the past 2 weeks and anxiety in the past week, as well as sociodemographic features; COVID-19 restriction stress, worry, perceived risk, coping strategies, and exposure; intolerance of uncertainty; and loneliness. Results: Across 12 months, an average of 24% of respondents reported moderate-to-severe depressive symptoms and 32% reported moderate-to-severe anxiety. Of the sociodemographic variables, age was most consistently associated with depressive symptoms and anxiety, with younger adults more likely to report higher levels of those outcomes. Intolerance of uncertainty and loneliness were consistently and strongly associated with the outcomes. Of the COVID-19-specific variables, stress from COVID-19 restrictions, worry about COVID-19, coping behaviors, and having COVID-19 were associated with a higher likelihood of depressive symptoms and anxiety. Conclusions: Depressive symptoms and anxiety were high in younger adults, adults who reported restriction stress or worry about COVID-19 or who had had COVID-19, and those with intolerance of uncertainty and loneliness. Symptom monitoring as well as early and accessible intervention are recommended. %M 35142619 %R 10.2196/33585 %U https://mental.jmir.org/2022/2/e33585 %U https://doi.org/10.2196/33585 %U http://www.ncbi.nlm.nih.gov/pubmed/35142619 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30359 %T Opportunities and Challenges for Professionals in Psychiatry and Mental Health Care Using Digital Technologies During the COVID-19 Pandemic: Systematic Review %A Kane,Hélène %A Gourret Baumgart,Jade %A El-Hage,Wissam %A Deloyer,Jocelyn %A Maes,Christine %A Lebas,Marie-Clotilde %A Marazziti,Donatella %A Thome,Johannes %A Fond-Harmant,Laurence %A Denis,Frédéric %+ Laboratoire Éducation, Éthique, Santé, Université de Tours, Boulevard Tonnellé, Tours, 37032, France, 33 279060019, helene.kane@gmail.com %K COVID-19 %K e–mental health %K professional practices %K quality of care %K telepsychiatry %K videoconferencing %D 2022 %7 4.2.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. Objective: As part of a research project that was cofunded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, the aim of this systematic literature review was to investigate how such uses of digital technologies have been developing. Methods: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was carried out in the MEDLINE (ie, PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts and then on full texts, 61 articles were included. Results: The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up their experience of remote care and, thus, better identify the possibilities and limits of these digital technologies. Conclusions: New uses of such technologies essentially consist of a transition from the classic consultation model toward teleconsultation and make less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The COVID-19 health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular to promote the autonomy and empowerment of mental health service users. %M 34736224 %R 10.2196/30359 %U https://humanfactors.jmir.org/2022/1/e30359 %U https://doi.org/10.2196/30359 %U http://www.ncbi.nlm.nih.gov/pubmed/34736224 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32368 %T Intensive Care Unit–Specific Virtual Reality for Critically Ill Patients With COVID-19: Multicenter Randomized Controlled Trial %A Vlake,Johan H %A van Bommel,Jasper %A Wils,Evert-Jan %A Bienvenu,Joe %A Hellemons,Merel E %A Korevaar,Tim IM %A Schut,Anna FC %A Labout,Joost AM %A Schreuder,Lois LH %A van Bavel,Marten P %A Gommers,Diederik %A van Genderen,Michel E %+ Department of Intensive Care, Erasmus MC, Dr Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 107039881, m.vangenderen@erasmusmc.nl %K SARS-CoV-2 %K intensive care %K post-intensive care syndrome %K virtual reality %K quality of life %K satisfaction %K COVID-19 %D 2022 %7 31.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although psychological sequelae after intensive care unit (ICU) treatment are considered quite intrusive, robustly effective interventions to treat or prevent these long-term sequelae are lacking. Recently, it was demonstrated that ICU-specific virtual reality (ICU-VR) is a feasible and acceptable intervention with potential mental health benefits. However, its effect on mental health and ICU aftercare in COVID-19 ICU survivors is unknown. Objective: This study aimed to explore the effects of ICU-VR on mental health and on patients’ perceived quality of, satisfaction with, and rating of ICU aftercare among COVID-19 ICU survivors. Methods: This was a multicenter randomized controlled trial. Patients were randomized to either the ICU-VR (intervention) or the control group. All patients were invited to an COVID-19 post-ICU follow-up clinic 3 months after hospital discharge, during which patients in the intervention group received ICU-VR. One month and 3 months later (4 and 6 months after hospital discharge), mental health, quality of life, perceived quality, satisfaction with, and rating of ICU aftercare were scored using questionnaires. Results: Eighty-nine patients (median age 58 years; 63 males, 70%) were included. The prevalence and severity of psychological distress were limited throughout follow-up, and no differences in psychological distress or quality of life were observed between the groups. ICU-VR improved satisfaction with (mean score 8.7, SD 1.6 vs 7.6, SD 1.6 [ICU-VR vs control]; t64=–2.82, P=.006) and overall rating of ICU aftercare (mean overall rating of aftercare 8.9, SD 0.9 vs 7.8, SD 1.7 [ICU-VR vs control]; t64=–3.25; P=.002) compared to controls. ICU-VR added to the quality of ICU aftercare according to 81% of the patients, and all patients would recommend ICU-VR to other ICU survivors. Conclusions: ICU-VR is a feasible and acceptable innovative method to improve satisfaction with and rating of ICU aftercare and adds to its perceived quality. We observed a low prevalence of psychological distress after ICU treatment for COVID-19, and ICU-VR did not improve psychological recovery or quality of life. Future research is needed to confirm our results in other critical illness survivors to potentially facilitate ICU-VR’s widespread availability and application during follow-up. Trial Registration: Netherlands Trial Register NL8835; https://www.trialregister.nl/trial/8835 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05271-z %M 34978530 %R 10.2196/32368 %U https://www.jmir.org/2022/1/e32368 %U https://doi.org/10.2196/32368 %U http://www.ncbi.nlm.nih.gov/pubmed/34978530 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e33114 %T Problematic Internet Use Before and During the COVID-19 Pandemic in Youth in Outpatient Mental Health Treatment: App-Based Ecological Momentary Assessment Study %A Gansner,Meredith %A Nisenson,Melanie %A Lin,Vanessa %A Pong,Sovannarath %A Torous,John %A Carson,Nicholas %+ Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, 02139, United States, 1 617 575 5498, meredith.gansner@gmail.com %K COVID-19 %K problematic internet use %K ecological momentary assessment %K internet %K app %K youth %K young adult %K teenager %K outpatient %K mental health %K treatment %K pilot %K cohort %K change %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Youth with existing psychiatric illness are more apt to use the internet as a coping skill. Because many “in-person” coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic internet use (PIU). The identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment or are reliant upon cross-sectional methodology and self-report measures of digital media use. Objective: This is a retrospective cohort study that used data collected from an app-based ecological momentary assessment protocol to examine potential pandemic-associated changes in digital media youth in outpatient mental health treatment. Secondary analyses assessed for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population. Methods: The participants were aged 12-23 years and were receiving mental health treatment in an outpatient community hospital setting. All participants completed a 6-week daily ecological momentary assessment protocol on their personal smartphones. Questions were asked about depression (PHQ-8 [8-item Patient Health Questionnaire]), anxiety (GAD-7 [7-item General Anxiety Disorder]), PIU (PIU-SF-6 [Problematic Internet Use Short Form 6]), digital media use based on Apple’s daily screen time reports, and personal and familial COVID-19 exposure. The analyses compared screen time, psychiatric symptoms, and PIU between cohorts, as well as between youth with personal or familial COVID-19 exposures and those without. The analyses also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores. Results: A total of 69 participants completed the study. The participants recruited during the pandemic were significantly more likely to meet the criteria for PIU based on their average PIU-SF-6 score (P=.02) and to spend more time using social media each day (P=.049). The overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P=.01). Youth with clinically significant PIU-SF-6 scores were younger and more likely to have higher PHQ-8 (P=.003) and GAD-7 (P=.003) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization. Conclusions: Our findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly the problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU. %M 35089157 %R 10.2196/33114 %U https://mental.jmir.org/2022/1/e33114 %U https://doi.org/10.2196/33114 %U http://www.ncbi.nlm.nih.gov/pubmed/35089157 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e30204 %T Patient Satisfaction and Recommendations for Delivering a Group-Based Intensive Outpatient Program via Telemental Health During the COVID-19 Pandemic: Cross-sectional Cohort Study %A Skime,Michelle K %A Puspitasari,Ajeng J %A Gentry,Melanie T %A Heredia Jr,Dagoberto %A Sawchuk,Craig N %A Moore,Wendy R %A Taylor-Desir,Monica J %A Schak,Kathryn M %+ Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 507 255 0501, skime.michelle@mayo.edu %K COVID-19 %K telemental health %K teletherapy %K telepsychiatry %K telemedicine %K intensive outpatient %K patient satisfaction %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although group-based intensive outpatient programs (IOPs) are a level of care commonly utilized by adults with serious mental illness, few studies have examined the acceptability of group-based IOPs that required rapid transition to a telemental health (TMH) format during the COVID-19 pandemic. Objective: The aim of this study was to evaluate patient satisfaction and future recommendations for a group-based IOP that was transitioned to a TMH format during the COVID-19 pandemic. Methods: A 17-item patient satisfaction questionnaire was completed by patients at discharge and covered 3 areas: IOP TMH satisfaction, future recommendations, and video technology challenges. Descriptive and content analyses were conducted for the quantitative and open-ended questions, respectively. Results: A total of 76 patients completed the program in 2020. A subset of patients (n=40, 53%) responded to the survey at program discharge. The results indicated that the patients were satisfied overall with the TMH program format; 50% (n=20) of the patients preferred the program continue offering the TMH format, and the rest preferred returning to in-person formats after the pandemic. The patients indicated the elements of the program that they found most valuable and provided recommendations for future program improvement. Conclusions: Overall, adults with serious mental illness reported high satisfaction with the group-based IOP delivered via TMH. Health care systems may want to consider offering both TMH and in-person formats regardless of the state of the pandemic. Patients’ feedback on future improvements should be considered to help ensure long-term success. %M 34878999 %R 10.2196/30204 %U https://mental.jmir.org/2022/1/e30204 %U https://doi.org/10.2196/30204 %U http://www.ncbi.nlm.nih.gov/pubmed/34878999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32731 %T Using the COVID-19 Pandemic to Assess the Influence of News Affect on Online Mental Health-Related Search Behavior Across the United States: Integrated Sentiment Analysis and the Circumplex Model of Affect %A Lekkas,Damien %A Gyorda,Joseph A %A Price,George D %A Wortzman,Zoe %A Jacobson,Nicholas C %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Suite 300, Office #313S, Lebanon, NH, 03766, United States, 1 603 646 7000, Damien.Lekkas.GR@dartmouth.edu %K affect %K sentiment %K circumplex %K news %K mental health %K online search behavior %K generalized mixed models %K natural language processing %K anxiety %K depression %K coronavirus %K internet %K information seeking %K behavior %K online health information %K COVID-19 %D 2022 %7 27.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The digital era has ushered in an unprecedented volume of readily accessible information, including news coverage of current events. Research has shown that the sentiment of news articles can evoke emotional responses from readers on a daily basis with specific evidence for increased anxiety and depression in response to coverage of the recent COVID-19 pandemic. Given the primacy and relevance of such information exposure, its daily impact on the mental health of the general population within this modality warrants further nuanced investigation. Objective: Using the COVID-19 pandemic as a subject-specific example, this work aimed to profile and examine associations between the dynamics of semantic affect in online local news headlines and same-day online mental health term search behavior over time across the United States. Methods: Using COVID-19–related news headlines from a database of online news stories in conjunction with mental health–related online search data from Google Trends, this paper first explored the statistical and qualitative affective properties of state-specific COVID-19 news coverage across the United States from January 23, 2020, to October 22, 2020. The resultant operationalizations and findings from the joint application of dictionary-based sentiment analysis and the circumplex theory of affect informed the construction of subsequent hypothesis-driven mixed effects models. Daily state-specific counts of mental health search queries were regressed on circumplex-derived features of semantic affect, time, and state (as a random effect) to model the associations between the dynamics of news affect and search behavior throughout the pandemic. Search terms were also grouped into depression symptoms, anxiety symptoms, and nonspecific depression and anxiety symptoms to model the broad impact of news coverage on mental health. Results: Exploratory efforts revealed patterns in day-to-day news headline affect variation across the first 9 months of the pandemic. In addition, circumplex mapping of the most frequently used words in state-specific headlines uncovered time-agnostic similarities and differences across the United States, including the ubiquitous use of negatively valenced and strongly arousing language. Subsequent mixed effects modeling implicated increased consistency in affective tone (SpinVA β=–.207; P<.001) as predictive of increased depression-related search term activity, with emotional language patterns indicative of affective uncontrollability (FluxA β=.221; P<.001) contributing generally to an increase in online mental health search term frequency. Conclusions: This study demonstrated promise in applying the circumplex model of affect to written content and provided a practical example for how circumplex theory can be integrated with sentiment analysis techniques to interrogate mental health–related associations. The findings from pandemic-specific news headlines highlighted arousal, flux, and spin as potentially significant affect-based foci for further study. Future efforts may also benefit from more expansive sentiment analysis approaches to more broadly test the practical application and theoretical capabilities of the circumplex model of affect on text-based data. %M 34932494 %R 10.2196/32731 %U https://www.jmir.org/2022/1/e32731 %U https://doi.org/10.2196/32731 %U http://www.ncbi.nlm.nih.gov/pubmed/34932494 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e33059 %T Gaming Activity and Possible Changes in Gaming Behavior Among Young People During the COVID-19 Pandemic: Cross-sectional Online Survey Study %A Claesdotter-Knutsson,Emma %A André,Frida %A Håkansson,Anders %+ Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Barav. 1, Lund, 22185, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K COVID-19 pandemic %K gaming %K screen time %K psychological distress %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Young people’s daily lives and social interactions changed remarkably during the COVID-19 pandemic as schools and cinemas closed, leisure activities were cancelled, and gatherings were regulated. Questions have been raised by the media, schools, policy makers, and research communities about the effect on young people’s online behaviors. Objective: This cross-sectional study aimed to study self-reported changes in gaming, focusing on a younger section of the population during the COVID-19 pandemic in Sweden. We also wanted to look at potential risk factors behind problematic gaming during the pandemic, including gaming patterns, gambling behavior, psychological distress, certain sociodemographic characteristics, health factors, and school situation. Methods: This was an anonymous online survey study of web panel participants in Sweden (n=1501) to study changes in gaming behaviors during the COVID-19 pandemic. Self-reported increases in gaming were analyzed in logistic regression analyses against sociodemographic and health factors. Results: Within the study population that reported changes in gaming activity, we found significant differences in age, employment status, disposable income, whether they ever played on loot boxes, time spent at home, school attendance, psychological distress, and gambling and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. When examining the 16–24-year-old age group who reported changes in gaming activity, we found significant differences within the group in disposable income, time at home, and school attendance. When examining the 25–39-year-old age group who reported changes in gaming activity, we found significant differences within the group in employment status, disposable income, time spent at home, whether the respondents were studying, school attendance level, psychological distress, and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. Psychological distress (all age groups analyzed together; 25–39-year-old age group), drinking less alcohol (all age groups analyzed together), spending more time at home (all age groups analyzed together), gaming problems, and exercising less (25–39-year-old age group) were positively correlated with a self-reported increase in gaming activity. Being employed (25–39-year-old age group) and being over 40 years of age (all age groups analyzed together) were negatively correlated with increased gaming. We found no significant correlations in the 16–24-year-old age group. Conclusions: Those who reported increased gaming during the COVID-19 pandemic were more likely to be 16 years to 39 years old. In the age group of 25 years to 39 years old, the increase was associated with psychological distress, reporting less exercise, and being unemployed. COVID-19 may present as a risk factor of increased online gaming in a small but vulnerable group. More research and preferably longitudinal studies are needed in the field of gaming and effects of the COVID-19 pandemic. %M 34817386 %R 10.2196/33059 %U https://games.jmir.org/2022/1/e33059 %U https://doi.org/10.2196/33059 %U http://www.ncbi.nlm.nih.gov/pubmed/34817386 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e32140 %T Patterns of Suicide Ideation Across Eight Countries in Four Continents During the COVID-19 Pandemic Era: Repeated Cross-sectional Study %A Schluter,Philip J %A Généreux,Mélissa %A Hung,Kevin KC %A Landaverde,Elsa %A Law,Ronald P %A Mok,Catherine Pui Yin %A Murray,Virginia %A O'Sullivan,Tracey %A Qadar,Zeeshan %A Roy,Mathieu %+ School of Health Sciences, University of Canterbury - Te Whare Wananga o Waitaha, Private Bag 4800, Christchurch, 8140, New Zealand, 64 275106239, philip.schluter@canterbury.ac.nz %K pandemic %K infodemic %K psychosocial impacts %K sense of coherence %K suicide ideation %K epidemiology %K suicide %K pattern %K COVID-19 %K cross-sectional %K mental health %K misinformation %K risk %K prevalence %K gender %K age %K sociodemographic %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and countries’ response measures have had a globally significant mental health impact. This mental health burden has also been fueled by an infodemic: an information overload that includes misinformation and disinformation. Suicide, the worst mental health outcome, is a serious public health problem that can be prevented with timely, evidence-based, and often low-cost interventions. Suicide ideation, one important risk factor for suicide, is thus important to measure and monitor, as are the factors that may impact on it. Objective: This investigation had 2 primary aims: (1) to estimate and compare country-specific prevalence of suicide ideation at 2 different time points, overall and by gender and age groups, and (2) to investigate the influence of sociodemographic and infodemic variables on suicide ideation. Methods: A repeated, online, 8-country (Canada, the United States, England, Switzerland, Belgium, Hong Kong, Philippines, and New Zealand), cross-sectional study was undertaken with adults aged ≥18 years, with measurement wave 1 conducted from May 29, 2020 to June 12, 2020 and measurement wave 2 conducted November 6-18, 2021. Self-reported suicide ideation was derived from item 9 of the Patient Health Questionnaire-9 (PHQ-9). Age-standardized suicide ideation rates were reported, a binomial regression model was used to estimate suicide ideation indication rates for each country and measurement wave, and logistic regression models were then employed to relate sociodemographic, pandemic, and infodemic variables to suicide ideation. Results: The final sample totaled 17,833 adults: 8806 (49.4%) from measurement wave 1 and 9027 (50.6%) from wave 2. Overall, 24.2% (2131/8806) and 27.5% (2486/9027) of participants reported suicide ideation at measurement waves 1 and 2, respectively, a difference that was significant (P<.001). Considerable variability was observed in suicide ideation age-standardized rates between countries, ranging from 15.6% in Belgium (wave 1) to 42.9% in Hong Kong (wave 2). Frequent social media usage was associated with increased suicide ideation at wave 2 (adjusted odds ratio [AOR] 1.47, 95% CI 1.25-1.72; P<.001) but not wave 1 (AOR 1.11, 95% CI 0.96-1.23; P=.16). However, having a weaker sense of coherence (SOC; AOR 3.80, 95% CI 3.18-4.55 at wave 1 and AOR 4.39, 95% CI 3.66-5.27 at wave 2; both P<.001) had the largest overall effect size. Conclusions: Suicide ideation is prevalent and significantly increasing over time in this COVID-19 pandemic era, with considerable variability between countries. Younger adults and those residing in Hong Kong carried disproportionately higher rates. Social media appears to have an increasingly detrimental association with suicide ideation, although having a stronger SOC had a larger protective effect. Policies and promotion of SOC, together with disseminating health information that explicitly tackles the infodemic’s misinformation and disinformation, may importantly reduce the rising mental health morbidity and mortality triggered by this pandemic. %M 34727524 %R 10.2196/32140 %U https://publichealth.jmir.org/2022/1/e32140 %U https://doi.org/10.2196/32140 %U http://www.ncbi.nlm.nih.gov/pubmed/34727524 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34984 %T Well-being of Canadian Armed Forces Veterans and Spouses of Veterans During the COVID-19 Pandemic: Protocol for a Prospective Longitudinal Survey %A Forchuk,Callista A %A Nazarov,Anthony %A Plouffe,Rachel A %A Liu,Jenny J W %A Deda,Erisa %A Le,Tri %A Gargala,Dominic %A Soares,Vanessa %A Bourret-Gheysen,Jesse %A St Cyr,Kate %A Nouri,Maede S %A Hosseiny,Fardous %A Smith,Patrick %A Dupuis,Gabrielle %A Roth,Maya %A Marlborough,Michelle %A Jetly,Rakesh %A Heber,Alexandra %A Lanius,Ruth %A Richardson,J Don %+ The MacDonald Franklin Operational Stress Injury Research Centre, Parkwood Institute, St. Joseph's Health Care, 550 Wellington Rd, London, ON, N6C 5J1, Canada, 1 519 685 4292 ext 42399, don.richardson@sjhc.london.on.ca %K well-being %K mental health %K veterans %K military %K survey %K COVID-19 %K protocol %K veteran %K physical health %K pandemic %K longitudinal survey %K healthcare %K treatment %K family support %K peer support %D 2022 %7 11.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has resulted in significant changes to everyday life, including social distancing mandates, changes to health care, and a heightened risk of infection. Previous research has shown that Canadian Armed Forces (CAF) veterans are at higher risk of developing mental and physical health conditions. Veterans and their families may face unique social challenges that can compound with pandemic-related disruptions to negatively impact well-being. Objective: This study aims to longitudinally characterize the mental health of CAF veterans and spouses of CAF veterans throughout the pandemic and to understand the dynamic influences of pandemic-related stressors on psychological health over time. Methods: We employed a prospective longitudinal panel design using an online data collection platform. Study participation was open to all CAF veterans and spouses of CAF veterans residing in Canada. Participants were asked to complete a comprehensive battery of assessments representing psychological well-being, chronic pain, health care access patterns, physical environment, employment, social integration, and adjustment to pandemic-related lifestyle changes. Follow-up assessments were conducted every 3 months over an 18-month period. This study was approved by the Western University Health Sciences and Lawson Health Research Institute Research Ethics Boards. Results: Baseline data were collected between July 2020 and February 2021. There were 3 population segments that participated in the study: 1047 veterans, 366 spouses of veterans, and 125 veterans who are also spouses of veterans completed baseline data collection. As of November 2021, data collection is ongoing, with participants completing the 9- or 12-month follow-up surveys depending on their date of self-enrollment. Data collection across all time points will be complete in September 2022. Conclusions: This longitudinal survey is unique in its comprehensive assessment of domains relevant to veterans and spouses of veterans during the COVID-19 pandemic, ranging from occupational, demographic, social, mental, and physical domains, to perceptions and experiences with health care treatments and access. The results of this study will be used to inform policy for veteran and veteran family support, and to best prepare for similar emergencies should they occur in the future. International Registered Report Identifier (IRRID): DERR1-10.2196/34984 %M 34935624 %R 10.2196/34984 %U https://www.researchprotocols.org/2022/1/e34984 %U https://doi.org/10.2196/34984 %U http://www.ncbi.nlm.nih.gov/pubmed/34935624 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31540 %T Infoveillance of the Croatian Online Media During the COVID-19 Pandemic: One-Year Longitudinal Study Using Natural Language Processing %A Beliga,Slobodan %A Martinčić-Ipšić,Sanda %A Matešić,Mihaela %A Petrijevčanin Vuksanović,Irena %A Meštrović,Ana %+ Department of Informatics, University of Rijeka, Radmile Matejčić 2, Rijeka, 51000, Croatia, 385 51584726, sbeliga@inf.uniri.hr %K COVID-19 %K pandemic %K online media %K news coverage %K infoveillance %K infodemic %K infodemiology %K natural language processing %K name entity recognition %K longitudinal study %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Online media play an important role in public health emergencies and serve as essential communication platforms. Infoveillance of online media during the COVID-19 pandemic is an important step toward gaining a better understanding of crisis communication. Objective: The goal of this study was to perform a longitudinal analysis of the COVID-19–related content on online media based on natural language processing. Methods: We collected a data set of news articles published by Croatian online media during the first 13 months of the pandemic. First, we tested the correlations between the number of articles and the number of new daily COVID-19 cases. Second, we analyzed the content by extracting the most frequent terms and applied the Jaccard similarity coefficient. Third, we compared the occurrence of the pandemic-related terms during the two waves of the pandemic. Finally, we applied named entity recognition to extract the most frequent entities and tracked the dynamics of changes during the observation period. Results: The results showed no significant correlation between the number of articles and the number of new daily COVID-19 cases. Furthermore, there were high overlaps in the terminology used in all articles published during the pandemic with a slight shift in the pandemic-related terms between the first and the second waves. Finally, the findings indicate that the most influential entities have lower overlaps for the identified people and higher overlaps for locations and institutions. Conclusions: Our study shows that online media have a prompt response to the pandemic with a large number of COVID-19–related articles. There was a high overlap in the frequently used terms across the first 13 months, which may indicate the narrow focus of reporting in certain periods. However, the pandemic-related terminology is well-covered. %M 34739388 %R 10.2196/31540 %U https://publichealth.jmir.org/2021/12/e31540 %U https://doi.org/10.2196/31540 %U http://www.ncbi.nlm.nih.gov/pubmed/34739388 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e30221 %T Core Competencies to Promote Consistency and Standardization of Best Practices for Digital Peer Support: Focus Group Study %A Collins-Pisano,Caroline %A Velez Court,Juan %A Johnson,Michael %A Mois,George %A Brooks,Jessica %A Myers,Amanda %A Muralidharan,Anjana %A Storm,Marianne %A Wright,Maggie %A Berger,Nancy %A Kasper,Ann %A Fox,Anthony %A MacDonald,Sandi %A Schultze,Sarah %A Fortuna,Karen %+ Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH, 03755, United States, 1 (603) 650 1200, Karen.L.Fortuna@dartmouth.edu %K COVID-19 %K peer support %K competencies %K training %K digital %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: As digital peer support is quickly expanding across the globe in the wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice, such as social work, psychiatry, and psychology, limited research has been done to develop and promote digital peer support competencies. Objective: The goal of this study is to introduce the coproduction of core competencies that can guide digital peer support. Methods: Peer support specialists were recruited through an international listserv and participated in a 1-hour virtual focus group. A total of four focus groups were conducted with 59 peer support specialists from 11 US states and three countries. Results: Analysis was conducted using the rigorous and accelerated data reduction (RADaR) technique, and 10 themes were identified: (1) protecting the rights of service users, (2) technical knowledge and skills in the practice of digital peer support, (3) available technologies, (4) equity of access, (5) digital communication skills, (6) performance-based training, (7) self-care, (8) monitoring digital peer support and addressing digital crisis, (9) peer support competencies, and (10) health literacy (emerging). The authors present recommendations based on these themes. Conclusions: The introduction of digital peer support core competencies is an initial first step to promote the standardization of best practices in digital peer support. The established competencies can potentially act as a guide for training and skill development to be integrated into US state peer support specialist competencies and to enhance competencies endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA). %M 34736223 %R 10.2196/30221 %U https://mental.jmir.org/2021/12/e30221 %U https://doi.org/10.2196/30221 %U http://www.ncbi.nlm.nih.gov/pubmed/34736223 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31358 %T Nursing Perspectives on the Impacts of COVID-19: Social Media Content Analysis %A Koren,Ainat %A Alam,Mohammad Arif Ul %A Koneru,Sravani %A DeVito,Alexa %A Abdallah,Lisa %A Liu,Benyuan %+ Solomont School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Suite 200, Health and Social Science Building, Lowell, MA, 01854-3058, United States, 1 9789344429, Ainat_Koren@uml.edu %K mental health %K information retrieval %K coronavirus %K COVID-19 %K nursing %K nurses %K health care workers %K pandemic %K impact %K social media analytics %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Nurses are at the forefront of the COVID-19 pandemic. During the pandemic, nurses have faced an elevated risk of exposure and have experienced the hazards related to a novel virus. While being heralded as lifesaving heroes on the front lines of the pandemic, nurses have experienced more physical, mental, and psychosocial problems as a consequence of the COVID-19 outbreak. Social media discussions by nursing professionals participating in publicly formed Facebook groups constitute a valuable resource that offers longitudinal insights. Objective: This study aimed to explore how COVID-19 impacted nurses through capturing public sentiments expressed by nurses on a social media discussion platform and how these sentiments changed over time. Methods: We collected over 110,993 Facebook discussion posts and comments in an open COVID-19 group for nurses from March 2020 until the end of November 2020. Scraping of deidentified offline HTML tags on social media posts and comments was performed. Using subject-matter expert opinions and social media analytics (ie, topic modeling, information retrieval, and sentiment analysis), we performed a human-in-a-loop analysis of nursing professionals’ key perspectives to identify trends of the COVID-19 impact among at-risk nursing communities. We further investigated the key insights of the trends of the nursing professionals’ perspectives by detecting temporal changes of comments related to emotional effects, feelings of frustration, impacts of isolation, shortage of safety equipment, and frequency of safety equipment uses. Anonymous quotes were highlighted to add context to the data. Results: We determined that COVID-19 impacted nurses’ physical, mental, and psychosocial health as expressed in the form of emotional distress, anger, anxiety, frustration, loneliness, and isolation. Major topics discussed by nurses were related to work during a pandemic, misinformation spread by the media, improper personal protective equipment (PPE), PPE side effects, the effects of testing positive for COVID-19, and lost days of work related to illness. Conclusions: Public Facebook nursing groups are venues for nurses to express their experiences, opinions, and concerns and can offer researchers an important insight into understanding the COVID-19 impact on health care workers. %M 34623957 %R 10.2196/31358 %U https://formative.jmir.org/2021/12/e31358 %U https://doi.org/10.2196/31358 %U http://www.ncbi.nlm.nih.gov/pubmed/34623957 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e34381 %T An eHealth Intervention for Promoting COVID-19 Knowledge and Protective Behaviors and Reducing Pandemic Distress Among Sexual and Gender Minorities: Protocol for a Randomized Controlled Trial (#SafeHandsSafeHearts) %A Newman,Peter A %A Chakrapani,Venkatesan %A Williams,Charmaine %A Massaquoi,Notisha %A Tepjan,Suchon %A Roungprakhon,Surachet %A Akkakanjanasupar,Pakorn %A Logie,Carmen %A Rawat,Shruta %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada, 1 416 946 8611, p.newman@utoronto.ca %K COVID-19 %K eHealth %K RCT %K protective behaviors %K psychological distress %K LGBT+ %K India %K Thailand %D 2021 %7 10.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Existing data on COVID-19 disparities among vulnerable populations portend excess risk for lesbian, gay, bisexual, transgender (LGBT) and other persons outside of heteronormative and cisgender identities (ie, LGBT+). Owing to adverse social determinants of health, including pervasive HIV and sexual stigma, harassment, violence, barriers in access to health care, and existing health and mental health disparities, sexual and gender minorities in India and Thailand are at disproportionate risk for SARS-CoV-2 infection and severe disease. Despite global health disparities among LGBT+ populations, there is a lack of coordinated, community-engaged interventions to address the expected excess burden of COVID-19 and public health–recommended protective measures. Objective: We will implement a randomized controlled trial (RCT) to evaluate the effectiveness of a brief, peer-delivered eHealth intervention to increase COVID-19 knowledge and public health–recommended protective behaviors, and reduce psychological distress among LGBT+ people residing in Bangkok, Thailand, and Mumbai, India. Subsequent to the RCT, we will conduct exit interviews with purposively sampled subgroups, including those with no intervention effect. Methods: SafeHandsSafeHearts is a 2-site, parallel waitlist-controlled RCT to test the efficacy of a 3-session, peer counselor–delivered eHealth intervention based on motivational interviewing and psychoeducation. The study methods, online infrastructure, and content were pilot-tested with LGBT+ individuals in Toronto, Canada, before adaptation and rollout in the other contexts. The primary outcomes are COVID-19 knowledge (index based on US Centers for Disease Control and Prevention [CDC] items), protective behaviors (index based on World Health Organization and US CDC guidelines), depression (Patient Health Questionnaire-2), and anxiety (Generalized Anxiety Disorder-2). Secondary outcomes include loneliness, COVID-19 stress, and intended care-seeking. We will enroll 310 participants in each city aged 18 years and older. One-third of the participants will be cisgender gay, bisexual, and other men who have sex with men; one-third will be cisgender lesbian, bisexual, and other women who have sex with women; and one-third will be transfeminine, transmasculine, and gender nonbinary people. Participants will be equally stratified in the immediate intervention and waitlist control groups. Participants are mainly recruited from online social media accounts of community-based partner organizations. They can access the intervention on a computer, tablet, or mobile phone. SafeHandsSafeHearts involves 3 sessions delivered weekly over 3 successive weeks. Exit interviews will be conducted online with 3 subgroups (n=12 per group, n=36 in each city) of purposively selected participants to be informed by RCT outcomes and focal populations of concern. Results: The RCT was funded in 2020. The trials started recruitment as of August 1, 2021, and all RCT data collection will likely be completed by January 31, 2022. Conclusions: The SafeHandsSafeHearts RCT will provide evidence about the effectiveness of a brief, peer-delivered eHealth intervention developed for LGBT+ populations amid the COVID-19 pandemic. If the intervention proves effective, it will provide a basis for future scale-up in India and Thailand, and other low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT04870723; https://clinicaltrials.gov/ct2/show/NCT04870723 International Registered Report Identifier (IRRID): DERR1-10.2196/34381 %M 34726610 %R 10.2196/34381 %U https://www.researchprotocols.org/2021/12/e34381 %U https://doi.org/10.2196/34381 %U http://www.ncbi.nlm.nih.gov/pubmed/34726610 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31746 %T Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review %A Appleton,Rebecca %A Williams,Julie %A Vera San Juan,Norha %A Needle,Justin J %A Schlief,Merle %A Jordan,Harriet %A Sheridan Rains,Luke %A Goulding,Lucy %A Badhan,Monika %A Roxburgh,Emily %A Barnett,Phoebe %A Spyridonidis,Spyros %A Tomaskova,Magdalena %A Mo,Jiping %A Harju-Seppänen,Jasmine %A Haime,Zoë %A Casetta,Cecilia %A Papamichail,Alexandra %A Lloyd-Evans,Brynmor %A Simpson,Alan %A Sevdalis,Nick %A Gaughran,Fiona %A Johnson,Sonia %+ NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 2039872554, r.appleton@ucl.ac.uk %K telemental health %K COVID-19 %K remote care %K telemedicine %K mental health %K systematic review, implementation science %D 2021 %7 9.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care. Objective: To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation. Methods: Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis. Results: A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified. Conclusions: Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these. Trial Registration: PROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025 %M 34709179 %R 10.2196/31746 %U https://www.jmir.org/2021/12/e31746 %U https://doi.org/10.2196/31746 %U http://www.ncbi.nlm.nih.gov/pubmed/34709179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28305 %T Anti-Asian Sentiments During the COVID-19 Pandemic Across 20 Countries: Analysis of a 12-Billion-Word News Media Database %A Ng,Reuben %+ Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Rd, Singapore, 259772, Singapore, 65 66015229, spprng@nus.edu.sg %K racism %K COVID-19 %K anti-Asian sentiments %K psychomics %K quantitative social science %K culture %K text as data %K xenophobia %K digital humanities %D 2021 %7 8.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: US president Joe Biden signed an executive action directing federal agencies to combat hate crimes and racism against Asians, which have percolated during the COVID-19 pandemic. This is one of the first known empirical studies to dynamically test whether global societal sentiments toward Asians have become more negative during the COVID-19 pandemic. Objective: This study aimed to investigate whether global societal sentiments toward Asians across 20 countries have become more negative, month by month, from before the pandemic (October 2019) to May 2020, along with the pandemic (incidence and mortality rates) and cultural (Hofstede’s cultural dimensions) predictors of this trend. Methods: We leveraged a 12-billion-word web-based media database, with over 30 million newspaper and magazine articles taken from over 7000 sites across 20 countries, and identified 6 synonyms of “Asian” that are related to the coronavirus. We compiled their most frequently used descriptors (collocates) from October 2019 to May 2020 across 20 countries, culminating in 85,827 collocates that were rated by 2 independent researchers to provide a Cumulative Asian Sentiment Score (CASS) per month. This allowed us to track significant shifts in societal sentiments toward Asians from a baseline period (October to December 2019) to the onset of the pandemic (January to May 2020). We tested the competing predictors of this trend: pandemic variables of incidence and mortality rates measured monthly for all 20 countries taken from the Oxford COVID-19 Government Response Tracker, and Hofstede’s Cultural Dimensions of Individualism, Power Distance, Uncertainty Avoidance, and Masculinity for the 20 countries. Results: Before the pandemic in December 2019, Jamaica and New Zealand evidenced the most negative societal sentiments toward Asians; when news about the coronavirus was released in January 2020, the United States and Nigeria evidenced the most negative sentiments toward Asians among 20 countries. Globally, sentiments of Asians became more negative—a significant linear decline during the COVID-19 pandemic. CASS trended neutral before the pandemic during the baseline period of October to November 2019 and then plummeted in February 2020. CASS were, ironically, not predicted by COVID-19’s incidence and mortality rates, but rather by Hofstede’s cultural dimensions: individualism, power distance, and uncertainty avoidance—as shown by mixed models (N=28,494). Specifically, higher power distance, individualism, and uncertainty avoidance were associated with negative societal sentiments toward Asians. Conclusions: Racism, in the form of Anti-Asian sentiments, are deep-seated, and predicated on structural undercurrents of culture. The COVID-19 pandemic may have indirectly and inadvertently exacerbated societal tendencies for racism. Our study lays the important groundwork to design interventions and policy communications to ameliorate Anti-Asian racism, which are culturally nuanced and contextually appropriate. %M 34678754 %R 10.2196/28305 %U https://www.jmir.org/2021/12/e28305 %U https://doi.org/10.2196/28305 %U http://www.ncbi.nlm.nih.gov/pubmed/34678754 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31645 %T The Pandemic, Infodemic, and People’s Resilience in India: Viewpoint %A Syed Abdul,Shabbir %A Ramaswamy,Meghna %A Fernandez-Luque,Luis %A John,Oommen %A Pitti,Thejkiran %A Parashar,Babita %+ Graduate Institute of Biomedical Informatics, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei, Taiwan, 886 02 2736 1661 ext 1514, drshabbir@tmu.edu.tw %K pandemic %K COVID-19 %K India %K digital health %K infodemics %K Sustainable Development Goals %K SDGs %D 2021 %7 8.12.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused widespread fear and stress. The pandemic has affected everyone, everywhere, and created systemic inequities, leaving no one behind. In India alone, more than 34,094,373 confirmed COVID-19 cases and 452,454 related deaths have been reported as of October 19, 2021. Around May 2021, the daily number of new COVID-19 cases crossed the 400,000 mark, seriously hampering the health care system. Despite the devastating situation, the public response was seen through their efforts to come forward with innovative ideas for potential ways to combat the pandemic, for instance, dealing with the shortage of oxygen cylinders and hospital bed availability. With increasing COVID-19 vaccination rates since September 2021, along with the diminishing number of daily new cases, the country is conducting preventive and preparatory measures for the third wave. In this article, we propose the pivotal role of public participation and digital solutions to re-establish our society and describe how Sustainable Development Goals (SDGs) can support eHealth initiatives and mitigate infodemics to tackle a postpandemic situation. This viewpoint reflects that the COVID-19 pandemic has featured a need to bring together research findings across disciplines, build greater coherence within the field, and be a driving force for multi-sectoral, cross-disciplinary collaboration. The article also highlights the various needs to develop digital solutions that can be applied to pandemic situations and be reprocessed to focus on other SDGs. Promoting the use of digital health care solutions to implement preventive measures can be enhanced by public empowerment and engagement. Wearable technologies can be efficiently used for remote monitoring or home-based care for patients with chronic conditions. Furthermore, the development and implementation of informational tools can aid the improvement of well-being and dissolve panic-ridden behaviors contributing toward infodemics. Thus, a call to action for an observatory of digital health initiatives on COVID-19 is required to share the main conclusions and lessons learned in terms of resilience, crisis mitigation, and preparedness. %M 34787574 %R 10.2196/31645 %U https://publichealth.jmir.org/2021/12/e31645 %U https://doi.org/10.2196/31645 %U http://www.ncbi.nlm.nih.gov/pubmed/34787574 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32587 %T Investigating the Use of Digital Health Technology to Monitor COVID-19 and Its Effects: Protocol for an Observational Study (Covid Collab Study) %A Stewart,Callum %A Ranjan,Yatharth %A Conde,Pauline %A Rashid,Zulqarnain %A Sankesara,Heet %A Bai,Xi %A Dobson,Richard J B %A Folarin,Amos A %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 20 7848 0924, amos.folarin@kcl.ac.uk %K mobile health %K COVID-19 %K digital health %K smartphone %K wearable devices %K mental health %K wearable %K data %K crowdsourced %K monitoring %K surveillance %K observational %K feasibility %K infectious disease %K recovery %K mobile phone %D 2021 %7 8.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The ubiquity of mobile phones and increasing use of wearable fitness trackers offer a wide-ranging window into people’s health and well-being. There are clear advantages in using remote monitoring technologies to gain an insight into health, particularly under the shadow of the COVID-19 pandemic. Objective: Covid Collab is a crowdsourced study that was set up to investigate the feasibility of identifying, monitoring, and understanding the stratification of SARS-CoV-2 infection and recovery through remote monitoring technologies. Additionally, we will assess the impacts of the COVID-19 pandemic and associated social measures on people’s behavior, physical health, and mental well-being. Methods: Participants will remotely enroll in the study through the Mass Science app to donate historic and prospective mobile phone data, fitness tracking wearable data, and regular COVID-19–related and mental health–related survey data. The data collection period will cover a continuous period (ie, both before and after any reported infections), so that comparisons to a participant’s own baseline can be made. We plan to carry out analyses in several areas, which will cover symptomatology; risk factors; the machine learning–based classification of illness; and trajectories of recovery, mental well-being, and activity. Results: As of June 2021, there are over 17,000 participants—largely from the United Kingdom—and enrollment is ongoing. Conclusions: This paper introduces a crowdsourced study that will include remotely enrolled participants to record mobile health data throughout the COVID-19 pandemic. The data collected may help researchers investigate a variety of areas, including COVID-19 progression; mental well-being during the pandemic; and the adherence of remote, digitally enrolled participants. International Registered Report Identifier (IRRID): DERR1-10.2196/32587 %M 34784292 %R 10.2196/32587 %U https://www.researchprotocols.org/2021/12/e32587 %U https://doi.org/10.2196/32587 %U http://www.ncbi.nlm.nih.gov/pubmed/34784292 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e32948 %T The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis %A Ellis,Louise A %A Meulenbroeks,Isabelle %A Churruca,Kate %A Pomare,Chiara %A Hatem,Sarah %A Harrison,Reema %A Zurynski,Yvonne %A Braithwaite,Jeffrey %+ Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, NSW 2113, Australia, 61 9850 2484, louise.ellis@mq.edu.au %K e-mental health %K mental health %K COVID-19 %K bibliometrics %K health systems %D 2021 %7 6.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the “new normal.” Objective: The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. Methods: We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. Results: A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. Conclusions: COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care. %M 34666306 %R 10.2196/32948 %U https://mental.jmir.org/2021/12/e32948 %U https://doi.org/10.2196/32948 %U http://www.ncbi.nlm.nih.gov/pubmed/34666306 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e33495 %T Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training: Protocol for the Development and Rapid-Response Deployment %A Fung,Kenneth %A Liu,Jenny JW %A Vahabi,Mandana %A Li,Alan Tai-Wai %A Zurowski,Mateusz %A Wong,Josephine Pui-Hing %+ Department of Psychiatry, Faculty of Medicine, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada, 1 (416) 603 5349, ken.fung@uhn.ca %K COVID %K COVID-19 %K coronavirus %K pandemic %K resilience %K acceptance commitment therapy %K group empowerment %D 2021 %7 6.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During a global pandemic, it is critical to rapidly deploy a psychological intervention to support the mental health and resilience of highly affected individuals and communities. Objective: This is the rationale behind the development and implementation of the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training, an online, blended, skills building intervention to increase the resilience and well-being of participants while promoting their individual and collective empowerment and capacity building. Methods: Based on acceptance and commitment therapy (ACT) and social justice–based group empowerment psychoeducation (GEP), we developed the Acceptance and Commitment to Empowerment (ACE) model to enhance psychological resilience and collective empowerment. The PACER program consists of 6 online, interactive, self-guided modules complemented by 6 weekly, 90-minute, videoconference, facilitator-led, group sessions. Results: As of August 2021, a total of 325 participants had enrolled in the PACER program. Participants include frontline health care providers and Chinese-Canadian community members. Conclusions: The PACER program is an innovative intervention program with the potential for increasing resilience and empowerment while reducing mental distress during the pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/33495 %M 34726602 %R 10.2196/33495 %U https://www.researchprotocols.org/2021/12/e33495 %U https://doi.org/10.2196/33495 %U http://www.ncbi.nlm.nih.gov/pubmed/34726602 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e33455 %T Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study %A Goldin,Shoshanna %A Kong,So Yeon Joyce %A Tokar,Anna %A Utunen,Heini %A Ndiaye,Ngouille %A Bahl,Jhilmil %A Appuhamy,Ranil %A Moen,Ann %+ Influenza Preparedness and Response, Organisation Mondiale de la Santé, 20 Avenue Appia, Genève, CH-1211, Switzerland, 41 795165651, goldins@who.int %K COVID-19 %K vaccination %K training %K massive open online course %K pandemic %K vaccine %K education %K online education %K preparation %K evaluation %K user experience %K challenge %K impact %K knowledge %K interest %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: To prepare key stakeholders for the global COVID-19 vaccination rollout, the World Health Organization and partners developed online vaccination training packages. The online course was launched in December 2020 on the OpenWHO learning platform. This paper presents the findings of an evaluation of this course. Objective: The aim of this evaluation was to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses. Methods: The primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform’s statistical data and metric reporting system. Data from the OpenWHO platform were analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a 3-week period (March 19 to April 9, 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access. Results: During the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0%) completed the course, which is substantially higher than the industry benchmark of 5%-10% for a massive open online course (MOOC). Overall, learners averaged 76.5% on the prequiz compared to 85% on the postquiz, resulting in an increase in average score of 9%. A total of 2019 learners from the course participated in the survey. Nearly 98% (n=1647 fully agree, n=308 somewhat agree; N=1986 survey respondents excluding missing values) of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course. Conclusions: The online vaccine training was well received by the target audience, with a measurable impact on knowledge gained. The key benefits of online training were the convenience, self-paced nature, access to downloadable material, and ability to replay material, as well as an increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout. %M 34794116 %R 10.2196/33455 %U https://publichealth.jmir.org/2021/12/e33455 %U https://doi.org/10.2196/33455 %U http://www.ncbi.nlm.nih.gov/pubmed/34794116 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e34016 %T Predicting the Number of Suicides in Japan Using Internet Search Queries: Vector Autoregression Time Series Model %A Taira,Kazuya %A Hosokawa,Rikuya %A Itatani,Tomoya %A Fujita,Sumio %+ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Shogoinkawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan, 81 75 751 3927, taira.kazuya.5m@kyoto-u.ac.jp %K suicide %K internet search engine %K infoveillance %K query %K time series analysis %K vector autoregression model %K COVID-19 %K suicide-related terms %K internet %K information seeking %K time series %K model %K loneliness %K mental health %K prediction %K Japan %K behavior %K trend %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The number of suicides in Japan increased during the COVID-19 pandemic. Predicting the number of suicides is important to take timely preventive measures. Objective: This study aims to clarify whether the number of suicides can be predicted by suicide-related search queries used before searching for the keyword “suicide.” Methods: This study uses the infoveillance approach for suicide in Japan by search trends in search engines. The monthly number of suicides by gender, collected and published by the National Police Agency, was used as an outcome variable. The number of searches by gender with queries associated with “suicide” on “Yahoo! JAPAN Search” from January 2016 to December 2020 was used as a predictive variable. The following five phrases highly relevant to suicide were used as search terms before searching for the keyword “suicide” and extracted and used for analyses: “abuse”; “work, don’t want to go”; “company, want to quit”; “divorce”; and “no money.” The augmented Dickey-Fuller and Johansen tests were performed for the original series and to verify the existence of unit roots and cointegration for each variable, respectively. The vector autoregression model was applied to predict the number of suicides. The Breusch-Godfrey Lagrangian multiplier (BG-LM) test, autoregressive conditional heteroskedasticity Lagrangian multiplier (ARCH-LM) test, and Jarque-Bera (JB) test were used to confirm model convergence. In addition, a Granger causality test was performed for each predictive variable. Results: In the original series, unit roots were found in the trend model, whereas in the first-order difference series, both men (minimum tau 3: −9.24; max tau 3: −5.38) and women (minimum tau 3: −9.24; max tau 3: −5.38) had no unit roots for all variables. In the Johansen test, a cointegration relationship was observed among several variables. The queries used in the converged models were “divorce” for men (BG-LM test: P=.55; ARCH-LM test: P=.63; JB test: P=.66) and “no money” for women (BG-LM test: P=.17; ARCH-LM test: P=.15; JB test: P=.10). In the Granger causality test for each variable, “divorce” was significant for both men (F104=3.29; P=.04) and women (F104=3.23; P=.04). Conclusions: The number of suicides can be predicted by search queries related to the keyword “suicide.” Previous studies have reported that financial poverty and divorce are associated with suicide. The results of this study, in which search queries on “no money” and “divorce” predicted suicide, support the findings of previous studies. Further research on the economic poverty of women and those with complex problems is necessary. %M 34823225 %R 10.2196/34016 %U https://publichealth.jmir.org/2021/12/e34016 %U https://doi.org/10.2196/34016 %U http://www.ncbi.nlm.nih.gov/pubmed/34823225 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28239 %T Pandemic Information Dissemination and Its Associations With the Symptoms of Mental Distress During the COVID-19 Pandemic: Cross-sectional Study %A Amundsen,Ole Myklebust %A Hoffart,Asle %A Johnson,Sverre Urnes %A Ebrahimi,Omid V %+ Department of Clinical Psychology, University of Bergen, Årstadveien 17, Bergen, 5009, Norway, 47 45209507, oleamundsen@me.com %K information sources %K COVID-19 %K avoidance %K psychopathology %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The 2020-2021 COVID-19 pandemic has added to the mental health strain on individuals and groups across the world in a variety of ways. Viral mitigation protocols and viral spread affect people on all continents every day, but at widely different degrees. To understand more about the mental health consequences of the pandemic, it is important to investigate whether or how people gather pandemic-related information and how obtaining this information differentially affects individuals. Objective: This study aimed to investigate whether and to what extent higher levels of COVID-19–related media consumption across information sources are associated with the symptoms of anxiety, health anxiety, and depression, and whether and to what extent using social media and online interactive platforms versus traditional media platforms is associated with the symptoms of anxiety, health anxiety, and depression. Additionally, we aimed to investigate whether and to what extent avoidance of COVID-19–related information is associated with the aforementioned symptoms. Methods: In a cross-sectional preregistered survey, 4936 participants responded between June 22 and July 13, 2020. Eligible participants were adults currently residing in Norway and were thus subjected to identical viral mitigation protocols. This sample was representative of the Norwegian population after utilizing an iterative raking algorithm to conduct poststratification. As 2 subgroups (transgender and intersex individuals) were too small to be analyzed, the final sample for descriptive statistics and regressions included 4921 participants. Multiple regressions were used to investigate associations between the symptoms of psychopathology and COVID-19–related information dissemination. Part correlations were calculated as measures of the effect size for each predictor variable. Due to the large anticipated sample size, the preregistered criterion for significance was set at P<.01. Results: The symptoms of anxiety and health anxiety were significantly associated with obtaining information from newspapers (P<.001), social media (P<.001), and the broader categories of online interactive (P<.001) and traditional media (P<.001). The symptoms of depression were significantly associated with obtaining information from newspapers (P=.003), social media (P=.009), and the broader category of online interactive media (P<.001). Additionally, avoidance of COVID-19–related information showed a significant association in all 3 domains of psychopathological symptoms (anxiety and depression, P<.001; health anxiety, P=.007). Conclusions: This study found significant associations between the symptoms of psychopathology and the use of media for obtaining information related to the COVID-19 pandemic. Significant findings for obtaining information through newspapers, social media, and online interactive media were seen across all 3 measures of psychopathology. Avoidance of COVID-19–related information and associations with the symptoms of psychopathology emerged as core findings, with generally higher effect sizes compared with information attainment. Trial Registration: ClinicalTrials.gov NCT04442360; https://clinicaltrials.gov/ct2/show/NCT04442360 %M 34678750 %R 10.2196/28239 %U https://formative.jmir.org/2021/12/e28239 %U https://doi.org/10.2196/28239 %U http://www.ncbi.nlm.nih.gov/pubmed/34678750 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e33125 %T Drinking and Social Media Use Among Workers During COVID-19 Pandemic Restrictions: Five-Wave Longitudinal Study %A Oksanen,Atte %A Oksa,Reetta %A Savela,Nina %A Celuch,Magdalena %A Savolainen,Iina %+ Tampere University, Faculty of Social Sciences, Kalevantie 5, Tampere, 33014, Finland, 358 503187279, atte.oksanen@tuni.fi %K excessive drinking %K alcohol %K COVID-19 %K social media %K remote work %K psychological distress %K distress %K pattern %K trend %K prediction %K survey %K app %K risk %D 2021 %7 2.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic restricted everyday life during 2020-2021 for many people worldwide. It also affected alcohol consumption patterns and leisure activities, including the use of social media. Objective: The aim of this study was to analyze whether social media use predicts increased risky drinking over time and during the COVID-19 pandemic restrictions in particular. Methods: This 5-wave longitudinal survey study, based on a nationwide sample of workers, was conducted in Finland in 2019-2021. A total of 840 respondents (male: 473/840, 56.31%; age range 18-64 years; mean age 43.90, SD 11.14 years) participated in all 5 waves of the study. The outcome variable was risky drinking, measured using the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). Multilevel linear hybrid modeling enabled the investigation of both within-person and between-person effects. Predictors included social media use and communication, involvement in social media identity bubbles, psychological distress, and remote working. Controls included sociodemographic factors and the Big Five personality traits. Results: Increased involvement in social media identity bubbles was associated with an increase in risky drinking behavior. Of all social media platforms examined, online dating app use was associated with riskier use of alcohol over time during the COVID-19 crisis. Daily social media communication with colleagues about nonwork topics was associated with risky drinking. Female gender, younger age, university education, nonindustrial occupational field, conscientiousness, agreeableness, and neuroticism were associated with lower levels of risky drinking. Conclusions: Social media use during a pandemic carries some risks for alcohol consumption. Involvement in social media identity bubbles and online dating are risk factors for excessive drinking during the COVID-19 pandemic. %M 34662290 %R 10.2196/33125 %U https://www.jmir.org/2021/12/e33125 %U https://doi.org/10.2196/33125 %U http://www.ncbi.nlm.nih.gov/pubmed/34662290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30702 %T Depression, Anxiety, and Daily Activity Among Adolescents Before and During the COVID-19 Pandemic: Cross-sectional Survey Study %A Jolliff,Anna %A Zhao,Qianqian %A Eickhoff,Jens %A Moreno,Megan %+ Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, 2870 University Avenue, Suite 200, Madison, WI, 53705, United States, 1 5035539361, ajolliff@wisc.edu %K COVID-19 %K pandemic %K adolescent %K depression %K anxiety %K socioeconomic status %K survey %K mental health %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has resulted in significant changes to adolescents’ daily lives and, potentially, to their mental health. The pandemic has also disproportionately affected historically marginalized and at-risk communities, including people of color, socioeconomically disadvantaged people, people identifying as female, and youth. Objective: This study aimed to understand differences in depression and anxiety among 2 groups of adolescents in the United States before and during the COVID-19 pandemic, and to examine demographic and daily activity variables associated with depression and anxiety. Methods: Online surveys were distributed in 2019 and 2020. Demographic questions were asked at the time of enrollment, and included participants’ age, gender, race and ethnicity, and socioeconomic status (SES). The 8-item Patient Health Questionnaire was used to assess symptoms of depression, and the 7-item Generalized Anxiety Disorder scale was used to assess symptoms of anxiety. A total of 4 pandemic-specific daily activity questions were asked only of the pandemic group. Analyses of covariance compared depression and anxiety between prepandemic and pandemic groups. Demographic and lifestyle variables were included as covariates. Results: The sample comprised a total of 234 adolescents, with 100 participants in the prepandemic group and 134 participants in the pandemic group. Within the pandemic group, 94% (n=126) of adolescents reported being out of school due to the pandemic, and another 85.8% (n=115) and 57.1% (n=76) were prevented from extracurricular activities and exercise, respectively. Higher depression was seen in the pandemic group, with a least-squares adjusted mean of 7.62 (SD 1.36) compared to 6.28 (SD 1.42) in the prepandemic group, although the difference was not significant (P=.08). There was no significant difference in anxiety scores between the 2 groups (least-squares adjusted means 5.52, SD 1.30 vs 5.01, SD 1.36; P=.48). Within the pandemic group, lower SES was predictive of anxiety, such that those in the pandemic group of lower SES were more anxious than their higher-SES peers (least-squares adjusted means 11.17, SD 2.34 vs 8.66, SD 2.16; P=.02). Within the pandemic group, being out of work or school and not partaking in extracurricular activities or exercise due to the pandemic were not associated with higher depression or anxiety scores. Conclusions: In this study, neither being in the pandemic group nor experiencing changes in daily activity due to the pandemic was associated with higher depression or anxiety. However, we found that adolescents from lower SES backgrounds experienced significantly more anxiety during the pandemic than their more privileged peers. Both instrumental and mental health interventions for low-income adolescents are imperative. %M 34609316 %R 10.2196/30702 %U https://formative.jmir.org/2021/12/e30702 %U https://doi.org/10.2196/30702 %U http://www.ncbi.nlm.nih.gov/pubmed/34609316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28734 %T Transitioning From In-Person to Remote Clinical Research on Depression and Traumatic Brain Injury During the COVID-19 Pandemic: Study Modifications and Preliminary Feasibility From a Randomized Controlled Pilot Study %A Fisher,Lauren B %A Tuchman,Sylvie %A Curreri,Andrew J %A Markgraf,Maggie %A Nyer,Maren B %A Cassano,Paolo %A Iverson,Grant L %A Fava,Maurizio %A Zafonte,Ross D %A Pedrelli,Paola %+ Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 6th Floor, Boston, MA, 02114, United States, 1 617 643 0877, fisher.lauren@mgh.harvard.edu %K COVID-19 %K telemental health %K clinical trial %K traumatic brain injury %K depression %K cognitive behavioral therapy %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Telehealth has provided many researchers, especially those conducting psychosocial research, with the tools necessary to transition from in-person to remote clinical trials during the COVID-19 pandemic. A growing body of research supports the effectiveness of telemental health for a variety of psychiatric conditions, but few studies have examined telemental health for individuals with comorbid medical diagnoses. Furthermore, little is known about the remote implementation of clinical trials examining telemental health interventions. Objective: This paper outlines the procedural modifications used to facilitate conversion of an in-person randomized controlled trial of cognitive behavioral therapy (CBT) for depression in individuals with traumatic brain injury (TBI; CBT-TBI) to a telemental health study administered remotely. Methods: Given the nature of remote implementation and specific challenges experienced by individuals with TBI, considerations related to treatment delivery, remote consent, data management, neuropsychological assessment, safety monitoring, and delivery of supportive material have been discussed. Feasibility, acceptability, and safety were evaluated by examining attendance and participant responses on self-report measures of treatment satisfaction and suicidal behavior. Results: High rates of treatment attendance, assessment completion, study retention, and satisfaction with the intervention and modality were reported by participants who completed at least one telemental health CBT-TBI session. Conclusions: Study modifications are necessary when conducting a study remotely, and special attention should be paid to comorbidities and population-specific challenges (eg, cognitive impairment). Preliminary data support the feasibility, acceptability, and safety of remotely conducting a randomized controlled trial of CBT-TBI. Trial Registration: ClinicalTrials.gov NCT03307070; https://clinicaltrials.gov/ct2/show/NCT03307070 %M 34662285 %R 10.2196/28734 %U https://formative.jmir.org/2021/12/e28734 %U https://doi.org/10.2196/28734 %U http://www.ncbi.nlm.nih.gov/pubmed/34662285 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e26743 %T Using Ecological Momentary Assessment to Study the Development of COVID-19 Worries in Sweden: Longitudinal Study %A Schulz,Peter Johannes %A Andersson,Elin M %A Bizzotto,Nicole %A Norberg,Margareta %+ Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, Lugano, 6900, Switzerland, 41 58666 ext 4724, schulzp@usi.ch %K COVID-19 %K coronavirus %K longitudinal studies %K EMA %K worry %K fear %K pandemics %D 2021 %7 29.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The foray of COVID-19 around the globe has certainly instigated worries in many people, and lockdown measures may well have triggered more specific worries. Sweden, more than other countries, relied on voluntary measures to fight the pandemic. This provides a particularly interesting context to assess people’s reactions to the threat of the pandemic. Objective: The general aim of this study was to better understand the worried reactions to the virus and the associated lockdown measures. As there have been very few longitudinal studies in this area published to date, development of feelings of worry over time was analyzed over a longer range than in previous research. Affective variables, worry in particular, were included because most of the research in this field has focused on cognitive variables. To employ new methodology, ecological momentary assessment was used for data collection and a multilevel modeling approach was adopted for data analysis. Methods: Results were based on an unbalanced panel sample of 260 Swedish participants filling in 3226 interview questionnaires by smartphone over a 7-week period in 2020 during the rapid rise of cases in the early phase of the pandemic. Causal factors considered in this study included the perceived severity of an infection, susceptibility of a person to the threat posed by the virus, perceived efficacy of safeguarding measures, and assessment of government action against the spread of COVID-19. The effect of these factors on worries was traced in two analytical steps: the effects at the beginning of the study and the effect on the trend during the study. Results: The level of general worry related to COVID-19 was modest (mean 6.67, SD 2.54 on an 11-point Likert scale); the increase during the study period was small, but the interindividual variation of both the worry level and its increase over time was large. Findings confirmed that the hypothesized causal factors (severity of infection, susceptibility to the threat of the virus, efficacy of safeguarding, and assessment of government preventive action) did indeed affect the level of worry. Conclusions: The results confirmed earlier research in a very special case and demonstrated the usefulness of a different study design, which takes a longitudinal perspective, and a new type of data analysis borrowed from multilevel study design. %M 34847065 %R 10.2196/26743 %U https://www.jmir.org/2021/11/e26743 %U https://doi.org/10.2196/26743 %U http://www.ncbi.nlm.nih.gov/pubmed/34847065 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e31635 %T Impact of the COVID-19 Pandemic on the Health Status and Behaviors of Adults in Korea: National Cross-sectional Web-Based Self-report Survey %A Kang,EunKyo %A Lee,Hyejin %A Sohn,Jee Hoon %A Yun,Jieun %A Lee,Jin Yong %A Hong,Yun-Chul %+ Department of Preventive Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 740 8394, ychong1@snu.ac.kr %K COVID-19 %K health status %K health behavior %K self-reported online survey %K pandemic %K epidemiology %K public health %K sociodemographic factors %K health interventions %K lockdown %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has radically shifted living practices, thereby influencing changes in the health status and behaviors of every person. Objective: The aim of this study was to investigate the impact of COVID-19 on the self-reported health status and health behaviors along with any associated factors in adults in the Republic of Korea wherein no stringent lockdown measures were implemented during the pandemic. Methods: We conducted a web-based self-reported survey from November 2020 to December 2020. The study participants (N=2097) were identified through quota sampling by age, sex, and geographical regions among residents aged 19 years or older in Korea. The survey collected information on basic demographics, changes in self-reported health status, and health behaviors during the COVID-19 pandemic. Self-reported health status and health behaviors were categorized into 3 groups: unchanged, improved, or worsened. A chi-square test and logistic regression analyses were conducted. Results: With regard to changes in the self-reported health status, the majority (1478/2097, 70.5%) of the participants reported that their health was unchanged, while 20% (420/2097) of the participants reported having worser health after the COVID-19 outbreak. With regard to changes in health behaviors, the proportion of participants who increased tobacco consumption was similar to that of those who decreased tobacco consumption (110/545, 20.2% vs 106/545, 19.5%, respectively), while the proportion of those who decreased their drinking frequency was more than twice as many as those who increased their drinking frequency (578/1603, 36.1% vs 270/1603, 16.8%, respectively). Further, those who decreased their exercising frequency were more than those who increased their exercising frequency (333/823, 15.9% vs 211/823, 10%, respectively). The factor that had the greatest influence on lifestyle was age. In the subgroup analysis, the group aged 20-29 years had the highest number of individuals with both a worsened (100/377, 26.5%) and an improved (218/377, 15.7%) health status. Further, individuals aged 20-29 years had greater odds of increased smoking (6.44, 95% CI 2.15-19.32), increased alcohol use (4.64, 95% CI 2.60-8.28), and decreased moderate or higher intensity aerobic exercise (3.39, 95% CI 1.82-6.33) compared to individuals aged 60 years and older. Younger adults showed deteriorated health behaviors, while older adults showed improved health behaviors. Conclusions: The health status and the behavior of the majority of the Koreans were not found to be heavily affected by the COVID-19 outbreak. However, in some cases, changes in health status or health behavior were identified. This study highlighted that some groups were overwhelmingly affected by COVID-19 compared to others. Certain groups reported experiencing both worsening and improving health, while other groups reported unchanged health status. Age was the most influential factor for behavior change; in particular, the younger generation’s negative health behaviors need more attention in terms of public health. As COVID-19 prolongs, public health interventions for vulnerable groups may be needed. %M 34653017 %R 10.2196/31635 %U https://publichealth.jmir.org/2021/11/e31635 %U https://doi.org/10.2196/31635 %U http://www.ncbi.nlm.nih.gov/pubmed/34653017 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29970 %T Demographics Associated With Stress, Severe Mental Distress, and Anxiety Symptoms During the COVID-19 Pandemic in Japan: Nationwide Cross-sectional Web-Based Survey %A Midorikawa,Haruhiko %A Tachikawa,Hirokazu %A Taguchi,Takaya %A Shiratori,Yuki %A Takahashi,Asumi %A Takahashi,Sho %A Nemoto,Kiyotaka %A Arai,Tetsuaki %+ Department of Disaster and Community Psychiatry, University of Tsukuba, Igakukei Gakukeitou 873, 1-1-1 Tennoudai, Tsukuba, 305-8577, Japan, 81 29 853 3057, tachikawa@md.tsukuba.ac.jp %K COVID-19 %K mental health %K stress %K depression %K anxiety %K occupation %K public health %K demographic factors %K epidemiology %K occupational health %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With the spread of COVID-19, the deterioration of public mental health has become a major global and social problem. Objective: The purpose of this study was to elucidate the relationship between the 3 mental health problems associated with COVID-19, that is, perceived stress, severe mental distress, and anxiety symptoms, and the various demographic factors, including occupation. Methods: A nationwide web-based questionnaire survey was conducted in Japan from August 4 to 31, 2020. In addition to sociodemographic data, the degrees of perceived stress, severe mental distress, and anxiety symptoms associated with COVID-19 were measured. After performing a descriptive statistical analysis, factors related to stress, severe mental distress, and anxiety symptoms were analyzed using logistic regression analysis. Results: A total of 8203 respondents submitted survey responses, among whom 34.9% (2861/8203) felt intense stress associated with COVID-19, 17.1% (1403/8203) were depressed, and 13.5% (1110/8203) had severe anxiety symptoms. The logistic regression analysis showed that each of the 3 mental health problems were prevalent in females, nonbinary gender, people in their 50s, 60s and older, respondents who visited psychiatrists, and those currently in psychiatric care. Severe mental distress and anxiety symptoms were associated with the number of effective lifestyle coping strategies during the lockdown period. Severe mental distress was only prevalent in teenagers and respondents in their 20s, as students tended to develop stress and severe mental distress. With regard to occupation, working in nursing care and welfare, education and research, and medical and health sectors was associated with stress; however, working in these occupations was not associated with severe mental distress and anxiety symptoms. Unemployment was associated with severe mental distress and anxiety symptoms. All 3 mental health problems were prevalent in part-time workers and those working in entertainment and arts sectors. Conclusions: Gender, age, occupation, history of psychiatric visits, and stress coping mechanisms were associated with mental health during the COVID-19 pandemic, but their associations with stress, severe mental distress, and anxiety symptoms differed. In addition, the actual state of mental health varied according to the respondents’ occupation. It is necessary to consider the impact of the COVID-19 pandemic on mental health not only at the individual level but also at the occupational level. %M 34653018 %R 10.2196/29970 %U https://publichealth.jmir.org/2021/11/e29970 %U https://doi.org/10.2196/29970 %U http://www.ncbi.nlm.nih.gov/pubmed/34653018 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e31908 %T Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study %A Ahlers-Schmidt,Carolyn R %A Schunn,Christy %A Hervey,Ashley M %A Torres,Maria %A Nelson,Jill Elizabeth V %+ Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3242 E. Murdock St., Suite 602, Wichita, KS, United States, 1 3169627923, cschmidt3@kumc.edu %K COVID-19 %K SIDS %K sudden infant death syndrome %K safe sleep %K tobacco cessation %K breastfeeding %K virtual education %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Safe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual. Objective: This study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events. Methods: Participants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys. Results: Based on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P≤.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84% vs virtual: 53/74, 72%; P=.03), intention to breastfeed ≥6 months (in-person: 79/128, 62% vs virtual: 52/66, 79%; P=.008), and confidence in the ability to breastfeed ≥6 months (in-person: 58/123, 47% vs virtual: 44/69, 64%; P=.02). Conclusions: Although both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events. %M 34550075 %R 10.2196/31908 %U https://pediatrics.jmir.org/2021/4/e31908 %U https://doi.org/10.2196/31908 %U http://www.ncbi.nlm.nih.gov/pubmed/34550075 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e32876 %T Machine Learning–Based Predictive Modeling of Anxiety and Depressive Symptoms During 8 Months of the COVID-19 Global Pandemic: Repeated Cross-sectional Survey Study %A Hueniken,Katrina %A Somé,Nibene Habib %A Abdelhack,Mohamed %A Taylor,Graham %A Elton Marshall,Tara %A Wickens,Christine M %A Hamilton,Hayley A %A Wells,Samantha %A Felsky,Daniel %+ Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, 250 College St, 12th Floor, Toronto, ON, M5T 1R8, Canada, 1 (416) 535 8501 ext 33587, Daniel.Felsky@camh.ca %K mental health %K machine learning %K COVID-19 %K emotional distress %K emotion %K distress %K prediction %K model %K anxiety %K depression %K symptom %K cross-sectional %K survey %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 global pandemic has increased the burden of mental illness on Canadian adults. However, the complex combination of demographic, economic, and lifestyle factors and perceived health risks contributing to patterns of anxiety and depression has not been explored. Objective: The aim of this study is to harness flexible machine learning methods to identify constellations of factors related to symptoms of mental illness and to understand their changes over time during the COVID-19 pandemic. Methods: Cross-sectional samples of Canadian adults (aged ≥18 years) completed web-based surveys in 6 waves from May to December 2020 (N=6021), and quota sampling strategies were used to match the English-speaking Canadian population in age, gender, and region. The surveys measured anxiety and depression symptoms, sociodemographic characteristics, substance use, and perceived COVID-19 risks and worries. First, principal component analysis was used to condense highly comorbid anxiety and depression symptoms into a single data-driven measure of emotional distress. Second, eXtreme Gradient Boosting (XGBoost), a machine learning algorithm that can model nonlinear and interactive relationships, was used to regress this measure on all included explanatory variables. Variable importance and effects across time were explored using SHapley Additive exPlanations (SHAP). Results: Principal component analysis of responses to 9 anxiety and depression questions on an ordinal scale revealed a primary latent factor, termed “emotional distress,” that explained 76% of the variation in all 9 measures. Our XGBoost model explained a substantial proportion of variance in emotional distress (r2=0.39). The 3 most important items predicting elevated emotional distress were increased worries about finances (SHAP=0.17), worries about getting COVID-19 (SHAP=0.17), and younger age (SHAP=0.13). Hopefulness was associated with emotional distress and moderated the impacts of several other factors. Predicted emotional distress exhibited a nonlinear pattern over time, with the highest predicted symptoms in May and November and the lowest in June. Conclusions: Our results highlight factors that may exacerbate emotional distress during the current pandemic and possible future pandemics, including a role of hopefulness in moderating distressing effects of other factors. The pandemic disproportionately affected emotional distress among younger adults and those economically impacted. %M 34705663 %R 10.2196/32876 %U https://mental.jmir.org/2021/11/e32876 %U https://doi.org/10.2196/32876 %U http://www.ncbi.nlm.nih.gov/pubmed/34705663 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e32708 %T Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences %A Wood,Sarah M %A Pickel,Julia %A Phillips,Alexis W %A Baber,Kari %A Chuo,John %A Maleki,Pegah %A Faust,Haley L %A Petsis,Danielle %A Apple,Danielle E %A Dowshen,Nadia %A Schwartz,Lisa A %+ Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, United States, 1 215 590 1000, woodsa@chop.edu %K telehealth %K telemedicine %K adolescent %K COVID-19 %K acceptability %K feasibility %K young adult %K teenager %K cross-sectional %K patient experience %K experience %K efficiency %K equity %K survey %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. Objective: The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. Methods: Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. Results: Survey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P<.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents’ concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. Conclusions: Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety. %M 34779782 %R 10.2196/32708 %U https://pediatrics.jmir.org/2021/4/e32708 %U https://doi.org/10.2196/32708 %U http://www.ncbi.nlm.nih.gov/pubmed/34779782 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e30259 %T Longitudinal Neurocognitive and Pulmonological Profile of Long COVID-19: Protocol for the COVIMMUNE-Clin Study %A Widmann,Catherine N %A Wieberneit,Michelle %A Bieler,Luzie %A Bernsen,Sarah %A Gräfenkämper,Robin %A Brosseron,Frederic %A Schmeel,Carsten %A Tacik,Pawel %A Skowasch,Dirk %A Radbruch,Alexander %A Heneka,Michael T %+ Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Venusberg-Campus-1, Building 80, Bonn, 53127, Germany, 49 228 287 13093, catherine.widmann@ukbonn.de %K SARS-CoV-2 %K COVID-19 %K postacute COVID-19 syndrome %K cognition %K neuropsychology %K lung %K magnetic resonance imaging %D 2021 %7 11.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a dearth of information about “brain fog,” characterized by concentration, word-finding, or memory problems, which has been listed in the new World Health Organization provisional classification “U09.9 Post-COVID-19 Condition.” Moreover, the extent to which these symptoms may be associated with neurological, pulmonary, or psychiatric difficulties is unclear. Objective: This ongoing cohort study aims to carefully assess neurocognitive function in the context of the neurological, psychiatric, and pulmonary sequelae of SARS-CoV-2 infection among patients with asymptomatic/mild and severe cases of COVID-19 after remission, including actively recruited healthy controls. Methods: A total of 150 participants will be included in this pilot study. The cohort will comprise patients who tested positive for SARS-CoV-2 infection with either an asymptomatic course or a mild course defined as no symptoms except for olfactory and taste dysfunction (n=50), patients who tested positive for SARS-CoV-2 infection with a severe disease course (n=50), and a healthy control group (n=50) with similar age and sex distribution based on frequency matching. A comprehensive neuropsychological assessment will be performed comprising nuanced aspects of complex attention, including language, executive function, verbal and visual learning, and memory. Psychiatric, personality, social and lifestyle factors, sleep, and fatigue will be evaluated. Brain magnetic resonance imaging, neurological and physical assessment, and pulmonological and lung function examinations (including body plethysmography, diffusion capacity, clinical assessments, and questionnaires) will also be performed. Three visits are planned with comprehensive testing at the baseline and 12-month visits, along with brief neurological and neuropsychological examinations at the 6-month assessment. Blood-based biomarkers of neurodegeneration will be quantified at baseline and 12-month follow-up. Results: At the time of submission, the study had begun recruitment through telephone and in-person screenings. The first patient was enrolled in the study at the beginning of April 2021. Interim data analysis of baseline information is expected to be complete by December 2021 and study completion is expected at the end of December 2022. Preliminary group comparisons indicate worse word list learning, short- and long-delayed verbal recall, and verbal recognition in both patient cohorts compared with those of the healthy control group, adjusted for age and sex. Initial volumetric comparisons show smaller grey matter, frontal, and temporal brain volumes in both patient groups compared with those of healthy controls. These results are quite robust but are neither final nor placed in the needed context intended at study completion. Conclusions: To the best of our knowledge, this is the first study to include objective and comprehensive longitudinal analyses of neurocognitive sequelae of COVID-19 in an extreme group comparison stratified by disease severity with healthy controls actively recruited during the pandemic. Results from this study will contribute to the nascent literature on the prolonged effects of COVID-19 on neurocognitive performance via our coassessment of neuroradiological, neurological, pulmonary, psychiatric, and lifestyle factors. Trial Registration: International Clinical Trials Registry Platform DRKS00023806; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00023806 International Registered Report Identifier (IRRID): DERR1-10.2196/30259 %M 34559059 %R 10.2196/30259 %U https://www.researchprotocols.org/2021/11/e30259 %U https://doi.org/10.2196/30259 %U http://www.ncbi.nlm.nih.gov/pubmed/34559059 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29319 %T Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey %A Monnig,Mollie A %A Treloar Padovano,Hayley %A Sokolovsky,Alexander W %A DeCost,Grace %A Aston,Elizabeth R %A Haass-Koffler,Carolina L %A Szapary,Claire %A Moyo,Patience %A Avila,Jaqueline C %A Tidey,Jennifer W %A Monti,Peter M %A Ahluwalia,Jasjit S %+ Department of Behavioral and Social Sciences, Brown University, Box G-S121-5, Providence, RI, 02912, United States, 1 4018633491, mollie_monnig@brown.edu %K SARS-CoV-2 %K novel coronavirus %K COVID-19 %K alcohol use %K alcohol drinking %K opioid use %K stimulant use %K nicotine %K smoking %K survey %K substance abuse %K addiction %K mental health %K pandemic %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk for COVID-19 in substance users are not well understood. Objective: The aim of this study was to evaluate whether alcohol or other drug use is associated with adherence to Centers for Disease Control and Prevention (CDC) guidelines for COVID-19 mitigation. Preregistered analyses tested the hypothesis that greater use of alcohol and other drugs would be associated with lower CDC guideline adherence. A secondary objective was to determine whether substance use was associated with the likelihood of COVID-19 testing or outcome. Methods: A cross-sectional web-based survey was administered to a convenience sample recruited through Amazon’s Mechanical Turk platform from June 18 to July 19, 2020. Individuals aged 18 years or older and residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to participate. The exposure of interest was past 7-day use of alcohol, cigarettes, electronic cigarettes, cannabis, stimulants, and nonmedical opioids. The primary outcome was CDC guideline adherence measured using a scale developed from behaviors advised to reduce the spread of COVID-19. Secondary outcomes were likelihood of COVID-19 testing and a positive COVID-19 test result. All analyses accounted for the sociodemographic characteristics. Results: The sample consisted of 1084 individuals (mean age 40.9 [SD 13.4] years): 529 (48.8%) men, 543 (50.1%) women, 12 (1.1%) other gender identity, 742 (68.5%) White individuals, 267 (24.6%) Black individuals, and 276 (25.5%) Hispanic individuals. Daily opioid users reported lower CDC guideline adherence than nondaily users (B=–0.24, 95% CI –0.44 to –0.05) and nonusers (B=–0.57, 95% CI –0.76 to –0.38). Daily alcohol drinkers reported lower adherence than nondaily drinkers (B=–0.16, 95% CI –0.30 to –0.02). Nondaily alcohol drinkers reported higher adherence than nondrinkers (B=0.10, 95% CI 0.02-0.17). Daily opioid use was related to greater odds of COVID-19 testing, and daily stimulant use was related to greater odds of a positive COVID-19 test. Conclusions: In a regionally-specific, racially, and ethnically diverse convenience sample, adults who engaged in daily alcohol or opioid use reported lower CDC guideline adherence for COVID-19 mitigation. Any opioid use was associated with greater odds of COVID-19 testing, and daily stimulant use was associated with greater odds of COVID-19 infection. Cigarettes, electronic cigarettes, cannabis, or stimulant use were not statistically associated with CDC guideline adherence, after accounting for sociodemographic covariates and other substance use variables. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors. %M 34591780 %R 10.2196/29319 %U https://publichealth.jmir.org/2021/11/e29319 %U https://doi.org/10.2196/29319 %U http://www.ncbi.nlm.nih.gov/pubmed/34591780 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31586 %T A Digital Human for Delivering a Remote Loneliness and Stress Intervention to At-Risk Younger and Older Adults During the COVID-19 Pandemic: Randomized Pilot Trial %A Loveys,Kate %A Sagar,Mark %A Pickering,Isabella %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Building 507, Level 3, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 0003, e.broadbent@auckland.ac.nz %K COVID-19 %K loneliness %K stress %K well-being %K eHealth %K digital human %K conversational agent %K older adults %K chronic illness %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is a growing public health issue that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Computer agents are capable of delivering psychological therapies through the internet; however, there is limited research on their acceptability to date. Objective: The objectives of this study were to evaluate (1) the feasibility and acceptability of a remote loneliness and stress intervention with digital human delivery to at-risk adults and (2) the feasibility of the study methods in preparation for a randomized controlled trial. Methods: A parallel randomized pilot trial with a mixed design was conducted. Participants were adults aged 18 to 69 years with an underlying medical condition or aged 70 years or older with a Mini-Mental State Examination score of >24 (ie, at greater risk of developing severe COVID-19). Participants took part from their place of residence (independent living retirement village, 20; community dwelling, 7; nursing home, 3). Participants were randomly allocated to the intervention or waitlist control group that received the intervention 1 week later. The intervention involved completing cognitive behavioral and positive psychology exercises with a digital human facilitator on a website for at least 15 minutes per day over 1 week. The exercises targeted loneliness, stress, and psychological well-being. Feasibility was evaluated using dropout rates and behavioral observation data. Acceptability was evaluated from behavioral engagement data, the Friendship Questionnaire (adapted), self-report items, and qualitative questions. Psychological measures were administered to evaluate the feasibility of the trial methods and included the UCLA Loneliness Scale, the 4-item Perceived Stress Scale, a 1-item COVID-19 distress measure, the Flourishing Scale, and the Scale of Positive and Negative Experiences. Results: The study recruited 30 participants (15 per group). Participants were 22 older adults and 8 younger adults with a health condition. Six participants dropped out of the study. Thus, the data of 24 participants were analyzed (intervention group, 12; waitlist group, 12). The digital human intervention and trial methods were generally found to be feasible and acceptable in younger and older adults living independently, based on intervention completion, and behavioral, qualitative, and some self-report data. The intervention and trial methods were less feasible to nursing home residents who required caregiver assistance. Acceptability could be improved with additional content, tailoring to the population, and changes to the digital human’s design. Conclusions: Digital humans are a promising and novel technological solution for providing at-risk adults with access to remote psychological support during the COVID-19 pandemic. Research should further examine design techniques to improve their acceptability in this application and investigate intervention effectiveness in a randomized controlled trial. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12620000786998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380113 %M 34596572 %R 10.2196/31586 %U https://mental.jmir.org/2021/11/e31586 %U https://doi.org/10.2196/31586 %U http://www.ncbi.nlm.nih.gov/pubmed/34596572 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e29896 %T Psychosocial and Behavioral Effects of the COVID-19 Pandemic in the Indian Population: Protocol for a Cross-sectional Study %A Joshi,Megha %A Shah,Aangi %A Trivedi,Bhavi %A Trivedi,Jaahnavee %A Patel,Viral %A Parghi,Devam %A Thakkar,Manini %A Barot,Kanan %A Jadawala,Vivek %+ Department of Psychiatry, Shrimati Nathiba Hargovandas Lakhamichand Municipal Medical College, Gujarat University, Pritamrai cross road,, Ellisbridge, Paldi, Ahmedabad, 380006, India, 91 9909896196, joshimegha1@gmail.com %K COVID-19 %K mental health %K India %K lockdown %K isolation %K social isolation %K behavior %K psychology %K psychosocial effects %D 2021 %7 5.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the year 2020, the COVID-19 pandemic spread from China to the rest of the world, which prompted the world to implement a widespread mandated quarantine or social isolation. The impending uncertainty of the pandemic must have resulted in a variety of widespread mental health maladies. There has been documentation in the literature about a lot of these in small populations of the world but limited studies have been conducted in India, leading to limited evidence in the literature. Objective: The main objective of our study is to investigate the mental health effects that the COVID-19 pandemic has had on the general population in India both quantitatively and qualitatively. These results will help contribute to reducing the knowledge gap that is recognized in the literature, which is the result of the unprecedented and novel nature of the pandemic. Methods: We designed and validated our own questionnaire and used the method of circulating the questionnaire via WhatsApp (Facebook Inc). WhatsApp is a social media app that is very popularly used in India; hence, it turned out to be an effective medium for gathering pilot data. We analyzed the pilot data and used them to validate the questionnaire. This was done with the expertise of our mentor, Nilima Shah, MD (psychiatry). We gathered pilot data on 545 subjects and used the results to determine the changes that were needed for the questionnaire while simultaneously validating the questionnaire. Results: The study protocol was approved in September 2020 by the institutional review board at Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India. Conclusions: The following preliminary assumptions can be made about the study based on the pilot data: the majority of the survey respondents were male (289/545, 53%), most of them were educated and employed as health care workers (199/545, 36.5%). The majority of the responders were self-employed (185/545, 33.9%), single (297/545, 54.5%), and stayed with their families (427/541, 79%) for the lockdown, which helped them psychologically. Findings that are specific to mental health have been elaborated upon in the manuscript. It is evident from the data collected in previous literature that the pandemic has had significant detrimental effects on the mental health of a vast proportion of the Indian population. International Registered Report Identifier (IRRID): DERR1-10.2196/29896 %M 34519652 %R 10.2196/29896 %U https://www.researchprotocols.org/2021/11/e29896 %U https://doi.org/10.2196/29896 %U http://www.ncbi.nlm.nih.gov/pubmed/34519652 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30747 %T Changes in Self-Reported Web-Based Gambling Activity During the COVID-19 Pandemic: Cross-sectional Study %A Claesdotter-Knutsson,Emma %A Håkansson,Anders %+ Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Barav 1, Lund, 221 85, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K COVID-19 %K pandemic %K web-based gambling %K psychological distress %K gender %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The COVID‑19 pandemic has affected not only somatic health with over 3.7 million deaths worldwide, but also has had a huge impact on psychological health, creating what amounts to a mental health crisis. The negative effect of the pandemic on traditional addictions is well described and concerning, and the same has been seen for gambling. Objective: This study explores self-reported web-based gambling behavior during the COVID‑19 pandemic in Sweden. We investigated overall changes, but also changes in specific web-based gambling types, and whether they are associated with certain risk factors or lifestyle changes. Methods: Our study is based on an anonymous web-based survey of web panel participants in Sweden (N=1501) designed to study a range of behavioral changes during the COVID‑19 pandemic. Increases in gambling were analyzed using logistic regression models against sociodemographic data and psychological distress. Results: The majority of the respondents who gambled reported no changes in their gambling habits during the COVID‑19 pandemic. We found significant associations with the problem gambling severity index (PGSI), the Kessler score (indicating psychological distress), employment status, changes in alcohol habits, and self-exclusion when looking at overall changes in gambling activity in the pandemic. In the subgroup that reported an increase in gambling activity, we found an association with both the PGSI and Kessler scores. The PGSI score was also an independent predictor for all specific web-based gambling (horses, sports, poker, and casino) whereas the Kessler score only had a significant impact on changes in casino gambling. In addition, male gender was an independent predictor for gambling on sports and casino gambling. Conclusions: The majority of respondents who gambled reported no changes in their gambling activity during the COVID‑19 pandemic. The group that reported an increase in overall gambling activity during the COVID-19 pandemic represent a group with gambling problems and psychological distress. The group that reported increased sports and casino gambling were often male, and this group seemed to experience more psychological distress. %M 34730540 %R 10.2196/30747 %U https://games.jmir.org/2021/4/e30747 %U https://doi.org/10.2196/30747 %U http://www.ncbi.nlm.nih.gov/pubmed/34730540 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30293 %T Adapting a Mental Health Intervention for Adolescents During the COVID-19 Pandemic: Web-Based Synchronous Focus Group Study %A Calvo-Valderrama,Maria Gabriela %A Marroquín-Rivera,Arturo %A Burn,Erin %A Ospina-Pinillos,Laura %A Bird,Victoria %A Gómez-Restrepo,Carlos %+ Unit for Social and Community Psychiatry, Institute of Population Health Sciences, Queen Mary University of London, Cherry Tree Way, London, E13 8SP, United Kingdom, 44 20754043802340, v.j.bird@qmul.ac.uk %K pandemic %K COVID-19 %K online focus groups %K qualitative research %K technology %K adolescents %K public health %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although focus groups are a valuable qualitative research tool, face-to-face meetings may be difficult to arrange and time consuming. This challenge has been further compounded by the global COVID-19 pandemic and the subsequent lockdown and physical distancing measures implemented, which caused exceptional challenges to human activities. Online focus groups (OFGs) are an example of an alternative strategy and require further study. At present, OFGs have mostly been studied and used in high-income countries, with little information relating to their implementation in low- and middle-income countries (LMICs). Objective: The aim of this study is to share our experiences of conducting OFGs through a web conferencing service and provide recommendations for future research. Methods: As part of a broader study, OFGs were developed with adults and adolescents in Colombia during the COVID-19 pandemic. Through a convenience sampling method, we invited eligible participants via email in two different cities of Colombia to participate in OFGs conducted via Microsoft Teams. Researcher notes and discussion were used to capture participant and facilitator experiences, as well as practical considerations. Results: Technical issues were encountered, but various measures were taken to minimize them, such as using a web conferencing service that was familiar to participants, sending written instructions, and performing a trial meeting prior to the OFG. Adolescent participants, unlike their adult counterparts, were fluent in using web conferencing platforms and did not encounter technical challenges. Conclusions: OFGs have great potential in research settings, especially during the current and any future public health emergencies. It is important to keep in mind that even with the advantages that they offer, technical issues (ie, internet speed and access to technology) are major obstacles in LMICs. Further research is required and should carefully consider the appropriateness of OFGs in different settings. %M 34637395 %R 10.2196/30293 %U https://formative.jmir.org/2021/11/e30293 %U https://doi.org/10.2196/30293 %U http://www.ncbi.nlm.nih.gov/pubmed/34637395 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e30961 %T An Online Assessment to Evaluate the Role of Cognitive Biases and Emotion Regulation Strategies for Mental Health During the COVID-19 Lockdown of 2020: Structural Equation Modeling Study %A Blanco,Ivan %A Boemo,Teresa %A Sanchez-Lopez,Alvaro %+ Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Campus de Somosaguas, Pozuelo de Alarcon, 28223, Spain, 34 650692547, ivan.blanco.martinez@ucm.es %K COVID-19 %K emotion regulation %K cognitive biases %K psychological adjustment %K resilience %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Extant research supports causal roles of cognitive biases in stress regulation under experimental conditions. However, their contribution to psychological adjustment in the face of ecological major stressors has been largely unstudied. Objective: We developed a novel online method for the ecological examination of attention and interpretation biases during major stress (ie, the COVID-19 lockdown in March/April 2020) and tested their relations with the use of emotion regulation strategies (ie, reappraisal and rumination) to account for individual differences in psychological adjustment to major COVID-19–related stressors (ie, low depression and anxiety, and high well-being and resilience). Methods: Participants completed an online protocol evaluating the psychological impact of COVID-19–related stressors and the use of emotion regulation strategies in response to them, during the initial weeks of the lockdown of March/April 2020. They also completed a new online cognitive task designed to remotely assess attention and interpretation biases for negative information. The psychometric properties of the online cognitive bias assessments were very good, supporting their feasibility for ecological evaluation. Results: Structural equation models showed that negative interpretation bias was a direct predictor of worst psychological adjustment (higher depression and anxiety, and lower well-being and resilience; χ29=7.57; root mean square error of approximation=0.000). Further, rumination mediated the influence of interpretation bias in anxiety (P=.045; 95% CI 0.03-3.25) and resilience (P=.001; 95% CI −6.34 to −1.65), whereas reappraisal acted as a mediator of the influence of both attention (P=.047; 95% CI −38.71 to −0.16) and interpretation biases (P=.04; 95% CI −5.25 to −0.12) in well-being. Conclusions: This research highlights the relevance of individual processes of attention and interpretation during periods of adversity and identifies modifiable protective factors that can be targeted through online interventions. %M 34517337 %R 10.2196/30961 %U https://mental.jmir.org/2021/11/e30961 %U https://doi.org/10.2196/30961 %U http://www.ncbi.nlm.nih.gov/pubmed/34517337 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e25298 %T A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study %A Aguilera,Adrian %A Hernandez-Ramos,Rosa %A Haro-Ramos,Alein Y %A Boone,Claire Elizabeth %A Luo,Tiffany Christina %A Xu,Jing %A Chakraborty,Bibhas %A Karr,Chris %A Darrow,Sabrina %A Figueroa,Caroline Astrid %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC7400, School of Social Welfare, Berkeley, CA, 94720, United States, 1 (510) 642 8564, aguila@berkeley.edu %K mobile health %K COVID-19 %K text messaging %K cognitive behavioral therapy %K anxiety %K depression %K microrandomized trials %K mHealth %K intervention %K mental health %K SMS %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19–related depression and anxiety symptoms among people who speak English and Spanish in the United States. Objective: This paper describes the changes in StayWell participants’ anxiety and depression levels after 60 days of exposure to skills-based SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. Results: The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of –1.72 (95% CI –2.35 to –1.09) in PHQ-8 scores and –0.48 (95% CI –0.71 to –0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively. Conclusions: StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health. Trial Registration: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID): RR2-10.2196/23592 %M 34543230 %R 10.2196/25298 %U https://mental.jmir.org/2021/11/e25298 %U https://doi.org/10.2196/25298 %U http://www.ncbi.nlm.nih.gov/pubmed/34543230 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29820 %T Emotional Tone, Analytical Thinking, and Somatosensory Processes of a Sample of Italian Tweets During the First Phases of the COVID-19 Pandemic: Observational Study %A Monzani,Dario %A Vergani,Laura %A Pizzoli,Silvia Francesca Maria %A Marton,Giulia %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy, 39 029 4372099, laura.vergani@ieo.it %K internet %K mHealth %K infodemiology %K infoveillance %K pandemic %K public health %K COVID-19 %K Twitter %K psycholinguistic analysis %K trauma %D 2021 %7 27.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is a traumatic individual and collective chronic experience, with tremendous consequences on mental and psychological health that can also be reflected in people’s use of words. Psycholinguistic analysis of tweets from Twitter allows obtaining information about people’s emotional expression, analytical thinking, and somatosensory processes, which are particularly important in traumatic events contexts. Objective: We aimed to analyze the influence of official Italian COVID-19 daily data (new cases, deaths, and hospital discharges) and the phase of managing the pandemic on how people expressed emotions and their analytical thinking and somatosensory processes in Italian tweets written during the first phases of the COVID-19 pandemic in Italy. Methods: We retrieved 1,697,490 Italian COVID-19–related tweets written from February 24, 2020 to June 14, 2020 and analyzed them using LIWC2015 to calculate 3 summary psycholinguistic variables: emotional tone, analytical thinking, and somatosensory processes. Official daily data about new COVID-19 cases, deaths, and hospital discharges were retrieved from the Italian Prime Minister's Office and Civil Protection Department GitHub page. We considered 3 phases of managing the COVID-19 pandemic in Italy. We performed 3 general models, 1 for each summary variable as the dependent variable and with daily data and phase of managing the pandemic as independent variables. Results: General linear models to assess differences in daily scores of emotional tone, analytical thinking, and somatosensory processes were significant (F6,104=21.53, P<.001, R2= .55; F5,105=9.20, P<.001, R2= .30; F6,104=6.15, P<.001, R2=.26, respectively). Conclusions: The COVID-19 pandemic affects how people express emotions, analytical thinking, and somatosensory processes in tweets. Our study contributes to the investigation of pandemic psychological consequences through psycholinguistic analysis of social media textual data. %M 34516386 %R 10.2196/29820 %U https://www.jmir.org/2021/10/e29820 %U https://doi.org/10.2196/29820 %U http://www.ncbi.nlm.nih.gov/pubmed/34516386 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e25489 %T High Work-Related Stress and Anxiety as a Response to COVID-19 Among Health Care Workers in South Korea: Cross-sectional Online Survey Study %A Ahn,Myung Hee %A Shin,Yong-Wook %A Suh,Sooyeon %A Kim,Jeong Hye %A Kim,Hwa Jung %A Lee,Kyoung-Uk %A Chung,Seockhoon %+ Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 2 3010 3411, schung@amc.seoul.kr %K COVID-19 %K health personnel %K occupational stress %K anxiety %K depression %K stress %K mental health %K South Korea %K health care worker %K assessment %K intervention %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 outbreak had a severe impact on health care workers' psychological health. It is important to establish a process for psychological assessment and intervention for health care workers during epidemics. Objective: We investigated risk factors associated with psychological impacts for each health care worker group, to help optimize psychological interventions for health care workers in countries affected by the COVID-19 pandemic. Methods: Respondents (n=1787) from 2 hospitals in Korea completed a web-based survey during the period from April 14 to 30, 2020. The web-based survey collected demographic information, psychiatric history, and responses to the 9-item Stress and Anxiety to Viral Epidemics (SAVE-9), 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder-7 (GAD-7) scales. We performed logistic regression to assess contributing factors as predictor variables, using health care workers’ depression as outcome variables. Results: Among 1783 health care workers, nursing professionals had significantly higher levels of depression (PHQ-9 score: meannurse 5.5, SD 4.6; meanother 3.8, SD 4.2; P<.001), general anxiety (GAD-7 score: meannurse 4.0, SD 4.1; meanother 2.7, SD 3.6; P<.001), and virus-related anxiety symptoms (SAVE-9 score: meannurse 21.6, SD 5.9; meanother 18.6, SD 6.3; P<.001). Among nursing professionals, single workers reported more severe depressive symptoms than married workers (PHQ-9 score ≥10; meannurse 20.3%; meanother 14.1%; P=.02), and junior (<40 years) workers reported more anxiety about the viral epidemic (SAVE-9 anxiety score; meannurse 15.6, SD 4.1; meanother 14.7, SD 4.4; P=.002). Logistic regression revealed that hospital (adjusted odds ratio [OR] 1.45, 95% CI 1.06-1.99), nursing professionals (adjusted OR 1.37, 95% CI 1.02-1.98), single workers (adjusted OR 1.51, 95% CI 1.05-2.16), higher stress and anxiety to the viral infection (high SAVE-9 score, adjusted OR 1.20, 95% CI 1.17-1.24), and past psychiatric history (adjusted OR 3.26, 95% CI 2.15-4.96) were positively associated with depression. Conclusions: Psychological support and interventions should be considered for health care workers, especially nursing professionals, those who are single, and those with high SAVE-9 scores. %M 34478401 %R 10.2196/25489 %U https://publichealth.jmir.org/2021/10/e25489 %U https://doi.org/10.2196/25489 %U http://www.ncbi.nlm.nih.gov/pubmed/34478401 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28088 %T Perceptions and Feelings of Brazilian Health Care Professionals Regarding the Effects of COVID-19: Cross-sectional Web-Based Survey %A Corrêa,Roberta Pires %A Castro,Helena Carla %A Quaresma,Bruna Maria Castro Salomão %A Stephens,Paulo Roberto Soares %A Araujo-Jorge,Tania Cremonini %A Ferreira,Roberto Rodrigues %+ Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Av Brasil, 4365, Rio de Janeiro, Brazil, 55 21 2562 1295, robertoferreira@ioc.fiocruz.br %K COVID-19 %K SARS-CoV-2 %K health professionals %K Brazil %K pandemic %K mental health %K health planning %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The importance of health professionals has been recognized in COVID-19 pandemic–affected countries, especially in those such as Brazil, which is one of the top 3 countries that have been affected in the world. However, the workers’ perception of the stress and the changes that the pandemic has caused in their lives vary according to the conditions offered by these affected countries, including salaries, individual protection equipment, and psychological support. Objective: The purpose of this study was to identify the perceptions of Brazilian health workers regarding the COVID-19 pandemic impact on their lives, including possible self-contamination and mental health. Methods: This cross-sectional web-based survey was conducted in Brazil by applying a 32-item questionnaire, including multiple-choice questions by using the Google Forms electronic assessment. This study was designed to capture spontaneous perceptions from health professionals. All questions were mandatory and divided into 2 blocks with different proposals: personal profile and COVID-19 pandemic impact. Results: We interviewed Brazilian health professionals from all 5 Brazilian regions (N=1376). Our study revealed that 1 in 5 (23%) complained about inadequate personal protective equipment, including face shields (234/1376, 17.0%), masks (206/1376, 14.9%), and laboratory coats (138/1376, 10.0%), whereas 1 in 4 health professionals did not have enough information to protect themselves from the coronavirus disease. These professionals had anxiety due to COVID-19 (604/1376, 43.9%), difficulties in sleep (593/1376, 43.1%), and concentrating on work (453/1376, 32.9%). Almost one-third experienced traumatic situations at work (385/1376, 28.0%), which may have led to negative feelings of fear of COVID-19 and sadness. Despite this situation, there was hope and empathy among their positive feelings. The survey also showed that 1 in 5 acquired COVID-19 with the most classic and minor symptoms, including headache (274/315, 87.0%), body pain (231/315, 73.3%), tiredness (228/315, 72.4%), and loss of taste and smell (208/315, 66.0%). Some of their negative feelings were higher than those of noninfected professionals (fear of COVID-19, 243/315, 77.1% vs 509/1061, 48.0%; impotence, 142/315, 45.1% vs 297/1061, 28.0%; and fault, 38/315, 12.1% vs 567/1061, 53.4%, respectively). Another worrying outcome was that 61.3% (193/315) reported acquiring an infection while working at a health facility and as expected, most of the respondents felt affected (344/1376, 25.0%) or very affected (619/1376, 45.0%) by the COVID-19. Conclusions: In Brazil, the health professionals were exposed to a stressful situation and to the risk of self-contamination—conditions that can spell future psychological problems for these workers. Our survey findings showed that the psychological support for this group should be included in the future health planning of Brazil and of other hugely affected countries to assure a good mental health condition for the medical teams in the near future. %M 34519656 %R 10.2196/28088 %U https://formative.jmir.org/2021/10/e28088 %U https://doi.org/10.2196/28088 %U http://www.ncbi.nlm.nih.gov/pubmed/34519656 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30491 %T Learning About the Current State of Digital Mental Health Interventions for Canadian Youth to Inform Future Decision-Making: Mixed Methods Study %A Kemp,Jessica %A Chorney,Jill %A Kassam,Iman %A MacDonald,Julie %A MacDonald,Tara %A Wozney,Lori %A Strudwick,Gillian %+ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501, gillian.strudwick@camh.ca %K youth mental health %K digital mental health %K COVID-19 %K digital mental health interventions %K e-mental health %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has increased the demand for youth mental health services in Canada as disruptions to clinical care continue to persist due to the risk of transmission and exposure to the virus. Digital mental health interventions, including web-based resources and mobile apps, have provided opportunities to support youth mental health remotely across Canada. There is a need to better understand how these digital interventions are being selected, recommended, and used in various regions across Canada. Objective: A national jurisdictional scan was completed to (1) determine what web-based programs, apps, and websites are promoted and licensed in Canada for youth mental health; (2) identify criteria and decision-making processes that Canadian jurisdictions use to select web-based programs, apps, and websites for youth mental health; and (3) identify upcoming trends, innovations, and digital mental health possibilities that are emerging in the youth sector. Methods: The aims of the jurisdictional scan were addressed through a review of related academic and grey literature; stakeholder interviews, including individuals involved in various areas of the youth mental health sector; and a social media review of pertinent Twitter content. Results: A total of 66 web-based resources and apps were identified for use by youth in Canada. 16 stakeholder interviews were completed and included discussions with researchers, clinicians, youth organizations, and others involved in digital interventions for youth mental health. These discussions identified a limited use of frameworks used to guide decision-making processes when selecting digital interventions. Many clinicians agreed on a similar set of eligibility requirements for youth mental health apps and digital resources, such as the evidence base and cultural relevance of the intervention. Stakeholders also identified upcoming trends and innovations in the youth digital mental health space, including artificial intelligence, digital phenotyping, and personalized therapy. Over 4 weeks, 2184 tweets were reviewed to identify and compare global and national trends and innovations involving digital mental health and youth. Key trends included the promotion of regional chat services as well as the effects of the COVID-19 pandemic on youth mental health and access to care. Conclusions: As organizations begin to plan for the delivery of mental health care following the pandemic, there are concerns about the sustainability of these digital mental health interventions as well as a need for services to be more informed by the experiences and preferences of youth. %M 34665141 %R 10.2196/30491 %U https://www.jmir.org/2021/10/e30491 %U https://doi.org/10.2196/30491 %U http://www.ncbi.nlm.nih.gov/pubmed/34665141 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e28071 %T Psychological Impact of the COVID-19 Pandemic and Social Determinants on the Portuguese Population: Protocol for a Web-Based Cross-sectional Study %A Aguiar,A %A Pinto,M %A Duarte,R %+ EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, Porto, 4050-600, Portugal, 351 222061820, ana.aguiar@ispup.up.pt %K COVID-19 %K public health %K mental health %K study protocol %K psychological impact %K anxiety %K depression %K grief %K behavior change %D 2021 %7 19.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 outbreak and consequent physical distance measures implemented worldwide have caused significant stress, anxiety, and mental health implications among the general population. Unemployment, working from home, and day-to-day changes may lead to a greater risk of poor mental health outcomes. Objective: This paper describes the protocol for a web-based cross-sectional study that aims to address the impact of the COVID-19 pandemic on mental health. Methods: Individuals from the general population aged 18 years or more and living in Portugal were included in this study. Data collection took place between November 10, 2020, and February 10, 2021. An exponential, nondiscriminative, snowball sampling method was applied to recruit participants. A web-based survey was developed and shared on social media platforms (eg, Facebook, Instagram, Twitter, LinkedIn, and WhatsApp groups) and through e-mail lists for recruitment of the seeds. Results: Data analysis will be performed in accordance with the different variables and outcomes of interest by using quantitative methods, qualitative methods, or mixed methods, as applicable. A total of 929 individuals had completed the web-based survey during the 3-month period; thus, our final sample comprised 929 participants. Results of the survey will be disseminated in national and international scientific journals in 2021-2022. Conclusions: We believe that the findings of this study will have broad implications for understanding the psychological impact of the COVID-19 pandemic on Portuguese residents, as well as aspects related to the informal economy. We also hope that the findings of this study are able to provide insights and guidelines for the Portuguese government to implement action. Finally, we expect this protocol to provide a roadmap for other countries and researchers that would like to implement a similar questionnaire considering the related conclusions. International Registered Report Identifier (IRRID): DERR1-10.2196/28071 %M 34516387 %R 10.2196/28071 %U https://www.researchprotocols.org/2021/10/e28071 %U https://doi.org/10.2196/28071 %U http://www.ncbi.nlm.nih.gov/pubmed/34516387 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e32425 %T Intervening on Trust in Science to Reduce Belief in COVID-19 Misinformation and Increase COVID-19 Preventive Behavioral Intentions: Randomized Controlled Trial %A Agley,Jon %A Xiao,Yunyu %A Thompson,Esi E %A Chen,Xiwei %A Golzarri-Arroyo,Lilian %+ Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St., Bloomington, IN, 47404, United States, 1 812 855 3123, jagley@indiana.edu %K infodemic %K misinformation %K trust in science %K COVID-19 %K RCT %K randomized controlled trial %D 2021 %7 14.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Trust in science meaningfully contributes to our understanding of people’s belief in misinformation and their intentions to take actions to prevent COVID-19. However, no experimental research has sought to intervene on this variable to develop a scalable response to the COVID-19 infodemic. Objective: Our study examined whether brief exposure to an infographic about the scientific process might increase trust in science and thereby affect belief in misinformation and intention to take preventive actions for COVID-19. Methods: This two-arm, parallel-group, randomized controlled trial aimed to recruit a US representative sample of 1000 adults by age, race/ethnicity, and gender using the Prolific platform. Participants were randomly assigned to view either an intervention infographic about the scientific process or a control infographic. The intervention infographic was designed through a separate pilot study. Primary outcomes were trust in science, COVID-19 narrative belief profile, and COVID-19 preventive behavioral intentions. We also collected 12 covariates and incorporated them into all analyses. All outcomes were collected using web-based assessment. Results: From January 22, 2021 to January 24, 2021, 1017 participants completed the study. The intervention slightly improved trust in science (difference-in-difference 0.03, SE 0.01, t1000=2.16, P=.031). No direct intervention effect was observed on belief profile membership, but there was some evidence of an indirect intervention effect mediated by trust in science (adjusted odds ratio 1.06, SE 0.03, 95% CI 1.00-1.12, z=2.01, P=.045) on membership in the “scientific” profile compared with the others. No direct nor indirect effects on preventive behaviors were observed. Conclusions: Briefly viewing an infographic about science appeared to cause a small aggregate increase in trust in science, which may have, in turn, reduced the believability of COVID-19 misinformation. The effect sizes were small but commensurate with our 60-second, highly scalable intervention approach. Researchers should study the potential for truthful messaging about how science works to serve as misinformation inoculation and test how best to do so. Trial Registration: NCT04557241; https://clinicaltrials.gov/ct2/show/NCT04557241 International Registered Report Identifier (IRRID): RR2-10.2196/24383 %M 34581678 %R 10.2196/32425 %U https://www.jmir.org/2021/10/e32425 %U https://doi.org/10.2196/32425 %U http://www.ncbi.nlm.nih.gov/pubmed/34581678 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29963 %T Attitudes About COVID-19 and Health (ATTACH): Online Survey and Mixed Methods Study %A Hood,Anna M %A Stotesbury,Hanne %A Murphy,Jennifer %A Kölbel,Melanie %A Slee,April %A Springall,Charlie %A Paradis,Matthew %A Corral-Frías,Nadia Saraí %A Reyes-Aguilar,Azalea %A Cuellar Barboza,Alfredo B %A Noser,Amy E %A Gomes,Stacey %A Mitchell,Monica %A Watkins,Sharon M %A Butsch Kovacic,Melinda %A Kirkham,Fenella J %A Crosby,Lori E %+ Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom, 44 02079052744, a.hood@ucl.ac.uk %K COVID-19 %K mental health %K international %K mitigation strategies %K deprivation %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Behavioral mitigation strategies to slow the spread of COVID-19 have resulted in sweeping lifestyle changes, with short- and long-term psychological, well-being, and quality of life implications. The Attitudes About COVID-19 and Health (ATTACH) study focuses on understanding attitudes and beliefs while considering the impact on mental and physical health and the influence of broader demographic and geographic factors on attitudes, beliefs, and mental health burden. Objective: In this assessment of our first wave of data collection, we provide baseline cohort description of the ATTACH study participants in the United Kingdom, the United States, and Mexico. Additionally, we assess responses to daily poll questions related to COVID-19 and conduct a cross-sectional analysis of baseline assessments collected in the UK between June 26 and October 31, 2020. Methods: The ATTACH study uses smartphone app technology and online survey data collection. Participants completed poll questions related to COVID-19 2 times daily and a monthly survey assessing mental health, social isolation, physical health, and quality of life. Poll question responses were graphed using 95% Clopper–Pearson (exact) tests with 95% CIs. Pearson correlations, hierarchical linear regression analyses, and generalized linear models assessed relationships, predictors of self-reported outcomes, and group differences, respectively. Results: By October 31, 2020, 1405, 80, and 90 participants had consented to participate in the UK, United States, and Mexico, respectively. Descriptive data for the UK daily poll questions indicated that participants generally followed social distancing measures, but worry and negative impacts on families increased as the pandemic progressed. Although participants generally reported feeling that the reasons for current measures had been made clear, there was low trust that the government was doing everything in its power to meet public needs. In the UK, 1282 participants also completed a monthly survey (94.99% [1326/1396] White, 72.22% [1014/1404] female, and 20.12% [277/1377] key or essential workers); 18.88% (242/1282) of UK participants reported a preexisting mental health disorder, 31.36% (402/1282) reported a preexisting chronic medical illness, and 35.11% (493/1404) were aged over 65; 57.72% (740/1282) of participants reported being more sedentary since the pandemic began, and 41.89% (537/1282) reported reduced access to medical care. Those with poorer mental health outcomes lived in more deprived neighborhoods, in larger households (Ps<.05), had more preexisting mental health disorders and medical conditions, and were younger than 65 years (all Ps<.001). Conclusions: Communities who have been exposed to additional harm during the COVID-19 pandemic were experiencing worse mental outcomes. Factors including having a medical condition, or living in a deprived neighborhood or larger household were associated with heightened risk. Future longitudinal studies should investigate the link between COVID-19 exposure, mental health, and sociodemographic and residential characteristics. %M 34357877 %R 10.2196/29963 %U https://mental.jmir.org/2021/10/e29963 %U https://doi.org/10.2196/29963 %U http://www.ncbi.nlm.nih.gov/pubmed/34357877 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e28873 %T Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study %A Ranjan,Yatharth %A Althobiani,Malik %A Jacob,Joseph %A Orini,Michele %A Dobson,Richard JB %A Porter,Joanna %A Hurst,John %A Folarin,Amos A %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 02078480924, amos.folarin@kcl.ac.uk %K mHealth %K COVID-19 %K mobile health %K remote monitoring %K wearables %K internet of things %K lung diseases %K respiratory health %K mental health %K cardiopulmonary diseases %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic lung disorders like chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are characterized by exacerbations. They are unpleasant for patients and sometimes severe enough to cause hospital admission and death. Moreover, due to the COVID-19 pandemic, vulnerable populations with these disorders are at high risk, and their routine care cannot be done properly. Remote monitoring offers a low cost and safe solution for gaining visibility into the health of people in their daily lives, making it useful for vulnerable populations. Objective: The primary objective is to assess the feasibility and acceptability of remote monitoring using wearables and mobile phones in patients with pulmonary diseases. The secondary objective is to provide power calculations for future studies centered around understanding the number of exacerbations according to sample size and duration. Methods: Twenty participants will be recruited in each of three cohorts (COPD, IPF, and posthospitalization COVID). Data collection will be done remotely using the RADAR-Base (Remote Assessment of Disease And Relapse) mobile health (mHealth) platform for different devices, including Garmin wearable devices and smart spirometers, mobile app questionnaires, surveys, and finger pulse oximeters. Passive data include wearable-derived continuous heart rate, oxygen saturation, respiration rate, activity, and sleep. Active data include disease-specific patient-reported outcome measures, mental health questionnaires, and symptom tracking to track disease trajectory. Analyses will assess the feasibility of lung disorder remote monitoring (including data quality, data completeness, system usability, and system acceptability). We will attempt to explore disease trajectory, patient stratification, and identification of acute clinical events such as exacerbations. A key aspect is understanding the potential of real-time data collection. We will simulate an intervention to acquire responses at the time of the event to assess model performance for exacerbation identification. Results: The Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH) study provides a unique opportunity to assess the use of remote monitoring in the evaluation of lung disorders. The study started in the middle of June 2021. The data collection apparatus, questionnaires, and wearable integrations were setup and tested by the clinical teams prior to the start of recruitment. While recruitment is ongoing, real-time exacerbation identification models are currently being constructed. The models will be pretrained daily on data of previous days, but the inference will be run in real time. Conclusions: The RALPMH study will provide a reference infrastructure for remote monitoring of lung diseases. It specifically involves information regarding the feasibility and acceptability of remote monitoring and the potential of real-time data collection and analysis in the context of chronic lung disorders. It will help plan and inform decisions in future studies in the area of respiratory health. Trial Registration: ISRCTN Registry ISRCTN16275601; https://www.isrctn.com/ISRCTN16275601 International Registered Report Identifier (IRRID): PRR1-10.2196/28873 %M 34319235 %R 10.2196/28873 %U https://www.researchprotocols.org/2021/10/e28873 %U https://doi.org/10.2196/28873 %U http://www.ncbi.nlm.nih.gov/pubmed/34319235 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30757 %T The COVID-19 Study of Healthcare and Support Personnel (CHAMPS): Protocol for a Longitudinal Observational Study %A Kaufmann,Peter G %A Havens,Donna S %A Mensinger,Janell L %A Bradley,Patricia K %A Brom,Heather M %A Copel,Linda C %A Costello,Alexander %A D'Annunzio,Christine %A Dean Durning,Jennifer %A Maldonado,Linda %A Barrow McKenzie,Ann %A Smeltzer,Suzanne C %A Yost,Jennifer %A , %+ M. Louise Fitzapatrick College of Nursing, Villanova University, 800 Lancaster Ave, Villanova, PA, 19085, United States, 1 6105195972, peter.kaufmann@villanova.edu %K COVID-19 %K SARS-CoV-2 %K stress %K depression %K anxiety %K sleep %K social support %K resilience %K mental health %K physical health %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress and workplace demands related to equipment shortages and rapidly growing infections in the general population. Although the effects of other sources of stress on health have been documented, the effects of these unique conditions of the COVID-19 pandemic on the long-term health and well-being of the health care workforce are not known. Objective: The COVID-19 Study of Healthcare and Support Personnel (CHAMPS) was designed to document early and longitudinal effects of the pandemic on the mental and physical health of essential workers engaged in health care. We will investigate mediators and moderators of these effects and evaluate the influence of exposure to stress, including morbidity and mortality, over time. We will also examine the effect of protective factors and resilience on health outcomes. Methods: The study cohort is a convenience sample recruited nationally through communities, professional organizations, networks, social media, and snowball sampling. Recruitment took place for 13 months to obtain an estimated sample of 2762 adults who provided self-reported information administered on the web through structured questionnaires about their work environment, mental and physical health, and psychosocial factors. Follow-up questionnaires will be administered after 6 months and annually thereafter to ascertain changes in health, well-being, and lifestyle. Participants who consented to be recontacted form the longitudinal cohort and the CHAMPS Registry may be contacted to ascertain their interest in ancillary studies for which they may be eligible. Results: The study was approved by the Institutional Review Board and launched in May 2020, with grants from Travere Therapeutics Inc, McKesson Corporation, anonymous donors, and internal funding from the M. Louise Fitzpatrick College of Nursing at Villanova University. Recruitment ended in June 2021 after enrolling 2762 participants, 1534 of whom agreed to participate in the longitudinal study and the registry as well as to be contacted about eligibility for future studies. Conclusions: The CHAMPS Study and Registry will enable the acquisition of detailed data on the effects of extended psychosocial and workplace stress on morbidity and mortality and serve as a platform for ancillary studies related to the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04370821; https://clinicaltrials.gov/ct2/show/NCT04370821 International Registered Report Identifier (IRRID): DERR1-10.2196/30757 %M 34582354 %R 10.2196/30757 %U https://www.researchprotocols.org/2021/10/e30757 %U https://doi.org/10.2196/30757 %U http://www.ncbi.nlm.nih.gov/pubmed/34582354 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31273 %T Supporting Mental Health During the COVID-19 Pandemic Using a Digital Behavior Change Intervention: An Open-Label, Single-Arm, Pre-Post Intervention Study %A Summers,Charlotte %A Wu,Philip %A Taylor,Alisdair J G %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 7969091134, charlotte@ddm.health %K stress %K mental health %K COVID-19 %K digital therapy %K mHealth %K support %K behavior %K intervention %K online intervention %K outcome %K wellbeing %K sleep %K activity %K nutrition %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is taking a toll on people’s mental health, particularly as people are advised to adhere to social distancing, self-isolation measures, and government-imposed national lockdowns. Digital health technologies have an important role to play in keeping people connected and in supporting their mental health and well-being. Even before the COVID-19 pandemic, mental health and social services were already strained. Objective: Our objective was to evaluate the 12-week outcomes of the digitally delivered Gro Health intervention, a holistic digital behavior change app designed for self-management of mental well-being, sleep, activity, and nutrition. Methods: The study used a quasi-experimental research design consisting of an open-label, single-arm, pre-post intervention engagement using a convenience sample. Adults who had joined the Gro Health app (intervention) and had a complete baseline dataset (ie, 7-item Generalized Anxiety Disorder scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire) were followed up at 12 weeks (n=273), including 33 (12.1%) app users who reported a positive COVID-19 diagnosis during the study period. User engagement with the Gro Health platform was tracked by measuring total minutes of app engagement. Paired t tests were used to compare pre-post intervention scores. Linear regression analysis was performed to assess the relationship between minutes of active engagement with the Gro Health app and changes in scores across the different mental health measures. Results: Of the 347 study participants, 273 (78.67%) completed both the baseline and follow-up surveys. Changes in scores for anxiety, perceived stress, and depression were predicted by app engagement, with the strongest effect observed for changes in perceived stress score (F1,271=251.397; R2=0.479; P<.001). Conclusions: A digital behavior change platform that provides remote mental well-being support can be effective in managing depression, anxiety, and perceived stress during times of crisis such as the current COVID-19 pandemic. The outcomes of this study may also support the implementation of remote digital health apps supporting behavior change and providing support for low levels of mental health within the community. %M 34459740 %R 10.2196/31273 %U https://formative.jmir.org/2021/10/e31273 %U https://doi.org/10.2196/31273 %U http://www.ncbi.nlm.nih.gov/pubmed/34459740 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30339 %T A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial %A Gonsalves,Pattie P %A Sharma,Rhea %A Hodgson,Eleanor %A Bhat,Bhargav %A Jambhale,Abhijeet %A Weiss,Helen A %A Fairburn,Christopher G %A Cavanagh,Kate %A Cuijpers,Pim %A Michelson,Daniel %A Patel,Vikram %+ Sangath, E-5, Lane 1, Westend Marg, Saiyad ul ajaib, Saket, New Delhi, 110030, India, 91 9899419704, pattie.gonsalves@sangath.in %K randomized controlled trial %K internet-based intervention %K smartphone %K adolescent %K schools %K mental health %K COVID-19 %K app %K protocol %K problem-solving %K intervention %K teenager %K young adult %K India %K feasibility %K effective %D 2021 %7 6.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: “POD Adventures” is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective: Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods: We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results: The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions: This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration: ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID): DERR1-10.2196/30339 %M 34586075 %R 10.2196/30339 %U https://www.researchprotocols.org/2021/10/e30339 %U https://doi.org/10.2196/30339 %U http://www.ncbi.nlm.nih.gov/pubmed/34586075 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e29953 %T The Association of Delayed Care With Depression Among US Middle-Aged and Older Adults During the COVID-19 Pandemic: Cross-sectional Analysis %A Luo,Yan %+ The University of Alabama, 2106 Forest Lake Dr., Tuscaloosa, AL, 35401, United States, 1 2058868781, yluo30@crimson.ua.edu %K depression %K COVID-19 %K delayed care %K middle-aged adults %K older adults %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Aging %G English %X Background: During the COVID-19 pandemic, the depression level among US adults has significantly increased. Age disparity in depression during the pandemic has been reported in recent studies. Delay or avoidance of medical care is one of the collateral damages associated with the COVID-19 pandemic, and it can lead to increased morbidity and mortality. Objective: This study aimed to assess the prevalence of depression and delayed care among US middle-aged adults and older adults during the pandemic, as well as investigate the association of delayed care with depression among those 2 age groups. Methods: This cross-sectional study used data from the 2020 Health and Retirement Study (HRS) COVID-19 Project (Early, Version 1.0). Univariate analyses, bivariate analyses, and binary logistic regression were applied. US adults older than 46 years were included. Depression was measured by the Composite International Diagnostic Interview-Short Form (CIDI-SF). Delayed care was measured by the following 4 items: delayed surgery, delayed seeing a doctor, delayed dental care, and other delayed care. Results: A total of 3246 participants were identified. More than half of the participants were older than 65 years (n=1890, 58.2%), and 274 (8.8%) participants had depression during the pandemic. Delayed dental care was positively associated with depression among both middle-aged adults (OR 2.05, 95% CI 1.04-4.03; P=.04) and older adults (OR 3.08, 95% CI 1.07-8.87; P=.04). Delayed surgery was positively associated with depression among older adults (OR 3.69, 95% CI 1.06-12.90; P=.04). Self-reported pain was positively related to depression among both age groups. Middle-aged adults who reported higher education levels (some college or above) or worse self-reported health had a higher likelihood of having depression. While perceived more loneliness was positively associated with depression among older adults, financial difficulty was positively associated with depression among middle-aged adults. Conclusions: This study found that depression was prevalent among middle-aged and older adults during the pandemic. The study highlighted the collateral damage of the COVID-19 pandemic by identifying the association of delayed surgery and dental care with depression during the pandemic. Although surgery and dental care cannot be delivered by telehealth, telehealth services can still be provided to address patients’ concerns on delayed surgery and dental care. Moreover, the implementation of telemental health services is needed to address mental health symptoms among US middle-aged and older adults during the pandemic. Future research that uses more comprehensive measurements for delayed care is needed to decipher the path through which delayed care is associated with depression. %M 34524964 %R 10.2196/29953 %U https://aging.jmir.org/2021/4/e29953 %U https://doi.org/10.2196/29953 %U http://www.ncbi.nlm.nih.gov/pubmed/34524964 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32353 %T Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19–Related Stress: Pilot Feasibility Study %A Gordon,Judith S %A Sbarra,David %A Armin,Julie %A Pace,Thaddeus W W %A Gniady,Chris %A Barraza,Yessenya %+ College of Nursing, University of Arizona, 1305 North Martin Avenue, Tucson, AZ, 85721, United States, 1 5206264970, judithg@email.arizona.edu %K COVID-19 %K stress %K anxiety %K isolation %K intervention %K guided imagery %K mobile app %D 2021 %7 4.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The SARS-CoV-2 pandemic has led to concerns about mental health resulting from regional and national lockdowns, social isolation, job loss, and concern about disease exposure. Objective: We describe results of the pilot feasibility study of the See Me Serene mHealth app. The app provides users with immersive, vivid, nature experiences to reduce stress and anxiety related to COVID-19 and other isolation. The goals of the study were to develop the See Me Serene app and test the feasibility and acceptability of study procedures, and explore the potential impact of the app on stress and anxiety. Methods: We developed and tested the See Me Serene app and our study procedures for feasibility, and gathered preliminary data with a goal of 100 participants. The research was conducted in 2 phases: (1) development and internal testing of the app; and (2) feasibility and pilot testing with participants recruited online through earned media (eg, news stories), presentations at a university campus, and social media (eg, online sharing of earned media and presentations). The feasibility study employed a mixed methods, within-subjects, pre-/posttest design. At baseline and 30-day follow-up, we assessed stress-related variables via validated self-report measures and saliva samples for determination of cortisol concentrations. Results: We met or surpassed all our feasibility benchmarks for recruitment (101 participants recruited), retention (91% [90/99] of 30-day assessment completed), and data collection (99 participants completed all baseline data; 85% [84/99] of salivary cortisol samples returned). Participants adhered to the intervention. On average, participants listened to 48.2 audio files over 30 days or approximately 1.6 audio files per day. Participants were satisfied with the app, with 87% (78/90) rating the app as helpful in dealing with stress and anxiety. The app showed the potential to reduce stress, anxiety, loneliness, and worry. We did not find significant differences (P=.41) in cortisol levels over time. Our findings suggest that future research is warranted to test the efficacy of the See Me Serene app with a representative, diverse sample. Conclusions: There is a need for evidence-based and easily disseminable stress-reduction interventions. See Me Serene is a feasible intervention and has the potential to reduce stress related to COVID-19 and other forms of social isolation. More research on See Me Serene is warranted. %M 34546941 %R 10.2196/32353 %U https://formative.jmir.org/2021/10/e32353 %U https://doi.org/10.2196/32353 %U http://www.ncbi.nlm.nih.gov/pubmed/34546941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31722 %T Practical and Emotional Problems Reported by Users of a Self-guided Digital Problem-solving Intervention During the COVID-19 Pandemic: Content Analysis %A Hentati,Amira %A Forsell,Erik %A Ljótsson,Brjánn %A Kraepelien,Martin %+ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, Stockholm, 11364, Sweden, 46 704411425, amira.hentati@ki.se %K digital intervention %K COVID-19 %K problem-solving %K self-guided intervention %K content analysis %K public health %K mental health %K depression %K anxiety %K pandemic %D 2021 %7 4.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: To better direct assessments and interventions toward the general population during both the ongoing COVID-19 pandemic and future crises with societal restrictions, data on the types of practical and emotional problems that people are experiencing are needed. Objective: The aim of this study was to examine the types of practical and emotional problems that the general population is experiencing during the COVID-19 pandemic and to construct an empirically derived inventory based on the findings. Methods: A total of 396 participants, recruited among members of the general public in Sweden who were experiencing practical and/or emotional problems during the pandemic, accessed a self-guided digital problem-solving intervention for a period of 1 week to report and solve the problems they experienced. Prior to accessing the intervention, the participants completed a short self-assessment regarding symptoms of depression and anxiety. Content analysis was used to account for the types of problems participants reported. A set of items for an inventory was later proposed based on the problem categories derived from the analysis. Results: A majority of participants had clinically relevant symptoms of either depression or anxiety. The problems reported were categorized as 13 distinct types of problems. The most common problem was difficulty managing daily activities. Based on the categories, a 13-item inventory was proposed. Conclusions: The 13 types of problems, and the proposed inventory, could be valuable when composing assessments and interventions for the general population during the ongoing pandemic or similar crises with societal restrictions. The most common problem was of a practical nature, indicating the importance of including examples of such problems within assessments and interventions. Trial Registration: ClinicalTrials.gov NCT04677270; https://clinicaltrials.gov/ct2/show/NCT04677270 %M 34559670 %R 10.2196/31722 %U https://formative.jmir.org/2021/10/e31722 %U https://doi.org/10.2196/31722 %U http://www.ncbi.nlm.nih.gov/pubmed/34559670 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29025 %T Public Sentiment and Discourse on Domestic Violence During the COVID-19 Pandemic in Australia: Analysis of Social Media Posts %A Usher,Kim %A Durkin,Joanne %A Martin,Sam %A Vanderslott,Samantha %A Vindrola-Padros,Cecilia %A Usher,Luke %A Jackson,Debra %+ University of New England, Pat O’Shane Building, Armidale, 2350, Australia, 61 401096117, jdurkin3@myune.edu.au %K COVID-19 %K domestic violence %K social media %K Twitter %K sentiment analysis %K discourse analysis %K keyword analysis %K pandemic %K sentiment %K public health %K public expression %D 2021 %7 1.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Measuring public response during COVID-19 is an important way of ensuring the suitability and effectiveness of epidemic response efforts. An analysis of social media provides an approximation of public sentiment during an emergency like the current pandemic. The measures introduced across the globe to help curtail the spread of the coronavirus have led to the development of a situation labeled as a “perfect storm,” triggering a wave of domestic violence. As people use social media to communicate their experiences, analyzing public discourse and sentiment on social platforms offers a way to understand concerns and issues related to domestic violence during the COVID-19 pandemic. Objective: This study was based on an analysis of public discourse and sentiment related to domestic violence during the stay-at-home periods of the COVID-19 pandemic in Australia in 2020. It aimed to understand the more personal self-reported experiences, emotions, and reactions toward domestic violence that were not always classified or collected by official public bodies during the pandemic. Methods: We searched social media and news posts in Australia using key terms related to domestic violence and COVID-19 during 2020 via digital analytics tools to determine sentiments related to domestic violence during this period. Results: The study showed that the use of sentiment and discourse analysis to assess social media data is useful in measuring the public expression of feelings and sharing of resources in relation to the otherwise personal experience of domestic violence. There were a total of 63,800 posts across social media and news media. Within these posts, our analysis found that domestic violence was mentioned an average of 179 times a day. There were 30,100 tweets, 31,700 news reports, 1500 blog posts, 548 forum posts, and 7 comments (posted on news and blog websites). Negative or neutral sentiment centered on the sharp rise in domestic violence during different lockdown periods of the 2020 pandemic, and neutral and positive sentiments centered on praise for efforts that raised awareness of domestic violence as well as the positive actions of domestic violence charities and support groups in their campaigns. There were calls for a positive and proactive handling (rather than a mishandling) of the pandemic, and results indicated a high level of public discontent related to the rising rates of domestic violence and the lack of services during the pandemic. Conclusions: This study provided a timely understanding of public sentiment related to domestic violence during the COVID-19 lockdown periods in Australia using social media analysis. Social media represents an important avenue for the dissemination of information; posts can be widely dispersed and easily accessed by a range of different communities who are often difficult to reach. An improved understanding of these issues is important for future policy direction. Heightened awareness of this could help agencies tailor and target messaging to maximize impact. %M 34519659 %R 10.2196/29025 %U https://www.jmir.org/2021/10/e29025 %U https://doi.org/10.2196/29025 %U http://www.ncbi.nlm.nih.gov/pubmed/34519659 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e27166 %T The Psychological Experience of Frontline Perioperative Health Care Staff in Responding to COVID-19: Qualitative Study %A Withiel,Toni %A Barson,Elizabeth %A Ng,Irene %A Segal,Reny %A Williams,Daryl Lindsay Goulding %A Krieser,Roni Benjamin %A Lee,Keat %A Mezzavia,Paul Mario %A Sindoni,Teresa %A Chen,Yinwei %A Fisher,Caroline Anne %+ Department of Allied Health, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3010, Australia, 61 411729045, toni.withiel@mh.org.au %K COVID-19 %K perioperative %K mental health %K qualitative %K grief %K psychology %K health care worker %K experience %K hospital %K trauma %K thematic analysis %K interview %D 2021 %7 29.9.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The rapid spread of the novel coronavirus (COVID-19) has presented immeasurable challenges to health care workers who remain at the frontline of the pandemic. A rapidly evolving body of literature has quantitatively demonstrated significant psychological impacts of the pandemic on health care workers. However, little is known about the lived experience of the pandemic for frontline medical staff. Objective: This study aimed to explore the qualitative experience of perioperative staff from a large trauma hospital in Melbourne, Australia. Methods: Inductive thematic analysis using a critical realist approach was used to analyze data from 9 semistructured interviews. Results: Four key themes were identified. Hospital preparedness related to the perceived readiness of the hospital to respond to the pandemic and encompassed key subthemes around communication of policy changes, team leadership, and resource availability. Perceptions of readiness contributed to the perceived psychological impacts of the pandemic, which were highly varied and ranged from anger to anxiety. A number of coping strategies were identified in response to psychological impacts which incorporated both internal and external coping mechanisms. Finally, adaptation with time reflected change and growth over time, and encompassed all other themes. Conclusions: While frontline staff and hospitals have rapidly marshalled a response to managing the virus, relatively less consideration was seen regarding staff mental health in our study. Findings highlight the vulnerability of health care workers in response to the pandemic and reinforce the need for a coordinated approach to managing mental health. %M 34346887 %R 10.2196/27166 %U https://periop.jmir.org/2021/2/e27166 %U https://doi.org/10.2196/27166 %U http://www.ncbi.nlm.nih.gov/pubmed/34346887 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27741 %T Emotional Analysis of Twitter Posts During the First Phase of the COVID-19 Pandemic in Greece: Infoveillance Study %A Geronikolou,Styliani %A Drosatos,George %A Chrousos,George %+ Biomedical Research Foundation of the Academy of Athens, Soranou Ephessiou 4, Athens, 11527, Greece, 30 2106597403, sgeronik@gmail.com %K emotional analysis %K COVID-19 %K Twitter %K Greece %K infodemics %K emotional contagion %K epidemiology %K pandemic %K mental health %D 2021 %7 29.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The effectiveness of public health measures depends upon a community’s compliance as well as on its positive or negative emotions. Objective: The purpose of this study was to perform an analysis of the expressed emotions in English tweets by Greek Twitter users during the first phase of the COVID-19 pandemic in Greece. Methods: The period of this study was from January 25, 2020 to June 30, 2020. Data collection was performed by using appropriate search words with the filter-streaming application programming interface of Twitter. The emotional analysis of the tweets that satisfied the inclusion criteria was achieved using a deep learning approach that performs better by utilizing recurrent neural networks on sequences of characters. Emotional epidemiology tools such as the 6 basic emotions, that is, joy, sadness, disgust, fear, surprise, and anger based on the Paul Ekman classification were adopted. Results: The most frequent emotion that was detected in the tweets was “surprise” at the emerging contagion, while the imposed isolation resulted mostly in “anger” (odds ratio 2.108, 95% CI 0.986-4.506). Although the Greeks felt rather safe during the first phase of the COVID-19 pandemic, their positive and negative emotions reflected a masked “flight or fight” or “fear versus anger” response to the contagion. Conclusions: The findings of our study show that emotional analysis emerges as a valid tool for epidemiology evaluations, design, and public health strategy and surveillance. %M 34469328 %R 10.2196/27741 %U https://formative.jmir.org/2021/9/e27741 %U https://doi.org/10.2196/27741 %U http://www.ncbi.nlm.nih.gov/pubmed/34469328 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30305 %T Effectiveness of an Internet-Based Machine-Guided Stress Management Program Based on Cognitive Behavioral Therapy for Improving Depression Among Workers: Protocol for a Randomized Controlled Trial %A Kawakami,Norito %A Imamura,Kotaro %A Watanabe,Kazuhiro %A Sekiya,Yuki %A Sasaki,Natsu %A Sato,Nana %A , %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 358413521, nkawakami@m.u-tokyo.ac.jp %K deep learning %K unguided intervention %K universal prevention %K workplace %K depression %K machine learning %D 2021 %7 29.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The effect of an unguided internet-based cognitive behavioral therapy (iCBT) stress management program on depression may be enhanced by applying artificial intelligence (AI) technologies to guide participants adopting the program. Objective: The aim of this study is to describe a research protocol to investigate the effect of a newly developed iCBT stress management program adopting AI technologies on improving depression among healthy workers during the COVID-19 pandemic. Methods: This study is a two-arm, parallel, randomized controlled trial. Participants (N=1400) will be recruited, and those who meet the inclusion criteria will be randomly allocated to the intervention or control (treatment as usual) group. A 6-week, six-module, internet-based stress management program, SMART-CBT, has been developed that includes machine-guided exercises to help participants acquire CBT skills, and it applies machine learning and deep learning technologies. The intervention group will participate in the program for 10 weeks. The primary outcome, depression, will be measured using the Beck Depression Inventory II at baseline and 3- and 6-month follow-ups. A mixed model repeated measures analysis will be used to test the intervention effect (group × time interactions) in the total sample (universal prevention) on an intention-to-treat basis. Results: The study was at the stage of recruitment of participants at the time of submission. The data analysis related to the primary outcome will start in January 2022, and the results might be published in 2022 or 2023. Conclusions: This is the first study to investigate the effectiveness of a fully automated machine-guided iCBT program for improving subthreshold depression among workers using a randomized controlled trial design. The study will explore the potential of a machine-guided stress management program that can be disseminated online to a large number of workers with minimal cost in the post–COVID-19 era. Trial Registration: UMIN Clinical Trials Registry（UMIN-CTR) UMIN000043897; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000050125 International Registered Report Identifier (IRRID): PRR1-10.2196/30305 %M 34460414 %R 10.2196/30305 %U https://www.researchprotocols.org/2021/9/e30305 %U https://doi.org/10.2196/30305 %U http://www.ncbi.nlm.nih.gov/pubmed/34460414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28700 %T Longitudinal Relationships Among Fear of COVID-19, Smartphone Online Self-Disclosure, Happiness, and Psychological Well-being: Survey Study %A Matthes,Jörg %A Koban,Kevin %A Neureiter,Ariadne %A Stevic,Anja %+ Department of Communication, University of Vienna, Währinger Straße 29, R. 7.45, Vienna, 1090, Austria, 43 1 4277 493 39, kevin.koban@univie.ac.at %K COVID-19 pandemic %K fear %K self-disclosure %K happiness, well-being %K panel study %K smartphones %K online platform %K social media %D 2021 %7 27.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given that governmental prevention measures restricted most face-to-face communications, online self-disclosure via smartphones emerged as an alternative coping strategy that aimed at reducing the impact of the COVID-19 pandemic on people’s psychological health. Prepandemic research demonstrated that online self-disclosure benefits people’s psychological health by establishing meaningful relationships, obtaining social support, and achieving self-acceptance, particularly in times of crisis. However, it is unclear whether these dynamics transition well to lockdown conditions where online self-disclosure must stand almost entirely on its own. Longitudinal investigations are needed to gain insights into the psychological functionalities of online self-disclosure during the COVID-19 pandemic. Objective: This study aimed to determine the temporal associations between smartphone online self-disclosure (as a communicative behavior) and critical indicators of psychological health (including psychopathological, as well as hedonic and eudaimonic states) during the first COVID-19 lockdown in Austria. Methods: We conducted a representative 2-wave panel survey between late March/April 2020 and May 2020. A total of 416 participants completed both waves (43.1% attrition rate, given n=731 participants who completed the first wave). A partially metric measurement invariant overtime structural equation model was used to determine the temporal associations among online self-disclosure, fear of COVID-19, happiness, and psychological well-being. Results: The analysis revealed that fear of COVID-19 significantly predicted online self-disclosure over time (b=0.24, P=.003) and happiness over time (b=−0.14, P=.04), but not psychological well-being (b=0.03, P=.48), that is, stronger COVID-19 fears at T1 prompted more online self-disclosure and less happiness at T2. Online self-disclosure, on the other hand, significantly predicted happiness (b=0.09, P=.02), but neither fear of COVID-19 (b=−0.01, P=.57) nor psychological well-being (b=−0.01, P=.57) over time. Participants who engaged more strongly in online self-disclosure at T1 felt happier at T2, but they did not differ from less-disclosing participants concerning COVID-19 fears and psychological well-being at T2. Importantly, happiness and psychological well-being were significantly related over time (happiness T1 → psychological well-being T2: b=0.11, P<.001; psychological well-being T1 → happiness T2: b=0.42, P<.001). Conclusions: Our findings suggest that online self-disclosure might play a pivotal role in coping with pandemic stressors. With restrictions on their options, individuals increasingly turn to their smartphones and social media to disclose their feelings, problems, and concerns during lockdown. While online self-disclosure might not alleviate fears or improve psychological well-being, our results demonstrate that it made people experience more happiness during this crisis. This psychological resource may help them withstand the severe psychological consequences of the COVID-19 crisis over longer timeframes. %M 34519657 %R 10.2196/28700 %U https://www.jmir.org/2021/9/e28700 %U https://doi.org/10.2196/28700 %U http://www.ncbi.nlm.nih.gov/pubmed/34519657 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e32663 %T Exploring the Well-being of Health Care Workers During the COVID-19 Pandemic: Protocol for a Prospective Longitudinal Study %A Liu,Jenny J W %A Nazarov,Anthony %A Plouffe,Rachel A %A Forchuk,Callista A %A Deda,Erisa %A Gargala,Dominic %A Le,Tri %A Bourret-Gheysen,Jesse %A Soares,Vanessa %A Nouri,Maede S %A Hosseiny,Fardous %A Smith,Patrick %A Roth,Maya %A MacDougall,Arlene G %A Marlborough,Michelle %A Jetly,Rakesh %A Heber,Alexandra %A Albuquerque,Joy %A Lanius,Ruth %A Balderson,Ken %A Dupuis,Gabrielle %A Mehta,Viraj %A Richardson,J Don %+ MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, St. Joseph's Health Care London, Parkwood Institute Research, Mental Health Building RM F4-367, 550 Wellington Road, London, ON, N6C 0A7, Canada, 1 519 685 4292 ext 48211, jenny.liu@sjhc.london.on.ca %K COVID-19 %K health care worker %K pandemic %K mental health %K wellbeing %K survey %K design %K longitudinal %K prospective %K protocol %K challenge %K impact %K distress %K perception %D 2021 %7 27.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care workers (HCWs) have experienced several stressors associated with the COVID-19 pandemic. Structural stressors, including extended work hours, redeployment, and changes in organizational mandates, often intersect with interpersonal and personal stressors, such as caring for those with COVID-19 infections; worrying about infection of self, family, and loved ones; working despite shortages of personal protective equipment; and encountering various difficult moral-ethical dilemmas. Objective: The paper describes the protocol for a longitudinal study seeking to capture the unique experiences, challenges, and changes faced by HCWs during the COVID-19 pandemic. The study seeks to explore the impact of COVID-19 on the mental well-being of HCWs with a particular focus on moral distress, perceptions of and satisfaction with delivery of care, and how changes in work structure are tolerated among HCWs providing clinical services. Methods: A prospective longitudinal design is employed to assess HCWs’ experiences across domains of mental health (depression, anxiety, posttraumatic stress, and well-being), moral distress and moral reasoning, work-related changes and telehealth, organizational responses to COVID-19 concerns, and experiences with COVID-19 infections to self and to others. We recruited HCWs from across Canada through convenience snowball sampling to participate in either a short-form or long-form web-based survey at baseline. Respondents to the baseline survey are invited to complete a follow-up survey every 3 months, for a total of 18 months. Results: A total of 1926 participants completed baseline surveys between June 26 and December 31, 2020, and 1859 participants provided their emails to contact them to participate in follow-up surveys. As of July 2021, data collection is ongoing, with participants nearing the 6- or 9-month follow-up periods depending on their initial time of self-enrollment. Conclusions: This protocol describes a study that will provide unique insights into the immediate and longitudinal impact of the COVID-19 pandemic on the dimensions of mental health, moral distress, health care delivery, and workplace environment of HCWs. The feasibility and acceptability of implementing a short-form and long-form survey on participant engagement and data retention will also be discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/32663 %M 34477557 %R 10.2196/32663 %U https://www.researchprotocols.org/2021/9/e32663 %U https://doi.org/10.2196/32663 %U http://www.ncbi.nlm.nih.gov/pubmed/34477557 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31278 %T The Influence of Social Distancing Behaviors and Psychosocial Factors on Physical Activity During the COVID-19 Pandemic: Cross-sectional Survey Study %A Cross,Troy J %A Isautier,Jennifer M J %A Morris,Sarah J %A Johnson,Bruce D %A Wheatley-Guy,Courtney M %A Taylor,Bryan J %+ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Camperdown, 2006, Australia, 61 2 9351 2222, troy.cross@sydney.edu.au %K physical activity %K COVID-19 %K mental health %K social distancing %K public health %K pandemic %K physical health %K exercise %D 2021 %7 24.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has arguably facilitated a shift toward increased sedentariness and reduced physical activity. Moreover, there is mounting evidence that mental health has also declined during the pandemic. However, it remains unknown to what extent social distancing (SD) behaviors and mental health have affected the physical activity levels of the general population. Objective: The purpose of this study was to determine the influence of SD behaviors and prevailing mental health on the odds of being physically active during the early COVID-19 pandemic response. Methods: A total of 4819 adults (2474/4819, 51.3%, female) from the US population with a median age of 46 (IQR 35-59) completed an online survey during the early pandemic response (April-June 2020). The survey included questions on adherence to 11 SD behaviors, and validated questionnaires which assessed self-reported physical activity, depression, anxiety, and mental well-being. Respondents were categorized into 2 physical activity groups: inactive (0-599 metabolic equivalent of task [MET]-minutes/week) and active (≥600 MET-minutes/week). A logistic generalized additive model (GAM) was used to determine which SD factors and mental health outcomes were associated with physical activity level. Results: The GAM analysis revealed that wearing a facemask in public (odds ratio [OR] 1.46, 95% CI 1.14-1.79; P=.003), limiting the use of public transport (OR 1.47, 95% CI 1.19-1.83; P=.001), and restricting travel outside the house (OR 1.56, 95% CI 1.19-2.05; P=.002) were SD behaviors associated with higher odds of being more physically active. Conversely, avoiding physical activity outside the house was associated with higher odds of being inactive (OR 0.52, 95% CI 0.46-0.63; P<.001). Leaving the house more frequently, and a higher mental well-being were associated with increasing odds of being physically active (P<.001). Engaging with a moderate number of SD behaviors (3-7 total) was positively associated with physical activity, whereas a very high SD vigilance (ie, engaging with ≥10 total behaviors) decreased the odds of being active during the early pandemic response. Conclusions: Based on the findings of our study, we suggest that future public health messaging of SD guidelines should include (1) a clear portrayal of the benefits of regular exercise on mental health; and (2) a specific focus on how to be physically active outdoors in a COVID-safe manner. %M 34509976 %R 10.2196/31278 %U https://publichealth.jmir.org/2021/9/e31278 %U https://doi.org/10.2196/31278 %U http://www.ncbi.nlm.nih.gov/pubmed/34509976 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28002 %T “Skip the Small Talk” Virtual Event Intended to Promote Social Connection During a Global Pandemic: Online Survey Study %A Mote,Jasmine %A Gill,Kathryn %A Fulford,Daniel %+ Department of Occupational Therapy, Tufts University, 574 Boston Ave, Medford, MA, 02155, United States, 1 617 627 3781, jasmine.mote@tufts.edu %K COVID-19 %K depression %K digital group %K loneliness %K social connection %K virtual social interaction %K community %K mental health %K connection %K virtual health %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social distancing measures meant to prevent the spread of COVID-19 in the past year have exacerbated loneliness and depression in the United States. While virtual tools exist to improve social connections, there have been limited attempts to assess community-based, virtual methods to promote new social connections. Objective: In this proof-of-concept study, we examined the extent to which Skip the Small Talk (STST)—a business dedicated to hosting events to facilitate structured, vulnerable conversations between strangers—helped reduce loneliness in a virtual format in the early months of the 2020 COVID-19 pandemic. We predicted that participants who attended STST virtual events would show a reduction in loneliness, improvement in positive affect, and reduction in negative affect after attending an event. We were also interested in exploring the role of depression symptoms on these results as well as the types of goals participants accomplished by attending STST events. Methods: Adult participants who registered for an STST virtual event between March 25 and June 30, 2020, completed a survey before attending the event (pre-event survey; N=64) and a separate survey after attending the event (postevent survey; n=25). Participants reported on their depression symptoms, loneliness, and positive and negative affect. Additionally, participants reported the goals they wished to accomplish as well as those they actually accomplished by attending the STST event. Results: The four most cited goals that participants hoped to accomplish before attending the STST event included the following: “to make new friends,” “to have deeper/better conversations with other people,” “to feel less lonely,” and “to practice social skills.” A total of 34% (20/58) of participants who completed the pre-event survey reported depression symptoms that indicated a high risk of a major depressive episode in the preceding 2 weeks. Of the 25 participants who completed the pre- and postevent surveys, participants reported a significant reduction in loneliness (P=.03, Cohen d=0.48) and negative affect (P<.001, Cohen d=1.52) after attending the STST event compared to before the event. Additionally, depressive symptoms were significantly positively correlated with change in negative affect (P=.03), suggesting that the higher the depression score was prior to attending the STST event, the higher the reduction in negative affect was following the event. Finally, 100% of the participants who wished to reduce their loneliness (11/11) or feel less socially anxious (5/5) prior to attending the STST event reported that they accomplished those goals after the event. Conclusions: Our preliminary assessment suggests that the virtual format of STST was helpful for reducing loneliness and negative affect for participants, including those experiencing depression symptoms, during the COVID-19 pandemic. While encouraging, additional research is necessary to demonstrate whether STST has benefits when compared to other social events and interventions and whether such benefits persist beyond the events themselves. %M 34468326 %R 10.2196/28002 %U https://formative.jmir.org/2021/9/e28002 %U https://doi.org/10.2196/28002 %U http://www.ncbi.nlm.nih.gov/pubmed/34468326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e25615 %T Pretesting a Poster on Recommended Stress Management During the COVID-19 Pandemic in Indonesia: Qualitative Study %A Wati,Risa Laras %A Ulfa,Annisa Sayyidatul %A Kevaladandra,Zulfa %A Shalihat,Shelly %A Syahadatina,Bella %A Pratomo,Hadi %+ Department of Health Education & Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Jl. Margonda Raya, Pondok Cina, Kecamatan Beji, Depok, 16424, Indonesia, 62 8161841277, hadi.pratomo@ui.ac.id %K pretesting %K media %K stress %K COVID-19 %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 Peritraumatic Distress Index (CPDI) is a self-report questionnaire developed to evaluate the frequency of anxiety and depression symptoms among individuals during the COVID-19 pandemic. A recent study in China showed high CPDI scores among individuals in the 18-30 years age group and those over 60 years. During the COVID-19 outbreak, people were expected to maintain their mental health conditions, especially stress levels. Therefore, many national governments actively published health promotion media in an effort to educate the public. One such media developed by the Ministry of Health, Republic of Indonesia, was a poster titled “Hindari Stres dan Tetap Optimis dengan Melakukan Aktivitas Sehari-hari dan Tetap Menjaga Jarak.” Objective: The aim of this study is to conduct a test on a stress management recommendation poster developed by the Ministry of Health, Republic of Indonesia, in response to the COVID-19 outbreak by using pretesting communication theory. Methods: In-depth interviews were conducted among 8 key informants and 1 graphic design expert. Results: Pretesting can identify the strengths and weaknesses of media. The large amount of text and the lack of illustrations made the poster less attractive to readers. Moreover, there was a discrepancy between the title and contents of the poster. The poster was not able to persuade the informants to change their behavior in the near future. Conclusions: The poster was understood and accepted by the informants, but there was still much to be improved considering the poster was a product of the Ministry of Health, Republic of Indonesia. %M 34254944 %R 10.2196/25615 %U https://formative.jmir.org/2021/9/e25615 %U https://doi.org/10.2196/25615 %U http://www.ncbi.nlm.nih.gov/pubmed/34254944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30274 %T Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups %A Van Herck,Maarten %A Goërtz,Yvonne M J %A Houben-Wilke,Sarah %A Machado,Felipe V C %A Meys,Roy %A Delbressine,Jeannet M %A Vaes,Anouk W %A Burtin,Chris %A Posthuma,Rein %A Franssen,Frits M E %A Hajian,Bita %A Vijlbrief,Herman %A Spies,Yvonne %A van 't Hul,Alex J %A Janssen,Daisy J A %A Spruit,Martijn A %+ REVAL Rehabilitation Research Center, BIOMED Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan gebouw A, Diepenbeek, 3590, Belgium, 32 494758248, maarten.vanherck@uhasselt.be %K COVID-19 %K SARS-CoV-2 %K long COVID %K post-COVID-19 syndrome %K post-acute sequelae of COVID-19 %K fatigue %K post-viral fatigue %K pandemic %K online health %K mental health %K online support %D 2021 %7 21.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Fatigue is the most commonly reported symptom in patients with persistent complaints following COVID-19 (ie, long COVID). Longitudinal studies examining the intensity of fatigue and differentiating between physical and mental fatigue are lacking. Objective: The objectives of this study were to (1) assess the severity of fatigue over time in members of online long COVID peer support groups, and (2) assess whether members of these groups experienced mental fatigue, physical fatigue, or both. Methods: A 2-wave web-based follow-up study was conducted in members of online long COVID peer support groups with a confirmed diagnosis approximately 3 and 6 months after the onset of infectious symptoms. Demographics, COVID-19 diagnosis, received health care (from medical professionals or allied health care professionals), fatigue (Checklist Individual Strength–subscale subjective fatigue [CIS-Fatigue]; 8-56 points), and physical and mental fatigue (self-constructed questions; 3-21 points) were assessed. Higher scores indicated more severe fatigue. A CIS-Fatigue score ≥36 points was used to qualify patients as having severe fatigue. Results: A total of 239 patients with polymerase chain reaction/computed tomography–confirmed COVID-19 completed the survey 10 weeks (SD 2) and 23 weeks (SD 2) after onset of infectious symptoms, respectively (T1 and T2). Of these 239 patients, 198 (82.8%) were women; 142 (59.4%) had no self-reported pre-existing comorbidities; 208 (87%) self-reported being in good health before contracting COVID-19; and 62 (25.9%) were hospitalized during acute infection. The median age was 50 years (IQR 39-56). The vast majority of patients had severe fatigue at T1 and T2 (n=204, 85.4%, and n=188, 78.7%, respectively). No significant differences were found in the prevalence of normal, mild, and severe fatigue between T1 and T2 (P=.12). The median CIS-Fatigue score was 48 points (IQR 42-53) at T1, and it decreased from T1 to T2 (median change: –2 points, IQR –7 to 3; P<.001). At T1, a median physical fatigue score of 19 points (IQR 16-20) and a median mental fatigue score of 15 points (IQR 10-17) were reported; these scores were lower at T2 for physical but not for mental fatigue (median change for physical fatigue –1 point, IQR –3 to 0, P<.001; median change for mental fatigue 0 points, IQR –3 to 3, P=.52). At the time of completing the follow-up survey, 194/239 (81.2%) and 164/239 (68.6%) of all patients had received care from at least one medical professional and one allied health care professional, respectively. Conclusions: Fatigue in members of online long COVID support groups with a confirmed COVID-19 diagnosis decreases from 10 to 23 weeks after onset of symptoms. Despite this, severe fatigue remains highly prevalent. Both physical and mental fatigue are present. It remains unclear whether and to what extent fatigue will resolve spontaneously in the longer term. Trial Registration: Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705. %M 34494964 %R 10.2196/30274 %U https://www.jmir.org/2021/9/e30274 %U https://doi.org/10.2196/30274 %U http://www.ncbi.nlm.nih.gov/pubmed/34494964 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27283 %T Chloe for COVID-19: Evolution of an Intelligent Conversational Agent to Address Infodemic Management Needs During the COVID-19 Pandemic %A Siedlikowski,Sophia %A Noël,Louis-Philippe %A Moynihan,Stephanie Anne %A Robin,Marc %+ Dialogue Health Technologies Inc, 390 Rue Notre-Dame Ouest #200, Montreal, QC, H2Y 1T9, Canada, 1 613 806 0671, marc.robin@dialogue.co %K chatbot %K COVID-19 %K conversational agents %K public health %K artificial intelligence %K infodemic %K infodemiology %K misinformation %K digital health %K virtual care %D 2021 %7 21.9.2021 %9 Viewpoint %J J Med Internet Res %G English %X There is an unprecedented demand for infodemic management due to rapidly evolving information about the novel COVID-19 pandemic. This viewpoint paper details the evolution of a Canadian digital information tool, Chloe for COVID-19, based on incremental leveraging of artificial intelligence techniques. By providing an accessible summary of Chloe’s development, we show how proactive cooperation between health, technology, and corporate sectors can lead to a rapidly scalable, safe, and secure virtual chatbot to assist public health efforts in keeping Canadians informed. We then highlight Chloe’s strengths, the challenges we faced during the development process, and future directions for the role of chatbots in infodemic management. The information presented here may guide future collaborative efforts in health technology in order to enhance access to accurate and timely health information to the public. %M 34375299 %R 10.2196/27283 %U https://www.jmir.org/2021/9/e27283 %U https://doi.org/10.2196/27283 %U http://www.ncbi.nlm.nih.gov/pubmed/34375299 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30280 %T Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context %A Budhwani,Suman %A Fujioka,Jamie Keiko %A Chu,Cherry %A Baranek,Hayley %A Pus,Laura %A Wasserman,Lori %A Vigod,Simone %A Martin,Danielle %A Agarwal,Payal %A Mukerji,Geetha %+ Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 (416) 323 6400, suman.budhwani@wchospital.ca %K virtual care %K mental health %K quality of care %K implementation %K COVID-19 %K digital health %K pandemic %K ambulatory care %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual care delivery within mental health has increased rapidly during the COVID-19 pandemic. Understanding facilitators and challenges to adoption and perceptions of the quality of virtual care when delivered at scale can inform service planning postpandemic. Objective: We sought to understand consistent facilitators and persistent challenges to adoption of virtual care and perceived impact on quality of care in an initial pilot phase prior to the pandemic and then during scaled use during the pandemic in the mental health department of an ambulatory care hospital. Methods: This study took place at Women’s College Hospital, an academic ambulatory hospital located in Toronto, Canada. We utilized a multimethods approach to collect quantitative data through aggregate utilization data of phone, video, and in-person visits prior to and during COVID-19 lockdown measures and through a provider experience survey administered to mental health providers (n=30). Qualitative data were collected through open-ended questions on provider experience surveys, focus groups (n=4) with mental health providers, and interviews with clinical administrative and implementation hospital staff (n=3). Results: Utilization data demonstrated slower uptake of video visits at launch and prior to COVID-19 lockdown measures in Ontario (pre-March 2020) and subsequent increased uptake of phone and video visits during COVID-19 lockdown measures (post-March 2020). Mental health providers and clinic staff highlighted barriers and facilitators to adoption of virtual care at the operational, behavioral, cultural, and system/policy levels such as required changes in workflows and scheduling, increased provider effort, provider and staff acceptance, and billing codes for physician providers. Much of the described provider experiences focused on perceived impact on quality of mental health care delivery, including perceptions on providing appropriate and patient-centered care, virtual care effectiveness, and equitable access to care for patients. Conclusions: Continued efforts to enhance suggested facilitators, reduce persistent challenges, and address provider concerns about care quality based on these findings can enable a hybrid model of patient-centered and appropriate care to emerge in the future, with options for in-person, video, and phone visits being used to meet patient and clinical needs as required. %M 34406967 %R 10.2196/30280 %U https://formative.jmir.org/2021/9/e30280 %U https://doi.org/10.2196/30280 %U http://www.ncbi.nlm.nih.gov/pubmed/34406967 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e30422 %T Trends in Stress Throughout Pregnancy and Postpartum Period During the COVID-19 Pandemic: Longitudinal Study Using Ecological Momentary Assessment and Data From the Postpartum Mothers Mobile Study %A Omowale,Serwaa S %A Casas,Andrea %A Lai,Yu-Hsuan %A Sanders,Sarah A %A Hill,Ashley V %A Wallace,Meredith L %A Rathbun,Stephen L %A Gary-Webb,Tiffany L %A Burke,Lora E %A Davis,Esa M %A Mendez,Dara D %+ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, United States, 1 4126243001, ddm11@pitt.edu %K COVID-19 %K ecological momentary assessment %K health status disparities %K pandemics %K postpartum %K pregnancy %K psychological stress %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States during the ongoing COVID-19 pandemic. Objective: This study aimed to do the following: (1) assess changes in reported stress before, during, and after initial emergency declarations (eg, stay-at-home orders) were in place due to the COVID-19 pandemic, and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania. Methods: We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS), which surveys participants in real time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019, and August 31, 2020, the time frame of this study. We divided data into four phases based on significant events during the COVID-19 pandemic: “pre” phase (baseline), “early” phase (first case of COVID-19 reported in United States), “during” phase (stay-at-home orders), and “post” phase (stay-at-home orders eased). We assessed mean stress levels at each phase using linear mixed-effects models and post hoc contrasts based on the models. Results: Overall mean stress (0=not at all to 4=a lot) during the pre phase was 0.8 for Black and White participants (range for Black participants: 0-3.9; range for White participants: 0-2.8). There was an increase of 0.3 points (t5649=5.2, P<.001) in the during phase as compared with the pre phase, and an increase of 0.2 points (t5649=3.1, P=.002) in the post phase compared with the pre phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre phase to the during phase (overall change predicted for the regression coefficient=–0.02, P=.87). There was a significant difference between Black and White participants in the change in mean stress from the during phase to the post phase (overall change predicted for the regression coefficient=0.4, P<.001). Conclusions: There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the United States. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the United States. International Registered Report Identifier (IRRID): RR2-10.2196/13569 %M 34328420 %R 10.2196/30422 %U https://mental.jmir.org/2021/9/e30422 %U https://doi.org/10.2196/30422 %U http://www.ncbi.nlm.nih.gov/pubmed/34328420 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30504 %T An App-Based Surveillance System for Undergraduate Students’ Mental Health During the COVID-19 Pandemic: Protocol for a Prospective Cohort Study %A Brogly,Chris %A Bauer,Michael A %A Lizotte,Daniel J %A Press,MacLean L %A MacDougall,Arlene %A Speechley,Mark %A Huner,Erin %A Mitchell,Marc %A Anderson,Kelly K %A Pila,Eva %+ School of Kinesiology, Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada, 1 519 661 2111, epila@uwo.ca %K undergraduate %K mental health %K smartphone %K app %K COVID-19 %K postsecondary institutions %K mobile apps %K mHealth %K mobile health %D 2021 %7 17.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic is a public health emergency that poses challenges to the mental health of approximately 1.4 million university students in Canada. Preliminary evidence has shown that the COVID-19 pandemic had a detrimental impact on undergraduate student mental health and well-being; however, existing data are predominantly limited to cross-sectional survey-based studies. Owing to the evolving nature of the pandemic, longer-term prospective surveillance efforts are needed to better anticipate risk and protective factors during a pandemic. Objective: The overarching aim of this study is to use a mobile (primarily smartphone-based) surveillance system to identify risk and protective factors for undergraduate students’ mental health. Factors will be identified from weekly self-report data (eg, affect and living accommodation) and device sensor data (eg, physical activity and device usage) to prospectively predict self-reported mental health and service utilization. Methods: Undergraduate students at Western University (London, Ontario, Canada), will be recruited via email to complete an internet-based baseline questionnaire with the option to participate in the study on a weekly basis, using the Student Pandemic Experience (SPE) mobile app for Android/iOS. The app collects sensor samples (eg, GPS coordinates and steps) and self-reported weekly mental health and wellness surveys. Student participants can opt in to link their mobile data with campus-based administrative data capturing health service utilization. Risk and protective factors that predict mental health outcomes are expected to be estimated from (1) cross-sectional associations among students’ characteristics (eg, demographics) and key psychosocial factors (eg, affect, stress, and social connection), and behaviors (eg, physical activity and device usage) and (2) longitudinal associations between psychosocial and behavioral factors and campus-based health service utilization. Results: Data collection began November 9, 2020, and will be ongoing through to at least October 31, 2021. Retention from the baseline survey (N=427) to app sign-up was 74% (315/427), with 175-215 (55%-68%) app participants actively responding to weekly surveys. From November 9, 2020, to August 8, 2021, a total of 4851 responses to the app surveys and 25,985 sensor samples (consisting of up to 68 individual data items each; eg, GPS coordinates and steps) were collected from the 315 participants who signed up for the app. Conclusions: The results of this real-world longitudinal cohort study of undergraduate students’ mental health based on questionnaires and mobile sensor metrics is expected to show psychosocial and behavioral patterns associated with both positive and negative mental health–related states during pandemic conditions at a relatively large, public, and residential Canadian university campus. The results can be used to support decision-makers and students during the ongoing COVID-19 pandemic and similar future events. For comparable settings, new interventions (digital or otherwise) might be designed using these findings as an evidence base. International Registered Report Identifier (IRRID): DERR1-10.2196/30504 %M 34516391 %R 10.2196/30504 %U https://www.researchprotocols.org/2021/9/e30504 %U https://doi.org/10.2196/30504 %U http://www.ncbi.nlm.nih.gov/pubmed/34516391 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31052 %T Associations Between the Perceived Severity of the COVID-19 Pandemic, Cyberchondria, Depression, Anxiety, Stress, and Lockdown Experience: Cross-sectional Survey Study %A Han,Lei %A Zhan,Yanru %A Li,Weizi %A Xu,Yuqing %A Xu,Yan %A Zhao,Jinzhe %+ Faculty of Psychology, Beijing Normal University, 19 Xinjiekouwai Street Haidian District, Beijing, 100875, China, 86 19800356013, sszbjz@163.com %K COVID-19 %K cyberchondria %K depression %K anxiety %K stress %K ABC theory of emotions %K lockdown experience %K perceived severity %K cross-sectional %K online health information %D 2021 %7 16.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The outbreak of the COVID-19 pandemic has caused great panic among the public, with many people suffering from adverse stress reactions. To control the spread of the pandemic, governments in many countries have imposed lockdown policies. In this unique pandemic context, people can obtain information about pandemic dynamics on the internet. However, searching for health-related information on the internet frequently increases the possibility of individuals being troubled by the information that they find, and consequently, experiencing symptoms of cyberchondria. Objective: We aimed to examine the relationships between people’s perceived severity of the COVID-19 pandemic and their depression, anxiety, and stress to explore the role of cyberchondria, which, in these relationship mechanisms, is closely related to using the internet. In addition, we also examined the moderating role of lockdown experiences. Methods: In February 2020, a total of 486 participants were recruited through a web-based platform from areas in China with a large number of infections. We used questionnaires to measure participants’ perceived severity of the COVID-19 pandemic, to measure the severity of their cyberchondria, depression, anxiety, and stress symptoms, and to assess their lockdown experiences. Confirmatory factor analysis, exploratory factor analysis, common method bias, descriptive statistical analysis, and correlation analysis were performed, and moderated mediation models were examined. Results: There was a positive association between perceived severity of the COVID-19 pandemic and depression (β=0.36, t=8.51, P<.001), anxiety (β=0.41, t=9.84, P<.001), and stress (β=0.46, t=11.45, P<.001), which were mediated by cyberchondria (β=0.36, t=8.59, P<.001). The direct effects of perceived severity of the COVID-19 pandemic on anxiety (β=0.07, t=2.01, P=.045) and stress (β=0.09, t=2.75, P=.006) and the indirect effects of cyberchondria on depression (β=0.10, t=2.59, P=.009) and anxiety (β=0.10, t=2.50, P=.01) were moderated by lockdown experience. Conclusions: The higher the perceived severity of the COVID-19 pandemic, the more serious individuals’ symptoms of depression, anxiety, and stress. In addition, the associations were partially mediated by cyberchondria. Individuals with higher perceived severity of the COVID-19 pandemic were more likely to develop cyberchondria, which aggravated individuals’ depression, anxiety, and stress symptoms. Negative lockdown experiences exacerbated the COVID-19 pandemic’s impact on mental health. %M 34478402 %R 10.2196/31052 %U https://publichealth.jmir.org/2021/9/e31052 %U https://doi.org/10.2196/31052 %U http://www.ncbi.nlm.nih.gov/pubmed/34478402 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e30833 %T Shift in Social Media App Usage During COVID-19 Lockdown and Clinical Anxiety Symptoms: Machine Learning–Based Ecological Momentary Assessment Study %A Ryu,Jihan %A Sükei,Emese %A Norbury,Agnes %A H Liu,Shelley %A Campaña-Montes,Juan José %A Baca-Garcia,Enrique %A Artés,Antonio %A Perez-Rodriguez,M Mercedes %+ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Icahn (East) Bldg, 4th Floor, L4-53, 1425 Madison Ave, New York, NY, 10029, United States, 1 241 9775, mercedes.perez@mssm.edu %K anxiety disorder %K COVID-19 %K social media %K public health %K digital phenotype %K ecological momentary assessment %K smartphone %K machine learning %K hidden Markov model %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anxiety symptoms during public health crises are associated with adverse psychiatric outcomes and impaired health decision-making. The interaction between real-time social media use patterns and clinical anxiety during infectious disease outbreaks is underexplored. Objective: We aimed to evaluate the usage pattern of 2 types of social media apps (communication and social networking) among patients in outpatient psychiatric treatment during the COVID-19 surge and lockdown in Madrid, Spain and their short-term anxiety symptoms (7-item General Anxiety Disorder scale) at clinical follow-up. Methods: The individual-level shifts in median social media usage behavior from February 1 through May 3, 2020 were summarized using repeated measures analysis of variance that accounted for the fixed effects of the lockdown (prelockdown versus postlockdown), group (clinical anxiety group versus nonclinical anxiety group), the interaction of lockdown and group, and random effects of users. A machine learning–based approach that combined a hidden Markov model and logistic regression was applied to predict clinical anxiety (n=44) and nonclinical anxiety (n=51), based on longitudinal time-series data that comprised communication and social networking app usage (in seconds) as well as anxiety-associated clinical survey variables, including the presence of an essential worker in the household, worries about life instability, changes in social interaction frequency during the lockdown, cohabitation status, and health status. Results: Individual-level analysis of daily social media usage showed that the increase in communication app usage from prelockdown to lockdown period was significantly smaller in the clinical anxiety group than that in the nonclinical anxiety group (F1,72=3.84, P=.05). The machine learning model achieved a mean accuracy of 62.30% (SD 16%) and area under the receiver operating curve 0.70 (SD 0.19) in 10-fold cross-validation in identifying the clinical anxiety group. Conclusions: Patients who reported severe anxiety symptoms were less active in communication apps after the mandated lockdown and more engaged in social networking apps in the overall period, which suggested that there was a different pattern of digital social behavior for adapting to the crisis. Predictive modeling using digital biomarkers—passive-sensing of shifts in category-based social media app usage during the lockdown—can identify individuals at risk for psychiatric sequelae. %M 34524091 %R 10.2196/30833 %U https://mental.jmir.org/2021/9/e30833 %U https://doi.org/10.2196/30833 %U http://www.ncbi.nlm.nih.gov/pubmed/34524091 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 3 %P e28495 %T Rates of Assessment of Social Media Use in Psychiatric Interviews Prior to and During COVID-19: Needs Assessment Survey %A Raphaely,Shiri %A Goldberg,Simon B %A Moreno,Megan %A Stowe,Zachary %+ Department of Psychiatry, University of Wisconsin, 6001 Research Park Boulevard, Madison, WI, 53719, United States, 1 2063510110, shiri.raphaely@gmail.com %K social media %K screentime %K problematic Internet use %K psychiatric interview %K psychiatric training %K COVID-19 %K residency %K training %K survey %K psychiatry %K evaluation %K quarantine %D 2021 %7 14.9.2021 %9 Short Paper %J JMIR Med Educ %G English %X Background: Current research suggests that there is a nuanced relationship between mental well-being and social media. Social media offers opportunities for empowerment, information, and connection while also showing links with depression, high-risk behavior, and harassment. As this medium rapidly integrates into interpersonal interactions, incorporation of social media assessment into the psychiatric evaluation warrants attention. Furthermore, the COVID-19 pandemic and containment measures (ie, social distancing) led to increased dependence on social media, allowing an opportunity to assess the adaptation of psychiatric interviews in response to sociocultural changes. Objective: The first aim of this study was to evaluate if general psychiatry residents and child and adolescent psychiatry fellows assessed social media use as part of the clinical interview. Second, the study examined whether changes were made to the social media assessment in response to known increase of social media use secondary to social distancing measures during the COVID-19 pandemic. Methods: As part of a quality improvement project, the authors surveyed general psychiatry residents and child psychiatry fellows in a university-based training program (n=21) about their assessment of social media use in patient evaluations. Soon after the survey closed, “stay-at-home” orders related to the COVID-19 pandemic began. A subsequent survey was sent out with the same questions to evaluate if residents and fellows altered their interview practices in response to the dramatic sociocultural changes (n=20). Results: Pre-COVID-19 pandemic survey results found that 10% (2/21) of respondents incorporated social media questions in patient evaluations. In a follow-up survey after the onset of the pandemic, 20% (4/20) of respondents included any assessment of social media use. Among the 15 participants who completed both surveys, there was a nonsignificant increase in the likelihood of asking about social media use (2/15, 13% vs 4/15, 27%, for pre- and during COVID-19, respectively; McNemar χ21=0.25, P=.617, Cohen d=0.33). Conclusions: These small survey results raise important questions relevant to the training of residents and fellows in psychiatry. The findings suggest that the assessment of social media use is a neglected component of the psychiatric interview by trainees. The burgeoning use and diversity of social media engagement warrant scrutiny with respect to how this is addressed in interview training. Additionally, given minimal adaptation of the interview in the midst of a pandemic, these findings imply an opportunity for improving psychiatric training that incorporates adapting clinical interviews to sociocultural change. %M 34375297 %R 10.2196/28495 %U https://mededu.jmir.org/2021/3/e28495 %U https://doi.org/10.2196/28495 %U http://www.ncbi.nlm.nih.gov/pubmed/34375297 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31295 %T Factors Associated With Longitudinal Psychological and Physiological Stress in Health Care Workers During the COVID-19 Pandemic: Observational Study Using Apple Watch Data %A Hirten,Robert P %A Danieletto,Matteo %A Tomalin,Lewis %A Choi,Katie Hyewon %A Zweig,Micol %A Golden,Eddye %A Kaur,Sparshdeep %A Helmus,Drew %A Biello,Anthony %A Pyzik,Renata %A Calcagno,Claudia %A Freeman,Robert %A Sands,Bruce E %A Charney,Dennis %A Bottinger,Erwin P %A Murrough,James W %A Keefer,Laurie %A Suarez-Farinas,Mayte %A Nadkarni,Girish N %A Fayad,Zahi A %+ The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, United States, 1 212 241 0150, robert.hirten@mountsinai.org %K wearable device %K COVID-19 %K stress %K heart rate variability %K psychological %K psychology %K physiology %K mental health %K health care worker %K observational %K app %K heart rate %K nervous system %K resilience %K emotion %K support %K quality of life %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact. Objective: This study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress. Methods: HCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally. Results: A total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3%) were enrolled. Multivariate analysis found New York City’s COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial. Conclusions: High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic. %M 34379602 %R 10.2196/31295 %U https://www.jmir.org/2021/9/e31295 %U https://doi.org/10.2196/31295 %U http://www.ncbi.nlm.nih.gov/pubmed/34379602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24624 %T Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh %A Rashid Soron,Tanjir %A Ashiq,Md Ashiqur Rahman %A Al-Hakeem,Marzia %A Chowdhury,Zaid Farzan %A Uddin Ahmed,Helal %A Afrooz Chowdhury,Chaman %+ Telepsychiatry Research and Innovation Network Ltd, 3D, 2nd Floor, Rupayan Trade Center, Bangla Motor, Dhaka, 1205, Bangladesh, 880 1718827138, tanjirsoron@gmail.com %K domestic violence %K COVID-19 %K mental health %K violence %K Bangladesh %K lockdown %K isolation %K anxiety %K stress %K telemental health %K telepsychiatry %K web-based survey %D 2021 %7 13.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Background: The COVID-19 lockdown, the advent of working from home, and other unprecedent events have resulted in multilayer and multidimensional impacts on our personal, social, and occupational lives. Mental health conditions are deteriorating, financial crises are increasing in prevalence, and the need to stay at home has resulted in the increased prevalence of domestic violence. In Bangladesh, where domestic violence is already prevalent, the lockdown period and stay-at-home orders could result in more opportunities and increased scope for perpetrators of domestic violence. Objective: In this study, we aimed to determine the prevalence and pattern of domestic violence during the initial COVID-19 lockdown period in Bangladesh and the perceptions of domestic violence survivors with regard to mental health care. Methods: We conducted this cross-sectional web-based study among the Bangladeshi population and used a semistructured self-reported questionnaire to understand the patterns of domestic violence and perceptions on mental health care from August to September 2020. The questionnaire was disseminated on different organizational websites and social media pages (ie, those of organizations that provide mental health and domestic violence services). Data were analyzed by using IBM SPSS (version 22.0; IBM Corporation). Results: We found that 36.8% (50/136) of respondents had faced domestic violence at some point in their lives; psychological abuse was the most common type of violence. However, the prevalence of the economical abuse domestic violence type increased after the COVID-19 lockdown was enforced. Although 96.3% (102/136) of the participants believed that domestic violence survivors need mental health support, only 25% (34/136) of the respondents had an idea about the mental health services that are available for domestic violence survivors in Bangladesh and how and where they could avail mental health services. Conclusions: Domestic violence is one of the most well-known stressors that have direct impacts on physical and mental health. However, the burden of domestic violence is often underreported, and its impact on mental health is neglected in Bangladesh. The burden of this problem has increased during the COVID-19 crisis, and the cry for mental health support is obvious in the country. However, it is necessary to provide information about available support services; telepsychiatry can be good option for providing immediate mental health support in a convenient and cost-effective manner. %M 34346893 %R 10.2196/24624 %U https://formative.jmir.org/2021/9/e24624 %U https://doi.org/10.2196/24624 %U http://www.ncbi.nlm.nih.gov/pubmed/34346893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e26513 %T Social Networking Site Use During the COVID-19 Pandemic and Its Associations With Social and Emotional Well-being in College Students: Survey Study %A Tuck,Alison B %A Thompson,Renee J %+ Department of Psychological and Brain Sciences, Washington University in St Louis, Campus Box 1125, One Brookings Drive, St Louis, MO, 63130, United States, 1 (314) 935 3502, alison.tuck@wustl.edu %K social media %K social networking sites %K COVID-19 %K loneliness %K well-being %D 2021 %7 7.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social distancing during the COVID-19 pandemic has reduced the frequency of in-person social interactions. College students were highly impacted, since many universities transferred curriculum from in-person to entirely online formats, physically separating students with little notice. With social distancing, their use of social networking sites (SNSs) likely changed during the COVID-19 pandemic, possibly holding implications for well-being. Objective: This study aimed to determine (1) how components of SNS use (ie, weekly frequency, time per day, habitual use, engagement, enjoyment, addiction, and emotional impact) changed from before to during COVID-19, (2) how these changes in SNS use were associated with pandemic-related social and emotional well-being, and (3) how SNS use and changes in use during the pandemic were associated with loneliness. Methods: College students (N=176) were surveyed during the time when their university campus in the United States was operating online. Participants completed the same SNS use questionnaires twice, once with regard to the month preceding the onset of COVID-19 and again with regard to the month since this time. They also reported the extent to which they experienced perceived change in social support resulting from the pandemic, pandemic-related stress, and general loneliness. Results: After the onset of COVID-19, participants showed an increase in daily time spent on SNSs (t169=5.53, d=0.42, P<.001), habitual use (t173=3.60, d=0.27, P<.001), and addiction (t173=4.96, d=0.38, P<.001); further, enjoyment on SNSs decreased (t173=–2.10, d=–0.16, P=.04) and the emotional impact of SNS activities became more negative (t172=–3.76, d=–0.29, P<.001). Increased perceived social support during COVID-19 was associated with changes in frequency of SNS use, time per day, addiction, and engagement (r>0.18 for all). Pandemic-related stress was associated with changes in SNS addiction and the extent to which one’s SNS content was related to the pandemic (r>0.20 for all). Loneliness was positively associated with SNS addiction (r=0.26) and negatively associated with SNS engagement (r=–0.19) during the pandemic. Loneliness was also negatively associated with changes in habit and engagement (r<–0.15 for all). Conclusions: Findings suggest that components of SNS use are associated with both positive and negative pandemic-related social outcomes, but largely negative pandemic-related emotional outcomes. Further, some components of SNS use are positively associated with loneliness (eg, addiction) while others show a negative association (eg, engagement). These findings provide a more nuanced picture of how SNS use is associated with social and emotional well-being during the time of a global health crisis when in-person interactions are scarce. %M 34313587 %R 10.2196/26513 %U https://formative.jmir.org/2021/9/e26513 %U https://doi.org/10.2196/26513 %U http://www.ncbi.nlm.nih.gov/pubmed/34313587 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e28849 %T Implementing Home Office Work at a Large Psychiatric University Hospital in Switzerland During the COVID-19 Pandemic: Field Report %A Krückl,Jana Sophia %A Moeller,Julian %A Gaupp,Rainer %A Meier,Christoph E %A Roth,Carl Bénédict %A Lang,Undine Emmi %A Huber,Christian G %+ University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, Basel, 4002, Switzerland, 41 61 325 52 00, jana.krueckl@upk.ch %K home office %K psychiatry %K employees %K mental health %K depression %K anxiety %K stress factors %K Patient Health Questionnaire %K PHQ-2 %K General Anxiety Disorder %K GAD-2 %K PHQ-D %K COVID-19 %K pandemic %D 2021 %7 1.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic in 2020, psychiatric hospitals all over the world had to adapt their services to the prevailing governmental regulations. As a consequence, home office use and telepsychiatry boomed. Objective: The purpose of this study was to evaluate the potential of home office use, its adoption, and the association of home office use with employees’ mental health in a large psychiatric university hospital in Switzerland. Methods: We obtained and analyzed home office implementation and use data from the psychiatric university hospital’s information technology services. We also conducted a cross-sectional web-based survey to assess the employees’ attitudes toward the clinic’s crisis management during the COVID-19 pandemic in early 2020. Part of this web-based survey consisted of questions about home office use between March and June 2020, attitudes toward home office implementation, and mental health. Three mental health measures assessed depressive symptoms (Patient Health Questionnaire [PHQ]–2), anxiety (General Anxiety Disorder [GAD]–2), and stress factors (stress module of the PHQ-D); a cut-off score ≥3 was used for the PHQ-2 and GAD-2. Results: Of the 200 participating employees, 69 reported that they had worked from home at least partially (34.5%). Home office use differed significantly across professional groups (χ162=72.72, P≤.001, n=200). Employees experienced neither depressive symptoms (mean 0.76, SD 1.14) nor anxiety (mean 0.70, SD 1.03). The employees reported minor psychosocial stressors (mean 2.83, SD 2.92). The number of reported stress factors varied significantly across groups with different levels of home office use (χ42=9.72, P=.04). Conclusions: In general, home office implementation appears to be feasible for large psychiatric hospitals, however, it is not equally feasible for all professional groups. Professional groups that require personal contact with patients and technical or manual tasks must work onsite. Further evaluation of home office use in psychiatric hospitals up to the development of clinics that function merely online will follow in future research. The situation created by the COVID-19 pandemic served as a stepping stone to promote home office use and should be used to improve employees’ work–life balance, to save employers costs and foster other benefits. %M 34115606 %R 10.2196/28849 %U https://mental.jmir.org/2021/9/e28849 %U https://doi.org/10.2196/28849 %U http://www.ncbi.nlm.nih.gov/pubmed/34115606 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28337 %T The Impact of COVID-19–Related Restrictions on Social and Daily Activities of Parents, People With Disabilities, and Older Adults: Protocol for a Longitudinal, Mixed Methods Study %A Reid,Holly %A Miller,William Cameron %A Esfandiari,Elham %A Mohammadi,Somayyeh %A Rash,Isabelle %A Tao,Gordon %A Simpson,Ethan %A Leong,Kai %A Matharu,Parmeet %A Sakakibara,Brodie %A Schmidt,Julia %A Jarus,Tal %A Forwell,Susan %A Borisoff,Jaimie %A Backman,Catherine %A Alic,Adam %A Brooks,Emily %A Chan,Janice %A Flockhart,Elliott %A Irish,Jessica %A Tsukura,Chihori %A Di Spirito,Nicole %A Mortenson,William Ben %+ Rehabilitation Research Program, GF Strong Rehabilitation Centre, 4255 Laurel Street, Vancouver, BC, Canada, 1 604 714 4108, bill.miller@ubc.ca %K COVID-19 %K longitudinal study %K spinal cord injury %K disability %K adult %K occupational disruption %K stroke %K older adults %D 2021 %7 1.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has led to wide-scale changes in societal organization. This has dramatically altered people’s daily activities, especially among families with young children, those living with disabilities such as spinal cord injury (SCI), those who have experienced a stroke, and older adults. Objective: We aim to (1) investigate how COVID-19 restrictions influence daily activities, (2) track the psychosocial effects of these restrictions over time, and (3) identify strategies to mitigate the potential negative effects of these restrictions. Methods: This is a longitudinal, concurrent, mixed methods study being conducted in British Columbia (BC), Canada. Data collection occurred at four time points, between April 2020 and February 2021. The first three data collection time points occurred within phases 1 to 3 of the Province of BC’s Restart Plan. The final data collection coincided with the initial distribution of the COVID-19 vaccines. At each time point, data regarding participants’ sociodemographics, depressive and anxiety symptoms, resilience, boredom, social support, instrumental activities of daily living, and social media and technology use were collected in an online survey. These data supplemented qualitative videoconference interviews exploring participants’ COVID-19–related experiences. Participants were also asked to upload photos representing their experience during the restriction period, which facilitated discussion during the final interview. Five groups of participants were recruited: (1) families with children under the age of 18 years, (2) adults with an SCI, (3) adults who experienced a stroke, (4) adults with other types of disabilities, and (5) older adults (>64 years of age) with no self-reported disability. The number of participants we could recruit from each group was limited, which may impact the validity of some subgroup analyses. Results: This study was approved by the University of British Columbia Behavioural Research Ethics Board (Approval No. H20-01109) on April 17, 2020. A total of 81 participants were enrolled in this study and data are being analyzed. Data analyses are expected to be completed in fall 2021; submission of multiple papers for publication is expected by winter 2021. Conclusions: Findings from our study will inform the development and recommendations of a new resource guide for the post–COVID-19 period and for future public health emergencies. International Registered Report Identifier (IRRID): DERR1-10.2196/28337 %M 34292163 %R 10.2196/28337 %U https://www.researchprotocols.org/2021/9/e28337 %U https://doi.org/10.2196/28337 %U http://www.ncbi.nlm.nih.gov/pubmed/34292163 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e30164 %T Association of COVID-19 Risk Misperceptions With Household Isolation in the United States: Survey Study %A Ladapo,Joseph A %A Rothwell,Jonathan T %A Ramirez,Christina M %+ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, United States, 1 3107942728, jladapo@mednet.ucla.edu %K COVID-19 %K pandemic %K mental health %K public health %K isolation %K loneliness %K guideline %K risk %K perception %K United States %K health risk %K well-being %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adverse mental and emotional health outcomes are increasingly recognized as a public health challenge associated with the COVID-19 pandemic. Objective: The goal of this study was to examine the association of COVID-19 risk misperceptions with self-reported household isolation, a potential risk factor for social isolation and loneliness. Methods: We analyzed data from the Franklin Templeton-Gallup Economics of Recovery Study (July to December 2020) of 24,649 US adults. We also analyzed data from the Gallup Panel (March 2020 to February 2021), which included 123,516 observations about loneliness. The primary outcome was self-reported household isolation, which we defined as a respondent having no contact or very little contact with people outside their household, analogous to quarantining. Results: From July to December 2020, 53% to 57% of respondents reported living in household isolation. Most participants reported beliefs about COVID-19 health risks that were inaccurate, and overestimation of health risk was most common. For example, while deaths in persons younger than 55 years old accounted for 7% of total US deaths, respondents estimated that this population represented 43% of deaths. Overestimating COVID-19 health risks was associated with increased self-reported household isolation, with percentage differences ranging from 5.6 to 11.8 (P<.001 at each time point). Characteristics associated with self-reported household isolation from the July and August 2020 surveys and persisting in the December 2020 survey included younger age (18 to 39 years), having a serious medical condition, having a household member with a serious medical condition, and identifying as a Democrat. In the Gallup Panel, self-reported household isolation was associated with a higher prevalence of loneliness. Conclusions: Pandemic-related harms to emotional and mental well-being may be attenuated by reducing risk overestimation and household isolation preferences that exceed public health guidelines. %M 34253507 %R 10.2196/30164 %U https://formative.jmir.org/2021/8/e30164 %U https://doi.org/10.2196/30164 %U http://www.ncbi.nlm.nih.gov/pubmed/34253507 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e30610 %T Psychosomatic Rehabilitation Patients and the General Population During COVID-19: Online Cross-sectional and Longitudinal Study of Digital Trainings and Rehabilitation Effects %A Keller,Franziska Maria %A Dahmen,Alina %A Derksen,Christina %A Kötting,Lukas %A Lippke,Sonia %+ Department of Psychology & Methods, Jacobs University Bremen gGmbH, Campus Ring 1, Bremen, 28759, Germany, 49 421200 ext 4730, s.lippke@jacobs-university.de %K mental health %K COVID-19 %K medical rehabilitation %K psychosomatic rehabilitation %K internet-delivered digital trainings %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has largely affected people’s mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic. Objective: Making use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19–related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients’ rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation. Methods: A large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points—before (N=1719) and after (n=738) rehabilitation—between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19–related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed. Results: Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F4,2028=183.74, P<.001, η2p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F1,837=31.67, P<.001, η2p=0.04), had lower financial worries (F1,837=38.96, P<.001, η2p=0.04), but had higher household-related worries (F1,837=5.34, P=.02, η2p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F1,712=23.21, P<.001, η2p=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (F3,2021=51.41, P<.001, η2p=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (β=–.14, P<.001), anxiety (β=–.12, P<.001), loneliness (β=–.18, P<.001), and stress postrehabilitation (β=–.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F1,725=4.82, P=.03, η2p=0.01) and anxiety (F1,725=6.22, P=.01, η2p=0.01) from pre- to postrehabilitation. Conclusions: This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare. Trial Registration: ClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735 %M 34270444 %R 10.2196/30610 %U https://mental.jmir.org/2021/8/e30610 %U https://doi.org/10.2196/30610 %U http://www.ncbi.nlm.nih.gov/pubmed/34270444 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e29419 %T The Persistence of the Impact of COVID-19–Related Distress, Mood Inertia, and Loneliness on Mental Health During a Postlockdown Period in Germany: An Ecological Momentary Assessment Study %A Haucke,Matthias %A Liu,Shuyan %A Heinzel,Stephan %+ Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, Berlin, Germany, 49 30450517002, siyan908@hotmail.com %K COVID-19 %K outbreaks %K epidemics %K pandemics %K psychological responses and emotional well-being %K ecological momentary assessment %K risk and protective factors %K low incidence and restrictions %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The first wave of the COVID-19 pandemic in early 2020 increased mental health problems globally. However, little is known about mental health problems during a low-incidence period of the pandemic without strict public health measures. Objective: We aim to investigate whether COVID-19–related risk factors for mental health problems persist beyond lockdown measures. We targeted a vulnerable population that is at risk of developing low mental health and assessed their daily dynamics of mood and emotion regulation after a strict lockdown. Methods: During a postlockdown period in Germany (between August 8, 2020, and November 1, 2020), we conducted an ecological momentary assessment with 131 participants who experienced at least mild COVID-19–related distress and loneliness. To estimate negative mood inertia, we built a lag-1 three-level autoregressive model. Results: We found that information exposure and active daily COVID-19 cases did not have an impact on negative mood amid a postlockdown period. However, there was a day-to-day carryover effect of negative mood. In addition, worrying about COVID-19, feeling restricted by COVID-19, and feeling lonely increased negative mood. Conclusions: The mental health of a vulnerable population is still challenged by COVID-19–related stressors after the lifting of a strict lockdown. This study highlights the need to protect mental health during postpandemic periods. %M 34347622 %R 10.2196/29419 %U https://mental.jmir.org/2021/8/e29419 %U https://doi.org/10.2196/29419 %U http://www.ncbi.nlm.nih.gov/pubmed/34347622 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e28736 %T Factors Associated With Psychological Disturbances During the COVID-19 Pandemic: Multicountry Online Study %A Plomecka,Martyna %A Gobbi,Susanna %A Neckels,Rachael %A Radzinski,Piotr %A Skorko,Beata %A Lazzeri,Samuel %A Almazidou,Kristina %A Dedic,Alisa %A Bakalovic,Asja %A Hrustic,Lejla %A Ashraf,Zainab %A Es Haghi,Sarvin %A Rodriguez-Pino,Luis %A Waller,Verena %A Jabeen,Hafsa %A Alp,A Beyza %A Behnam,Mehdi %A Shibli,Dana %A Baranczuk-Turska,Zofia %A Haq,Zeeshan %A Qureshi,Salah %A Strutt,Adriana M %A Jawaid,Ali %+ Center of Excellence for Neural Plasticity and Brain Disorders: BRAINCITY, Nencki Institute of Experimental Biology, Ludwika Pasteura 3, Warsaw, 02-093, Poland, 48 518892048, a.jawaid@nencki.edu.pl %K COVID-19 %K pandemic %K mental health %K depression %K posttraumatic stress disorder %K general psychological disturbance %K global %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Accumulating evidence suggests that the COVID-19 pandemic has negatively impacted the mental health of individuals. However, the susceptibility of individuals to be impacted by the pandemic is variable, suggesting potential influences of specific factors related to participants’ demographics, attitudes, and practices. Objective: We aimed to identify the factors associated with psychological symptoms related to the effects of the first wave of the pandemic in a multicountry cohort of internet users. Methods: This study anonymously screened 13,332 internet users worldwide for acute psychological symptoms related to the COVID-19 pandemic from March 29 to April 14, 2020, during the first wave of the pandemic amidst strict lockdown conditions. A total of 12,817 responses were considered valid. Moreover, 1077 participants from Europe were screened a second time from May 15 to May 30, 2020, to ascertain the presence of psychological effects after the ease down of restrictions. Results: Female gender, pre-existing psychiatric conditions, and prior exposure to trauma were identified as notable factors associated with increased psychological symptoms during the first wave of COVID-19 (P<.001). The same factors, in addition to being related to someone who died due to COVID-19 and using social media more than usual, were associated with persistence of psychological disturbances in the limited second assessment of European participants after the restrictions had relatively eased (P<.001). Optimism, ability to share concerns with family and friends like usual, positive prediction about COVID-19, and daily exercise were related to fewer psychological symptoms in both assessments (P<.001). Conclusions: This study highlights the significant impact of the COVID-19 pandemic at the worldwide level on the mental health of internet users and elucidates prominent associations with their demographics, history of psychiatric disease risk factors, household conditions, certain personality traits, and attitudes toward COVID-19. %M 34254939 %R 10.2196/28736 %U https://mental.jmir.org/2021/8/e28736 %U https://doi.org/10.2196/28736 %U http://www.ncbi.nlm.nih.gov/pubmed/34254939 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29150 %T Long-term Effects of the COVID-19 Pandemic on Public Sentiments in Mainland China: Sentiment Analysis of Social Media Posts %A Tan,Hao %A Peng,Sheng-Lan %A Zhu,Chun-Peng %A You,Zuo %A Miao,Ming-Cheng %A Kuai,Shu-Guang %+ Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Key Laboratory of Brain Functional Genomics (Ministry of Education), The Institute of Brain and Education Innovation, School of Psychology and Cognitive Science, East China Normal University, Room 309, Old Library Building, No. 3663, North Zhongshan Road, Shanghai, 200062, China, 86 15618582866, shuguang.kuai@gmail.com %K COVID-19 %K emotional trauma %K public sentiment on social media %K long-term effect %D 2021 %7 12.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 outbreak has induced negative emotions among people. These emotions are expressed by the public on social media and are rapidly spread across the internet, which could cause high levels of panic among the public. Understanding the changes in public sentiment on social media during the pandemic can provide valuable information for developing appropriate policies to reduce the negative impact of the pandemic on the public. Previous studies have consistently shown that the COVID-19 outbreak has had a devastating negative impact on public sentiment. However, it remains unclear whether there has been a variation in the public sentiment during the recovery phase of the pandemic. Objective: In this study, we aim to determine the impact of the COVID-19 pandemic in mainland China by continuously tracking public sentiment on social media throughout 2020. Methods: We collected 64,723,242 posts from Sina Weibo, China’s largest social media platform, and conducted a sentiment analysis based on natural language processing to analyze the emotions reflected in these posts. Results: We found that the COVID-19 pandemic not only affected public sentiment on social media during the initial outbreak but also induced long-term negative effects even in the recovery period. These long-term negative effects were no longer correlated with the number of new confirmed COVID-19 cases both locally and nationwide during the recovery period, and they were not attributed to the postpandemic economic recession. Conclusions: The COVID-19 pandemic induced long-term negative effects on public sentiment in mainland China even as the country recovered from the pandemic. Our study findings remind public health and government administrators of the need to pay attention to public mental health even once the pandemic has concluded. %M 34280118 %R 10.2196/29150 %U https://www.jmir.org/2021/8/e29150 %U https://doi.org/10.2196/29150 %U http://www.ncbi.nlm.nih.gov/pubmed/34280118 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e29671 %T Mental Health Service User and Worker Experiences of Psychosocial Support Via Telehealth Through the COVID-19 Pandemic: Qualitative Study %A Venville,Annie %A O'Connor,Sarah %A Roeschlein,Hannah %A Ennals,Priscilla %A McLoughlan,Grace %A Thomas,Neil %+ Social Work, College of Health and Biomedicine, Victoria University, Ballarat Road, Footscray, 3011, Australia, 61 +6199194571 ext 4571, annie.venville@vu.edu.au %K telehealth %K mental health %K psychosocial support %K COVID-19 %K service user %K workers %K qualitative %K e-mental health %K support %K telemedicine %K intervention %K user experience %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic, we saw telehealth rapidly become the primary way to receive mental health care. International research has validated many of the benefits and challenges of telehealth known beforehand for specific population groups. However, if telehealth is to assume prominence in future mental health service delivery, greater understanding of its capacity to be used to provide psychosocial support to people with complex and enduring mental health conditions is needed. Objective: We focused on an Australian community-managed provider of psychosocial intervention and support. We aimed to understand service user and worker experiences of psychosocial support via telehealth throughout the COVID-19 pandemic. Methods: This study was jointly developed and conducted by people with lived experience of mental ill health or distress, mental health service providers, and university-based researchers. Semistructured interviews were conducted between August and November 2020 and explored participant experiences of receiving or providing psychosocial support via telehealth, including telephone, text, and videoconferencing. Qualitative data were analyzed thematically; quantitative data were collated and analyzed using descriptive statistics. Results: Service users (n=20) and workers (n=8) completed individual interviews via telephone or videoconferencing platform. Service users received psychosocial support services by telephone (12/20, 60%), by videoconferencing (6/20, 30%), and by both telephone and videoconferencing (2/20, 10%). Of note, 55% (11/20) of service user participants stated a future preference for in-person psychosocial support services, 30% (6/20) preferred to receive a mixture of in-person and telehealth, and 15% (3/20) elected telehealth only. Two meta-themes emerged as integral to worker and service user experience of telehealth during the pandemic: (1) creating safety and comfort and (2) a whole new way of working. The first meta-theme comprises subthemes relating to a sense of safety and comfort while using telehealth; including trusting in the relationship and having and exercising choice and control. The second meta-theme contains subthemes reflecting key challenges and opportunities associated with the shift from in-person psychosocial support to telehealth. Conclusions: Overall, our findings highlighted that most service users experienced telehealth positively, but this was dependent on them continuing to get the support they needed in a way that was safe and comfortable. While access difficulties of a subgroup of service users should not be ignored, most service users and workers were able to adapt to telehealth by focusing on maintaining the relationship and using choice and flexibility to maintain service delivery. Although most research participants expressed a preference for a return to in-person psychosocial support or hybrid in-person and telehealth models, there was a general recognition that intentional use of telehealth could contribute to flexible and responsive service delivery. Challenges to telehealth provision of psychosocial support identified in this study are yet to be fully understood. %M 34182461 %R 10.2196/29671 %U https://mental.jmir.org/2021/8/e29671 %U https://doi.org/10.2196/29671 %U http://www.ncbi.nlm.nih.gov/pubmed/34182461 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e28360 %T Mental Health and the Perceived Usability of Digital Mental Health Tools Among Essential Workers and People Unemployed Due to COVID-19: Cross-sectional Survey Study %A Mata-Greve,Felicia %A Johnson,Morgan %A Pullmann,Michael D %A Friedman,Emily C %A Griffith Fillipo,Isabell %A Comtois,Katherine A %A Arean,Patricia %+ Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 616 2129, parean@uw.edu %K digital health %K COVID-19 %K essential worker %K unemployed %K usability %K user burden %K mental health %K e-mental health %K survey %K distress %D 2021 %7 5.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: COVID-19 has created serious mental health consequences for essential workers or people who have become unemployed as a result of the pandemic. Digital mental health tools have the potential to address this problem in a timely and efficient manner. Objective: The purpose of this study was to document the extent of digital mental health tool (DMHT) use by essential workers and those unemployed due to COVID-19, including asking participants to rate the usability and user burden of the DMHT they used most to cope. We also explored which aspects and features of DMHTs were seen as necessary for managing stress during a pandemic by having participants design their own ideal DMHT. Methods: A total of 2000 people were recruited from an online research community (Prolific) to complete a one-time survey about mental health symptoms, DMHT use, and preferred digital mental health features. Results: The final sample included 1987 US residents that identified as either an essential worker or someone who was unemployed due to COVID-19. Almost three-quarters of the sample (1479/1987, 74.8%) reported clinically significant emotional distress. Only 14.2% (277/1957) of the sample used a DMHT to cope with stress associated with COVID-19. Of those who used DMHTs to cope with COVID-19, meditation apps were the most common (119/261, 45.6%). Usability was broadly in the acceptable range, although participants unemployed due to COVID-19 were less likely to report user burden with DMHTs than essential workers (t198.1=–3.89, P<.001). Individuals with emotional distress reported higher financial burden for their DMHT than nondistressed individuals (t69.0=–3.21, P=.01). When the sample was provided the option to build their own DMHT, the most desired features were a combination of mindfulness/meditation (1271/1987, 64.0%), information or education (1254/1987, 63.1%), distraction tools (1170/1987, 58.9%), symptom tracking for mood and sleep (1160/1987, 58.4%), link to mental health resources (1140/1987, 57.4%), and positive psychology (1131/1986, 56.9%). Subgroups by employment, distress, and previous DMHT use status had varied preferences. Of those who did not use a DMHT to cope with COVID-19, most indicated that they did not consider looking for such a tool to help with coping (1179/1710, 68.9%). Conclusions: Despite the potential need for DMHTs, this study found that the use of such tools remains similar to prepandemic levels. This study also found that regardless of the level of distress or even past experience using an app to cope with COVID-19, it is possible to develop a COVID-19 coping app that would appeal to a majority of essential workers and unemployed persons. %M 34081592 %R 10.2196/28360 %U https://mental.jmir.org/2021/8/e28360 %U https://doi.org/10.2196/28360 %U http://www.ncbi.nlm.nih.gov/pubmed/34081592 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e29952 %T Measuring the Impact of COVID-19 on Siyan Mental Health Patients Using the Epidemic-Pandemic Impacts Inventory: Survey Study %A Shah,Anish %A Darling,Michele %A Arstein-Kerslake,Olivia %A Morgan,Tiffany %A Vance Tovrea,Aubreen %A Young,James %A Laines,Helen %+ Siyan Clinical Corporation, 480 Tesconi Cir B, Santa Rosa, CA, 95401, United States, 1 707 206 7273, ashah@siyanclinical.com %K COVID-19 %K coronavirus %K pandemic %K mental health %K social isolation %K wellness %D 2021 %7 29.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent research has shown that the impacts of the COVID-19 pandemic and social isolation on people’s mental health are quite extensive, but there are limited studies on the effects of the pandemic on patients with mental health disorders. Objective: The objective of this study was to assess the negative impacts of the COVID-19 pandemic on individuals who have previously sought treatment for a mental health disorder. Methods: This study uses the newly developed Epidemic-Pandemic Impacts Inventory (EPII) survey. This tool was designed to assess tangible impacts of epidemics and pandemics across personal and social life domains. From November 9, 2020, to February 18, 2021, a total of 245 adults recruited from a mental health clinic completed the consent form and responded to the survey link from the Siyan Clinical Corporation and Siyan Clinical Research practices located in Santa Rosa, California, USA. Results: We found that the least affected age group included individuals aged 75 years or older. This was followed closely by the 65- to 75-year-old age group. People with children under the age of 18 years also reported both more negative indicators associated with the pandemic and more positive indicators compared to those without children at home. Gender queer, nonconforming, and transgender individuals may also be at higher risk for more negative impacts associated with the pandemic. When respondents were assessed with regard to their mental health diagnosis, no differences were noted. Substance use also increased during the pandemic. Conclusions: In conclusion, the data collected here may serve as foundational research in the prevention, care, and treatment of mental health disorders during pandemics such as COVID-19. Populations such as those with previously diagnosed mental health disorders are particularly at risk for negative effects of pandemic-related stressors such as social isolation, especially if they have children in the household, are part of a younger age group, or have substance use disorder. Gender may also be a factor. Further, the EPII survey may prove to be a useful tool in understanding these effects. Overall, these data may be a critical step toward understanding the effects of the COVID-19 pandemic on populations with a mental health diagnosis, which may aid mental health practitioners in understanding the consequences of pandemics on their patients’ overall well-being. Trial Registration: ClinicalTrials.gov NCT04568135; https://clinicaltrials.gov/ct2/show/NCT04568135 %M 34323851 %R 10.2196/29952 %U https://formative.jmir.org/2021/7/e29952 %U https://doi.org/10.2196/29952 %U http://www.ncbi.nlm.nih.gov/pubmed/34323851 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e26187 %T Tele–Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction %A Mazziotti,Raffaele %A Rutigliano,Grazia %+ Department of Pathology, University of Pisa, via Savi, 10, Pisa, 56126, Italy, 39 3496117744, grazia.rutigliano.gr@gmail.com %K telepsychiatry %K telepsychology %K e-mental health %K document clustering %K survey %K COVID-19 %K access to care %K patient satisfaction %K mental health %K tele–mental health %K review %K telemedicine %K satisfaction %K access %D 2021 %7 29.7.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic threatened to impact mental health by disrupting access to care due to physical distance measures and the unexpected pressure on public health services. Tele–mental health was rapidly implemented to deliver health care services. Objective: The aims of this study were (1) to present state-of-the-art tele–mental health research, (2) to survey mental health providers about care delivery during the pandemic, and (3) to assess patient satisfaction with tele–mental health. Methods: Document clustering was applied to map research topics within tele–mental health research. A survey was circulated among mental health providers. Patient satisfaction was investigated through a meta-analysis of studies that compared satisfaction scores between tele–mental health and face-to-face interventions for mental health disorders, retrieved from Web of Knowledge and Scopus. Hedges g was used as the effect size measure, and effect sizes were pooled using a random-effect model. Sources of heterogeneity and bias were examined. Results: Evidence on tele–mental health has been accumulating since 2000, especially regarding service implementation, depressive or anxiety disorders, posttraumatic stress disorder, and special populations. Research was concentrated in a few countries. The survey (n=174 respondents from Italy, n=120 international) confirmed that, after the onset of COVID-19 outbreak, there was a massive shift from face-to-face to tele–mental health delivery of care. However, respondents held skeptical views about tele–mental health and did not feel sufficiently trained and satisfied. Meta-analysis of 29 studies (n=2143) showed that patients would be equally satisfied with tele–mental health as they are with face-to-face interventions (Hedges g=−0.001, 95% CI −0.116 to 0.114, P=.98, Q=43.83, I2=36%, P=.03) if technology-related issues were minimized. Conclusions: Mental health services equipped with tele–mental health will be better able to cope with public health crises. Both providers and patients need to be actively engaged in digitization, to reshape their reciprocal trust around technological innovations. %M 34114956 %R 10.2196/26187 %U https://mental.jmir.org/2021/7/e26187 %U https://doi.org/10.2196/26187 %U http://www.ncbi.nlm.nih.gov/pubmed/34114956 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27865 %T Acceptability and Feasibility of the Transfer of Face-to-Face Group Therapy to Online Group Chats in a Psychiatric Outpatient Setting During the COVID-19 Pandemic: Longitudinal Observational Study %A Scholl,Julia %A Kohls,Elisabeth %A Görges,Frauke %A Steinbrecher,Marc %A Baldofski,Sabrina %A Moessner,Markus %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Semmelweisstraße 10, Haus 13, Leipzig, 04103, Germany, 49 3419724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K online %K group chats %K COVID-19 pandemic %K psychiatric outpatient setting %K online interventions %K e-mental health %K COVID-19 %K pandemic %K mental health %K psychoeducation %K online chat %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: At the height of the COVID-19 pandemic, several mental health care providers were obliged to shut down outpatient services, including group therapy and psychoeducational sessions. The lockdown in many countries is a serious threat to people’s mental well-being, especially for individuals with severe mental illnesses. Discontinued outpatient treatments and disruption of daily routines are considered to be risk factors for destabilization of patients with mental illness. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of a group chat program to replace cancelled face-to-face group sessions in an outpatient psychiatric department. Methods: Participants (N=33) were recruited in the outpatient department of a large university medical center in Leipzig, Germany. Former face-to-face group participants were invited to take part in a therapist-guided group-chat for 4 weeks (8 sessions) and were asked to evaluate the program via self-administered standardized questionnaires at baseline (T0, preintervention), after every chat session (T1), and posttreatment (T2, after 4-6 weeks). The chat groups were specific to the following mental disorder diagnoses and based on the same therapeutic principles and techniques as the former face-to-face groups: anxiety, depression, obsessive-compulsive disorder, and adult attention-deficit/hyperactivity disorder (ADHD). Sociodemographic measures, attitudes toward the COVID-19 pandemic, depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), treatment credibility/expectancy (Credibility Expectancy Questionnaire), and participants’ satisfaction (Client Satisfaction Questionnaire-8 [ZUF-8]) were measured. Results: Participants joined an average of 5 out of 8 offered chat sessions. Participation rates in the respective groups were highest in the ADHD group (8.6/11, 78%) and lowest in the anxiety group (3.7/9, 41%). The overall preintervention level of depressive symptoms was moderate and showed a slight, nonsignificant improvement at posttreatment (T0: mean 10.7, SD 5.5; T2: mean 10.2, SD 5.5). A similar result was observed regarding quality of life (T0: median 41.7-68.8; T2: median 50-70.3). Treatment credibility and expectancy scores were medium-high (T0: meancredibility 18.1, SD 3.8; meanexpectancy 11.2, SD 5.1; T2: meancredibility 17.1, SD 4.8; meanexpectancy 10.3, SD 5.8). Further, significant correlations were detected between posttreatment expectancy score and posttreatment PHQ-9 score (r=–0.41, P=.02), posttreatment physical quality of life (r=0.54, P=.001), and posttreatment psychological quality of life (r=0.53, P=.002). Overall, participants’ satisfaction with the program was very high, both after chat sessions and at posttreatment (ZUF-8: mean score 20.6, SD 1.0). Of all participants, a majority (27/31, 87%) rated the program as excellent/good and indicated they would recommend the group chat program to a friend in need of similar help (23/31, 74%). Conclusions: A therapist-guided group chat program to substitute outpatient group setting treatment during the COVID-19 lockdown was shown to be feasible, usable, and highly acceptable for participants. Web-based programs such as this one provide an easy-to-implement tool to successfully stabilize participants during a difficult time, such as the COVID-19 pandemic. Trial Registration: German Clinical Trials Register DRKS00021527; https://tinyurl.com/3btyxc2r %M 34161252 %R 10.2196/27865 %U https://formative.jmir.org/2021/7/e27865 %U https://doi.org/10.2196/27865 %U http://www.ncbi.nlm.nih.gov/pubmed/34161252 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e25926 %T Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial %A Mhende,Josephine %A Bell,Sharrill A %A Cottrell-Daniels,Cherell %A Luong,Jackie %A Streiff,Micah %A Dannenfelser,Mark %A Hayat,Matthew J %A Spears,Claire Adams %+ Georgia State University, 140 Decatur Street, Suite 400, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K acceptability %K addiction %K African American %K cessation %K COVID-19 %K feasibility %K income %K low socioeconomic status %K mHealth %K mindfulness %K minority %K smoking %K SMS %K text messaging %K treatment %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program “iQuit Mindfully” was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of .39). First responders who had tested positive and those who had been quarantined were more likely to engage in the program. A click count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, with 382 and 122 clicks, respectively, over 15 weeks. Overall, first responders expressed satisfaction with the program. Conclusions: Engagement of first responders in the multimodule web-based COAST program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, including those in quarantine and those who tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and the development of additional modules, including just-in-time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms. %M 33999835 %R 10.2196/28055 %U https://formative.jmir.org/2021/6/e28055 %U https://doi.org/10.2196/28055 %U http://www.ncbi.nlm.nih.gov/pubmed/33999835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28892 %T Mental Health and Behavior of College Students During the COVID-19 Pandemic: Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study, Part II %A Mack,Dante L %A DaSilva,Alex W %A Rogers,Courtney %A Hedlund,Elin %A Murphy,Eilis I %A Vojdanovski,Vlado %A Plomp,Jane %A Wang,Weichen %A Nepal,Subigya K %A Holtzheimer,Paul E %A Wagner,Dylan D %A Jacobson,Nicholas C %A Meyer,Meghan L %A Campbell,Andrew T %A Huckins,Jeremy F %+ Department of Psychological and Brain Sciences, Dartmouth College, Moore Hall, 3 Maynard St, Hanover, NH, 03755, United States, 1 603 646 3181, f002vhk@dartmouth.edu %K anxiety %K college %K COVID-19 %K COVID fatigue %K depression %K George Floyd %K mobile sensing %K phone usage %K sleep %K digital phenotyping %D 2021 %7 4.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since late 2019, the lives of people across the globe have been disrupted by COVID-19. Millions of people have become infected with the disease, while billions of people have been continually asked or required by local and national governments to change their behavioral patterns. Previous research on the COVID-19 pandemic suggests that it is associated with large-scale behavioral and mental health changes; however, few studies have been able to track these changes with frequent, near real-time sampling or compare these changes to previous years of data for the same individuals. Objective: By combining mobile phone sensing and self-reported mental health data in a cohort of college-aged students enrolled in a longitudinal study, we seek to understand the behavioral and mental health impacts associated with the COVID-19 pandemic, measured by interest across the United States in the search terms coronavirus and COVID fatigue. Methods: Behaviors such as the number of locations visited, distance traveled, duration of phone use, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife mobile smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments, including the Patient Health Questionnaire-4. The participants were 217 undergraduate students. Differences in behaviors and self-reported mental health collected during the Spring 2020 term, as compared to previous terms in the same cohort, were modeled using mixed linear models. Results: Linear mixed models demonstrated differences in phone use, sleep, sedentary time and number of locations visited associated with the COVID-19 pandemic. In further models, these behaviors were strongly associated with increased interest in COVID fatigue. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, phone use, sedentary time), both anxiety and depression (P<.001) were significantly associated with interest in COVID fatigue. Notably, these behavioral and mental health changes are consistent with those observed around the initial implementation of COVID-19 lockdowns in the spring of 2020. Conclusions: In the initial lockdown phase of the COVID-19 pandemic, people spent more time on their phones, were more sedentary, visited fewer locations, and exhibited increased symptoms of anxiety and depression. As the pandemic persisted through the spring, people continued to exhibit very similar changes in both mental health and behaviors. Although these large-scale shifts in mental health and behaviors are unsurprising, understanding them is critical in disrupting the negative consequences to mental health during the ongoing pandemic. %M 33900935 %R 10.2196/28892 %U https://www.jmir.org/2021/6/e28892 %U https://doi.org/10.2196/28892 %U http://www.ncbi.nlm.nih.gov/pubmed/33900935 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 6 %P e28497 %T Using Electronic Health Records to Mitigate Workplace Burnout Among Clinicians During the COVID-19 Pandemic: Field Study in Iran %A Esmaeilzadeh,Pouyan %A Mirzaei,Tala %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, Modesto A Maidique Campus 11200 SW 8th St, RB 261 B, Miami, FL, 33199, United States, 1 3053483302, pesmaeil@fiu.edu %K COVID-19 %K pandemic %K clinician burnout %K electronic health record %K health information technologies %K hospital intervention %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic spread worldwide in 2020. Notably, in the countries dealing with massive casualties, clinicians have worked in new conditions characterized by a heavy workload and a high risk of being infected. The issue of clinician burnout during the pandemic has attracted considerable attention in health care research. Electronic health records (EHRs) provide health care workers with several features to meet a health system’s clinical needs. Objective: We aim to examine how the use of EHR features affects the burnout of clinicians working in hospitals that have special wards for confirmed COVID-19 cases. Methods: Using an online survey, we collected data from 368 physicians, physician assistants, and nurses working in six hospitals that have implemented EHRs in the city of Tehran in Iran. We used logistic regression to assess the association between burnout and awareness of EHR features, EHR system usability, concerns about COVID-19, technology solutions, hospital technology interventions, hospital preparedness, and professional efficacy adjusted for demographic and practice characteristics. Results: The primary outcome of our study was self-reported burnout during the COVID-19 pandemic. Of the 368 respondents, 36% (n=134) reported having at least one symptom of burnout. Participants indicated that the leading cause of EHR-related stress is inadequate training for using technology (n=159, 43%), followed by having less face-to-face time with patients (n=140, 38%). Positive perceptions about the EHR’s ease of use were associated with lower odds of burnout symptoms. More interventions, such as clear communication of regulations; transparency in policies, expectations, and goals regarding the use of technology in the clinical workflow; and hospital preparedness to cope with the challenges of the pandemic, were associated with lower odds of burnout. Conclusions: The use of EHR applications, hospital pandemic preparation programs, and transparent technology-related policies and procedures throughout the epidemic can be substantial mitigators of technology-based stress and clinician burnout. Hospitals will then be better positioned to devise or modify technology-related policies and procedures to support physicians’ and nurses’ well-being during the COVID-19 pandemic. Training programs, transparency in communications of regulations, and developing a clear channel for informing clinicians of changes in policies may help reduce burnout symptoms among physicians and nurses during a pandemic. Providing easily accessible mentorship through teleconsultation and 24-hour available information technology support may also help to mitigate the odds of burnout. %M 34033578 %R 10.2196/28497 %U https://medinform.jmir.org/2021/6/e28497 %U https://doi.org/10.2196/28497 %U http://www.ncbi.nlm.nih.gov/pubmed/34033578 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26282 %T Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study %A Yoon,Sungwon %A Goh,Hendra %A Nadarajan,Gayathri Devi %A Sung,Sharon %A Teo,Irene %A Lee,Jungup %A Ong,Marcus E H %A Graves,Nicholas %A Teo,Tess Lin %+ Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore, , Singapore, 65 66013198, sungwon.yoon@duke-nus.edu.sg %K COVID-19 %K frontline health care workers %K mHealth %K well-being %K psychosocial %D 2021 %7 31.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Frontline health care workers are experiencing a myriad of physical and psychosocial challenges amid the COVID-19 pandemic. There is growing recognition that digital technologies have the potential to improve the well-being of frontline workers. However, there has been limited development of wellness interventions using mobile health (mHealth) technology. More importantly, little research has been conducted on how frontline workers perceive mHealth-based support to promote their well-being. Objective: This study aimed to explore frontline workers’ experience of conventional psychological wellness programs and their perceptions of the usefulness of mHealth apps and features for promoting well-being. It also sought to identify factors that could potentially influence uptake and retention of an mHealth-based wellness program. Methods: We conducted semistructured interviews using purposive sampling with frontline workers involved in the COVID-19 response. Various visual materials, collated from existing mHealth app features, were presented to facilitate discussion. Interviews were audio-recorded and transcribed verbatim. Thematic analysis based on grounded theory was undertaken. Themes were subsequently mapped to key nudge strategies—those commonly used for mHealth development—to assess participants’ preferences for particular features and their reasoning. Results: A total of 42 frontline workers participated in 12 one-on-one interviews or focus group discussions. Frontline workers generally had a limited ability to identify their own psychological problems and liked the reminders functionality of the app to track their mood over time. A personalized goal-setting feature (ie, tailoring) and in-app resources were generally valued, while frequent coaching and messages (ie, framing) were seen as a distraction. The majority of participants desired a built-in chat function with a counselor (ie, guidance) for reasons of accessibility and protection of privacy. Very few participants appreciated a gamification function. Frontline workers commonly reported the need for ongoing social support and desired access to an in-app peer support community (ie, social influence). There were, however, concerns regarding potential risks from virtual peer interactions. Intrinsic motivational factors, mHealth app technicality, and tangible rewards were identified as critical for uptake and retention. Conclusions: Our study highlights the potential of mHealth apps with relevant features to be used as wellness tools by frontline health care workers. Future work should focus on developing a nonintrusive and personalized mHealth app with in-app counseling, peer support to improve well-being, and tangible and extrinsic rewards to foster continued use. %M 33979296 %R 10.2196/26282 %U https://www.jmir.org/2021/5/e26282 %U https://doi.org/10.2196/26282 %U http://www.ncbi.nlm.nih.gov/pubmed/33979296 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26989 %T Use of a Self-guided Computerized Cognitive Behavioral Tool During COVID-19: Evaluation Study %A Detweiler Guarino,Isadora %A Cowan,Devin R %A Fellows,Abigail M %A Buckey,Jay C %+ Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 6012, Jay.C.Buckey.Jr@dartmouth.edu %K computerized cognitive behavioral therapy %K interactive media %K COVID-19 %K computer-based therapy %K usability %K acceptability %K cognitive behavioral therapy %K therapy %K effectiveness %K digital health %K depression %K stress %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based programs can help provide accessible and inexpensive behavioral health care to those in need; however, the evaluation of these interventions has been mostly limited to controlled trials. Data regarding patterns of use and effectiveness of self-referred, open-access online interventions are lacking. We evaluated an online-based treatment designed to address stress, depression, and conflict management, the Dartmouth PATH Program, in a freely available and self-guided format during the COVID-19 pandemic. Objective: The primary aim is to determine users’ levels of stress and depression, and the nature of problems and triggers they reported during the COVID-19 pandemic. A secondary objective is to assess the acceptability and usability of the PATH content and determine whether such a program would be useful as a stand-alone open-access resource. The final objective is understanding the high dropout rates associated with online behavioral programs by contrasting the use pattern and program efficacy of individuals who completed session one and did not return to the program with those who came back to complete more sessions. Methods: Cumulative anonymous data from 562 individuals were analyzed. Stress triggers, stress responses, and reported problems were analyzed using qualitative analysis techniques. Scores on usability and acceptability questionnaires were evaluated using the sign test and Wilcoxon signed rank test. Mixed-effects linear modeling was used to evaluate changes in stress and depression over time. Results: A total of 2484 users registered from April through October 2020, most of whom created an account without initiating a module. A total of 562 individuals started the program and were considered in the data analysis. The most common stress triggers individuals reported involved either conflicts with family or spouses and work or workload. The most common problems addressed in the mood module were worry, anxiousness, or stress and difficulty concentrating or procrastination. The attrition rate was high with 13% (21/156) completing the conflict module, 17% (50/289) completing session one of the mood module, and 14% (16/117) completing session one of the stress module. Usability and acceptability scores for the mood and stress modules were significantly better than average. In those who returned to complete sessions, symptoms of stress showed a significant improvement over time (P=.03), and there was a significant decrease in depressive symptoms over all time points (P=.01). Depression severity decreased on average by 20% (SD 35.2%; P=.60) between sessions one and two. Conclusions: Conflicts with others, worry, and difficulty concentrating were some of the most common problems people used the programs to address. Individuals who completed the modules indicated improvements in self-reported stress and depression symptoms. Users also found the modules to be effective and rated the program highly for usability and acceptability. Nevertheless, the attrition rate was very high, as has been found with other freely available online-based interventions. Trial Registration: ClinicalTrials.gov NCT02726061; https://clinicaltrials.gov/ct2/show/NCT02726061 %M 33973856 %R 10.2196/26989 %U https://formative.jmir.org/2021/5/e26989 %U https://doi.org/10.2196/26989 %U http://www.ncbi.nlm.nih.gov/pubmed/33973856 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e27965 %T Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study %A Gabrielli,Silvia %A Rizzi,Silvia %A Bassi,Giulia %A Carbone,Sara %A Maimone,Rosa %A Marchesoni,Michele %A Forti,Stefano %+ Digital Health Lab, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461 312 47 ext 247, sgabrielli@fbk.eu %K mobile mental health %K chatbots %K anxiety %K stress %K university students %K digital health %K healthy-coping intervention %K COVID-19 %D 2021 %7 28.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: University students are increasingly reporting common mental health problems, such as stress, anxiety, and depression, and they frequently face barriers to seeking psychological support because of stigma, cost, and availability of mental health services. This issue is even more critical in the challenging time of the COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy-coping interventions by lowering cost and supporting prevention. Objective: The goal of this study was to conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, among a population of university students. Methods: In a proof-of-concept study, 71 university students were recruited during the COVID-19 pandemic; 68% (48/71) were female, they were all in their first year of university, and their mean age was 20.6 years (SD 2.4). Enrolled students were asked to use the Atena psychoeducational chatbot for 4 weeks (eight sessions; two per week), which provided healthy-coping strategies based on cognitive behavioral therapy, positive psychology, and mindfulness techniques. The intervention program consisted of conversations combined with audiovisual clips delivered via the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the Five-Facet Mindfulness Questionnaire (FFMQ) at baseline and postintervention to assess effectiveness. They were also asked to complete the User Engagement Scale–Short Form at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena postintervention. Results: Participants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. A total of 61 out of 71 (86%) participants completed the first 2 weeks of the intervention and provided data on engagement (10/71, 14% attrition). A total of 41 participants out of 71 (58%) completed the full intervention and the postintervention questionnaires (30/71, 42% attrition). Results from the completer analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t39=0.94; P=.009) and a decrease in stress symptoms as measured by the PSS-10 (t39=2.00; P=.05) for all participants postintervention. Participants also improved significantly in the describing and nonjudging facets, based on their FFMQ subscale scores, and asked for some improvements in the user experience with the chatbot. Conclusions: This study shows the benefit of deploying a digital healthy-coping intervention via a chatbot to support university students experiencing higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions. %M 33950849 %R 10.2196/27965 %U https://mhealth.jmir.org/2021/5/e27965 %U https://doi.org/10.2196/27965 %U http://www.ncbi.nlm.nih.gov/pubmed/33950849 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26037 %T Associations Between Rural or Urban Status, Health Outcomes and Behaviors, and COVID-19 Perceptions Among Meditation App Users: Longitudinal Survey Study %A Bhuiyan,Nishat %A Puzia,Megan %A Stecher,Chad %A Huberty,Jennifer %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, United States, 1 480 406 2644, nbhuiyan@asu.edu %K mHealth %K rural health %K physical activity %K mental health %K COVID-19 %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rural and urban differences in health outcomes and behaviors have been well-documented, with significant rural health disparities frequently highlighted. Mobile health (mHealth) apps, such as meditation apps, are a novel method for improving health and behaviors. These apps may be a critical health promotion strategy during the COVID-19 pandemic and could potentially be used to address rural health disparities. However, limited research has assessed whether meditation app health outcomes are associated with rural and urban residence, and it is unclear whether disparities in health and behaviors between rural and urban populations would persist among meditation app users. Objective: We aimed to explore associations between rural or urban status, psychological outcomes, and physical activity among users of a mobile meditation app. We further aimed to explore associations between rural or urban status and perceived effects of COVID-19 on stress, mental health, and physical activity, and to explore changes in these outcomes in rural versus urban app users over time. Methods: This study was a secondary analysis of a national survey conducted among subscribers to the meditation app Calm. Eligible participants completed online baseline surveys from April to June 2020, and follow-up surveys from June to September 2020, assessing demographics, psychological outcomes, physical activity, and perceived effects of COVID-19 on stress, mental health, and physical activity. Results: Participants (N=8392) were mostly female (7041/8392, 83.9%), non-Hispanic (7855/8392, 93.6%), and White (7704/8392, 91.8%); had high socioeconomic status (income ≥US $100,000: 4389/8392, 52.3%; bachelor’s degree or higher: 7251/8392, 86.4%); and resided in a metropolitan area core (rural-urban commuting area code 1: 7192/8392, 85.7%). Rural or urban status was not associated with baseline stress, depression, anxiety, pre–COVID-19 and current physical activity, or perceived effects of COVID-19 on stress, mental health, and physical activity. Repeated-measures models showed overall decreases in depression, anxiety, and perceived effects of COVID-19 on physical activity from baseline to follow-up, and no significant changes in stress or perceived effects of COVID-19 on stress and mental health over time. Models also showed no significant main effects of rural or urban status, COVID-19 statewide prevalence at baseline, or change in COVID-19 statewide prevalence. Conclusions: We did not find associations between rural or urban status and psychological outcomes (ie, stress, depression, and anxiety), physical activity, or perceived effects of COVID-19 on stress, mental health, and physical activity. Rural or urban status does not appear to drive differences in outcomes among meditation app users, and the use of mHealth apps should continue to be explored as a health promotion strategy in both rural and urban populations. Furthermore, our results did not show negative cumulative effects of COVID-19 on psychological outcomes and physical activity among app users in our sample, the majority of whom were urban, White, female, and of high socioeconomic status. Further research is needed to investigate meditation app use as a health promotion strategy in rural and urban populations. %M 33900930 %R 10.2196/26037 %U https://mhealth.jmir.org/2021/5/e26037 %U https://doi.org/10.2196/26037 %U http://www.ncbi.nlm.nih.gov/pubmed/33900930 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e27473 %T Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma for Health Care Staff Working During COVID-19: Exploratory Pilot Study With Nurses %A Singh,Laura %A Kanstrup,Marie %A Depa,Katherine %A Falk,Ann-Charlotte %A Lindström,Veronica %A Dahl,Oili %A Göransson,Katarina E %A Rudman,Ann %A Holmes,Emily A %+ Department of Psychology, Uppsala University, Box 1225, Uppsala, 75142, Sweden, 46 018 471 2118, laura.singh@psyk.uu.se %K intrusive memories %K psychological trauma %K prevention %K pilot trial %K COVID-19 %K digital intervention %K remote delivery %K cognitive science %K person-based approach %K mixed methods %K co-design %K health care staff %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19–related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff’s working context in a hospital setting used a co-design approach. Objective: The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant’s perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection. Methods: We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis. Results: After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure. Conclusions: The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial. %M 33886490 %R 10.2196/27473 %U https://formative.jmir.org/2021/5/e27473 %U https://doi.org/10.2196/27473 %U http://www.ncbi.nlm.nih.gov/pubmed/33886490 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e24623 %T The Differential Effects of Social Media on Depressive Symptoms and Suicidal Ideation Among the Younger and Older Adult Population in Hong Kong During the COVID-19 Pandemic: Population-Based Cross-sectional Survey Study %A Yang,Xue %A Yip,Benjamin H K %A Mak,Arthur D P %A Zhang,Dexing %A Lee,Eric K P %A Wong,Samuel Y S %+ Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, School of Public Health Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, Hong Kong, 852 2252 8488, yeungshanwong@cuhk.edu.hk %K social media %K depression %K suicidal ideation %K social loneliness %K posttraumatic stress %K suicide %K mental health %K COVID-19 %K loneliness %K age %K mediation %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media has become a ubiquitous part of daily life during the COVID-19 pandemic isolation. However, the role of social media use in depression and suicidal ideation of the general public remains unclear. Related empirical studies were limited and reported inconsistent findings. Little is known about the potential underlying mechanisms that may illustrate the relationship between social media use and depression and suicidal ideation during the COVID-19 pandemic. Objective: This study tested the mediation effects of social loneliness and posttraumatic stress disorder (PTSD) symptoms on the relationship between social media use and depressive symptoms and suicidal ideation, as well as the moderation effect of age on the mediation models. Methods: We administered a population-based random telephone survey in May and June 2020, when infection control measures were being vigorously implemented in Hong Kong. A total of 1070 adults (658 social media users and 412 nonusers) completed the survey. Structural equation modeling (SEM) and multigroup SEM were conducted to test the mediation and moderation effects. Results: The weighted prevalence of probable depression was 11.6%; 1.6% had suicidal ideation in the past 2 weeks. Both moderated mediation models of depressive symptoms (χ262=335.3; P<.05; comparative fit index [CFI]=0.94; nonnormed fit index [NNFI]=0.92; root mean square error of approximation [RMSEA]=0.06) and suicidal ideation (χ234=50.8; P<.05; CFI=0.99; NNFI=0.99; RMSEA=0.02) showed acceptable model fit. There was a significantly negative direct effect of social media use on depressive symptoms among older people (β=–.07; P=.04) but not among younger people (β=.04; P=.55). The indirect effect via PTSD symptoms was significantly positive among both younger people (β=.09; P=.02) and older people (β=.10; P=.01). The indirect effect via social loneliness was significant among older people (β=–.01; P=.04) but not among younger people (β=.01; P=.31). The direct effect of social media use on suicidal ideation was not statistically significant in either age group (P>.05). The indirect effects via PTSD symptoms were statistically significant among younger people (β=.02; P=.04) and older people (β=.03; P=.01). Social loneliness was not a significant mediator between social media use and suicidal ideation among either age group (P>.05). Conclusions: Social media may be a “double-edged sword” for psychosocial well-being during the COVID-19 pandemic, and its roles vary across age groups. The mediators identified in this study can be addressed by psychological interventions to prevent severe mental health problems during and after the COVID-19 pandemic. %M 33835937 %R 10.2196/24623 %U https://publichealth.jmir.org/2021/5/e24623 %U https://doi.org/10.2196/24623 %U http://www.ncbi.nlm.nih.gov/pubmed/33835937 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e27818 %T The Impact of the COVID-19 Pandemic on Physical and Mental Health in China and Spain: Cross-sectional Study %A Wang,Cuiyan %A López-Núñez,María Inmaculada %A Pan,Riyu %A Wan,Xiaoyang %A Tan,Yilin %A Xu,Linkang %A Choo,Faith %A Ho,Roger %A Ho,Cyrus %A Aparicio García,Marta E %+ Department of Psychological Medicine, Institute of Health Innovation and Technology, National University of Singapore, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 97321097, pcmrhcm@nus.edu.sg %K anxiety %K China %K coronavirus %K COVID-19 %K depression %K developing countries %K knowledge %K masks %K pandemic %K physical %K precaution %K psychological impact %K Spain %K stress %D 2021 %7 21.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Differences in physical and mental health impact across continents during the COVID-19 pandemic are unknown. Objective: This study compared the levels of impact of COVID-19 on mental health among people from Spain and China and correlated mental health parameters with variables relating to symptoms similar to COVID-19, COVID-19 knowledge, and precautionary measures. Methods: We collected information on demographic data, physical symptoms, contact history with persons with a confirmed COVID-19 diagnosis, COVID-19 knowledge, and precautionary measures. Participants completed the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale–21 Items (DASS-21). To analyze the differences in the mental health parameters, the mean scores between Chinese and Spanish respondents were compared using the independent samples t test. The differences in categorical variables between the two samples were analyzed by the chi-square test. Linear regression was used to calculate the univariate associations between the independent variables and mental health parameters for both groups separately, with adjustments made for age, gender, and education. Results: A total of 1528 participants (Spain: n=687; China: n=841) were recruited. The mean age of the Chinese respondents was 24.73 years (SD 7.60; range 18-65 years), and the mean age of the Spanish respondents was 43.06 years (SD 11.95; range 18-76 years). Spanish participants reported significantly more symptoms similar to COVID-19 infection (eg, fever, sore throat, and breathing difficulties), contact history with COVID-19, higher perceived risk of contracting COVID-19, frequent use of medical services, and less confidence in medical services compared with their Chinese counterparts (P<.001). Spanish participants reported significantly higher DASS-21 stress and depression scores, while Chinese participants reported significantly higher IES-R scores (P<.001). Chinese participants encountered more discrimination from other countries (P<.001). Significantly more Chinese participants reported using face masks than Spanish ones (P<.001). More exposure to health information was associated with adverse mental health in Spain (depression: P=.02; anxiety: P=.02; stress: P=.001). Conclusions: Our study found that Spanish respondents reported higher levels of stress and depression as well as more symptoms and use of medical services. In preparation for the next pandemic, Spain needs to establish a prompt policy to implement rapid response and enhance medical services to safeguard physical and mental health. %M 33900933 %R 10.2196/27818 %U https://formative.jmir.org/2021/5/e27818 %U https://doi.org/10.2196/27818 %U http://www.ncbi.nlm.nih.gov/pubmed/33900933 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27331 %T Sleep Disturbances in Frontline Health Care Workers During the COVID-19 Pandemic: Social Media Survey Study %A Stewart,Nancy H %A Koza,Anya %A Dhaon,Serena %A Shoushtari,Christiana %A Martinez,Maylyn %A Arora,Vineet M %+ Department of Medicine, University of Kansas Medical Center, 4000 Cambridge St., Mailstop 3007, Kansas City, KS, 66106, United States, 1 913 588 6045, nstewart5@kumc.edu %K social media %K sleep disorders %K frontline health care workers %K burnout %K insomnia %K sleep %K health care worker %K stress %K survey %K demographic %K outcome %K COVID-19 %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, health care workers are sharing their challenges, including sleep disturbances, on social media; however, no study has evaluated sleep in predominantly US frontline health care workers during the COVID-19 pandemic. Objective: The aim of this study was to assess sleep among a sample of predominantly US frontline health care workers during the COVID-19 pandemic using validated measures through a survey distributed on social media. Methods: A self-selection survey was distributed on Facebook, Twitter, and Instagram for 16 days (August 31 to September 15, 2020), targeting health care workers who were clinically active during the COVID-19 pandemic. Study participants completed the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), and they reported their demographic and career information. Poor sleep quality was defined as a PSQI score ≥5. Moderate-to-severe insomnia was defined as an ISI score >14. The Mini-Z Burnout Survey was used to measure burnout. Multivariate logistic regression tested associations between demographics, career characteristics, and sleep outcomes. Results: A total of 963 surveys were completed. Participants were predominantly White (894/963, 92.8%), female (707/963, 73.4%), aged 30-49 years (692/963, 71.9%), and physicians (620/963, 64.4%). Mean sleep duration was 6.1 hours (SD 1.2). Nearly 96% (920/963, 95.5%) of participants reported poor sleep (PSQI). One-third (288/963, 30%) reported moderate or severe insomnia. Many participants (554/910, 60.9%) experienced sleep disruptions due to device use or had nightmares at least once per week (420/929, 45.2%). Over 50% (525/932, 56.3%) reported burnout. In multivariable logistic regressions, nonphysician (odds ratio [OR] 2.4, 95% CI 1.7-3.4), caring for patients with COVID-19 (OR 1.8, 95% CI 1.2-2.8), Hispanic ethnicity (OR 2.2, 95% CI 1.4-3.5), female sex (OR 1.6, 95% CI 1.1-2.4), and having a sleep disorder (OR 4.3, 95% CI 2.7-6.9) were associated with increased odds of insomnia. In open-ended comments (n=310), poor sleep was mapped to four categories: children and family, work demands, personal health, and pandemic-related sleep disturbances. Conclusions: During the COVID-19 pandemic, nearly all the frontline health care workers surveyed on social media reported poor sleep, over one-third reported insomnia, and over half reported burnout. Many also reported sleep disruptions due to device use and nightmares. Sleep interventions for frontline health care workers are urgently needed. %M 33875414 %R 10.2196/27331 %U https://www.jmir.org/2021/5/e27331 %U https://doi.org/10.2196/27331 %U http://www.ncbi.nlm.nih.gov/pubmed/33875414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24496 %T Experiences and Attitudes of Elementary School Students and Their Parents Toward Online Learning in China During the COVID-19 Pandemic: Questionnaire Study %A Cui,Shu %A Zhang,Chao %A Wang,Shijiang %A Zhang,Xingong %A Wang,Lei %A Zhang,Ling %A Yuan,Qiuyu %A Huang,Cui %A Cheng,Fangshuo %A Zhang,Kai %A Zhou,Xiaoqin %+ Department of Psychiatry, Chaohu Hospital, Anhui Medical University, 64 Chaohu Road, Chaohu, Hefei, China, 86 055182324014, zhouxqlulu@126.com %K attitude %K elementary school students %K parents %K online learning %K COVID-19 %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to widespread SARS-CoV-2 infection, an emergency homeschooling plan was rigorously implemented throughout China. Objective: This study aimed to investigate the experiences and attitudes of elementary school students and their parents (two generations from the same family) toward online learning in China during the pandemic. Methods: A 16-item questionnaire was distributed at the 10-day and 40-day marks after the start of the first online course to 867 parent-child pairs and 141 parent-child pairs, respectively. The questionnaire was comprised of questions pertaining to course and homework completeness, effectiveness, reliability, and abundance as well as the students’ enthusiasm for taking part in online classes and their satisfaction with the courses. Results: Our findings indicate that 90.7% (786/867) of students exhibited high or moderate enthusiasm for participating in online classes. However, most students performed poorly in online learning classes and after-school homework. With regard to satisfaction, parents' and students' average scores were 7.35 and 7.25, respectively (10-point scoring system). During the second stage of this study, parents' positive evaluations for online learning declined, including those for the effectiveness and reliability of the courses. Furthermore, the proportion of students who completed the courses and homework on time decreased; this difference proved statistically significant (P=.047). The parents’ and students’ overall satisfaction with online learning also declined during the second stage (parents: 7.21; students: 7.23); however, the difference in overall satisfaction between the two stages was not statistically significant (parents: P=.53; students: P=.60). Several of the parents (315/867, 36.2%) indicated that assisting with and supervising the students’ online learning resulted in increased stress. Further, 36% of parents expressed dissatisfaction with or provided suggestions for online learning; most parents and students hoped to return to face-to-face classes (parents: 823/867, 94.9%; students: 811/867, 93.5%). Finally, our results presented the following six main issues that parents were the most concerned about: (1) disappointment regarding timely interaction in courses; (2) apprehensiveness about students’ understanding of the course; (3) the increased burden of annoying adult responsibilities; (4) concern about children's eyesight; (5) the idea that teachers’ explanations were not detailed enough; and (6) concerns about the decline of students' interest in and attention toward online courses. Conclusions: Online learning can prevent the spread of infectious diseases while still allowing elementary school students to attain knowledge. However, in our study, children’s completion of the courses and homework were not satisfactory. Furthermore, their parents often experienced stress and had many concerns and complaints. Measures such as increasing the interactivity of the courses and prohibiting teachers from assigning tasks to parents could improve the effectiveness of these courses and the mental health of parents and students. %M 33878022 %R 10.2196/24496 %U https://www.jmir.org/2021/5/e24496 %U https://doi.org/10.2196/24496 %U http://www.ncbi.nlm.nih.gov/pubmed/33878022 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e27039 %T A Mobile Phone–Based Intervention to Reduce Mental Health Problems in Health Care Workers During the COVID-19 Pandemic (PsyCovidApp): Randomized Controlled Trial %A Fiol-DeRoque,Maria Antònia %A Serrano-Ripoll,Maria Jesús %A Jiménez,Rafael %A Zamanillo-Campos,Rocío %A Yáñez-Juan,Aina María %A Bennasar-Veny,Miquel %A Leiva,Alfonso %A Gervilla,Elena %A García-Buades,M Esther %A García-Toro,Mauro %A Alonso-Coello,Pablo %A Pastor-Moreno,Guadalupe %A Ruiz-Pérez,Isabel %A Sitges,Carolina %A García-Campayo,Javier %A Llobera-Cánaves,Joan %A Ricci-Cabello,Ignacio %+ Health Research Institute of the Balearic Islands, Edificio S, Hospital Universitario Son Espases, Carretera de Valldemossa, Palma de Mallorca, 07120, Spain, 34 +34610753696, mariajesus.serranoripoll@ssib.es %K COVID-19 %K randomized controlled trial %K mental health %K health care workers %K mHealth %K app %D 2021 %7 18.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to health care workers, who are facing heavy workloads under psychologically difficult situations. Mental mobile Health (mHealth) interventions are now being widely deployed due to their attractive implementation features, despite the lack of evidence about their efficacy in this specific population and context. Objective: The aim of this trial is to evaluate the effectiveness of a psychoeducational, mindfulness-based mHealth intervention to reduce mental health problems in health care workers during the COVID-19 pandemic. Methods: We conducted a blinded, parallel-group, controlled trial in Spain. Health care workers providing face-to-face health care to patients with COVID-19 were randomly assigned (1:1) to receive the PsyCovidApp intervention (an app targeting emotional skills, healthy lifestyle behavior, burnout, and social support) or a control app (general recommendations about mental health care) for 2 weeks. The participants were blinded to their group allocation. Data were collected telephonically at baseline and after 2 weeks by trained health psychologists. The primary outcome was a composite of depression, anxiety, and stress (overall score on the Depression Anxiety Stress Scale-21 [DASS-21]). Secondary outcomes were insomnia (Insomnia Severity Index), burnout (Maslach Burnout Inventory Human Services Survey), posttraumatic stress (Davidson Trauma Scale), self-efficacy (General Self-Efficacy Scale), and DASS-21 individual scale scores. Differences between groups were analyzed using general linear modeling according to an intention-to-treat protocol. Additionally, we measured the usability of the PsyCovidApp (System Usability Scale). The outcome data collectors and trial statisticians were unaware of the treatment allocation. Results: Between May 14 and July 25, 2020, 482 health care workers were recruited and randomly assigned to PsyCovidApp (n=248) or the control app (n=234). At 2 weeks, complete outcome data were available for 436/482 participants (90.5%). No significant differences were observed between the groups at 2 weeks in the primary outcome (standardized mean difference –0.04; 95% CI –0.11 to 0.04; P=.15) or in the other outcomes. In our prespecified subgroup analyses, we observed significant improvements among health care workers consuming psychotropic medications (n=79) in the primary outcome (–0.29; 95% CI –0.48 to –0.09; P=.004), and in posttraumatic stress, insomnia, anxiety, and stress. Similarly, among health care workers receiving psychotherapy (n=43), we observed improvements in the primary outcome (–0.25; 95% CI –0.49 to –0.02; P=.02), and in insomnia, anxiety, and stress. The mean usability score of PsyCovidApp was high (87.21/100, SD 12.65). After the trial, 208/221 participants in the intervention group (94.1%) asked to regain access to PsyCovidApp, indicating high acceptability. Conclusions: In health care workers assisting patients with COVID-19 in Spain, PsyCovidApp, compared with a control app, reduced mental health problems at 2 weeks only among health care workers receiving psychotherapy or psychotropic medications. Trial Registration: ClinicalTrials.gov NCT04393818; https://clinicaltrials.gov/ct2/show/NCT04393818. %M 33909587 %R 10.2196/27039 %U https://mhealth.jmir.org/2021/5/e27039 %U https://doi.org/10.2196/27039 %U http://www.ncbi.nlm.nih.gov/pubmed/33909587 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26431 %T Cognitive Outcomes During COVID-19 Confinement Among Older People and Their Caregivers Using Technologies for Dementia: Protocol for an Observational Cohort Study %A Goodman-Casanova,Jessica Marian %A Dura-Perez,Elena %A Guerrero-Pertiñez,Gloria %A Barnestein-Fonseca,Pilar %A Guzman-Parra,Jose %A Vega-Nuñez,Amanda %A Varela-Moreno,Esperanza %A Cuesta-Vargas,Antonio %A Mayoral-Cleries,Fermin %+ Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital Civil s/n, Málaga, 29009, Spain, 34 660901966, jmariangoodman@gmail.com %K caregiver %K cognition %K cognitive impairment %K cohort %K COVID-19 %K dementia %K older people %K informal caregivers %K information and communications technologies %K isolation %K older adults %K outcome %K quality of life %K social isolation %K stress %K technologies %D 2021 %7 18.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has led to worldwide implementation of unprecedented restrictions to control its rapid spread and mitigate its impact. The Spanish government has enforced social distancing, quarantine, and home confinement measures. Such restrictions on activities of daily life and separation from loved ones may lead to social isolation and loneliness with health-related consequences among community-dwelling older adults with mild cognitive impairment or mild dementia and their caregivers. Additionally, inadequate access to health care and social support services may aggravate chronic conditions. Home-based technological interventions have emerged for combating social isolation and loneliness, while simultaneously preventing the risk of virus exposure. Objective: The aim of this cohort study is to explore, analyze, and determine the impact of social isolation on (1) cognition, quality of life, mood, technophilia, and perceived stress among community-dwelling older adults with mild cognitive impairment or mild dementia and on the caregiver burden; (2) access to and utilization of health and social care services; and (3) cognitive, social, and entertainment-related uses of information and communication technologies. Methods: This study will be conducted in Málaga (Andalucía, Spain). In total 200 dyads, consisting of a person with mild cognitive impairment or mild dementia and his/her informal caregiver, will be contacted by telephone. Potential respondents will be participants of the following clinical trials: support, monitoring, and reminder technology for mild dementia (n=100) and television-based assistive integrated service to support European adults living with mild dementia or mild cognitive impairment (n=100). Results: As of May 2021, a total of 153 participants have been enrolled and assessed during COVID-19 confinement, of whom 67 have been assessed at 6 months of enrollment. Changes in the mean values of the variables will be analyzed relative to baseline findings of previous studies with those during and after confinement, using repeated-measures analysis of variance or the nonparametric Friedman test, as appropriate. The performance of multivariate analysis of covariance (ANCOVA) to introduce potential covariates will also be considered. Values of 95% CI will be used. Conclusions: If our hypothesis is accepted, these findings will demonstrate the negative impact of social isolation owing to COVID-19 confinement on cognition, quality of life, mood, and perceived stress among community-dwelling older adults with mild cognitive impairment and mild dementia, the impact on technophilia, caregiver burden, the access to and utilization of health and social care services, and the cognitive, social, and entertainment-related use of information and communication technologies during and after COVID-19 confinement. Trial Registration: ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797 International Registered Report Identifier (IRRID): DERR1-10.2196/26431 %M 33909588 %R 10.2196/26431 %U https://www.researchprotocols.org/2021/5/e26431 %U https://doi.org/10.2196/26431 %U http://www.ncbi.nlm.nih.gov/pubmed/33909588 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24412 %T Factors Influencing Anxiety Among WeChat Users During the Early Stages of the COVID-19 Pandemic in Mainland China: Cross-sectional Survey Study %A Zou,Changqing %A Zhang,Weiyu %A Sznajder,Kristin %A Yang,Fengzhi %A Jia,Yajing %A Ma,Ruqing %A Cui,Can %A Yang,Xiaoshi %+ Department of Social Medicine, School of Public Health, China Medical University, No 77 Puhe Road, Shenyang North New Area, Liaoning Province, Shenyang, 110122, China, 86 18900910796, xsyang@cmu.edu.cn %K anxiety %K COVID-19 %K information seeking behavior %K positive psychological response %K health information %K public health emergency %K mental health %K online survey %K China %K cross-sectional study %D 2021 %7 17.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid outbreak of COVID-19 around the world has adversely affected the mental health of the public. The prevalence of anxiety among the public has increased dramatically during the COVID-19 pandemic. However, there are few studies evaluating the effects of positive psychological responses and information-seeking behaviors on anxiety experienced among social media users during the COVID-19 pandemic. Objective: This study evaluated the prevalence of anxiety and its associated factors among WeChat users in mainland China during the early stages of the COVID-19 pandemic. Methods: From February 10 to February 24, 2020, a nationwide, web-based cross-sectional survey study was carried out using convenience sampling. Participants’ levels of anxiety, positive psychological responses, and information-seeking behaviors were assessed. The survey was distributed among WeChat users via the WeChat smartphone platform. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with anxiety. Results: This study found that the prevalence of anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale score ≥7) among WeChat users in China was 17.96% (446/2483) during the early stages of the COVID-19 pandemic. Results of multivariable logistic regression analysis showed that information-seeking behaviors such as cannot stop searching for information on COVID-19, being concerned about the COVID-19 pandemic, and spending more than 1 hour per day consuming information about the pandemic were found to be associated with increased levels of anxiety. Additionally, participants who chose social media and commercial media as the primary sources to obtain information about the COVID-19 pandemic were found more likely to report anxiety. Conversely, participants who were confident or rational about the COVID-19 pandemic were less likely to report anxiety. Conclusions: This study found that positive psychological responses and information-seeking behaviors were closely associated with anxiety among WeChat users during the COVID-19 pandemic in China. It might be paramount to enhance mental well-being by helping people respond to the COVID-19 pandemic more rationally and positively in order to decrease symptoms of anxiety. %M 33878025 %R 10.2196/24412 %U https://www.jmir.org/2021/5/e24412 %U https://doi.org/10.2196/24412 %U http://www.ncbi.nlm.nih.gov/pubmed/33878025 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26948 %T Suicide Prevention Among College Students Before and During the COVID-19 Pandemic: Protocol for a Systematic Review and Meta-analysis %A Xiao,Yunyu %A Hinrichs,Rachel %A Johnson,Nina %A McKinley,Amanda %A Carlson,Joan %A Agley,Jon %A Yip,Paul Siu Fai %+ School of Social Work, Indiana University–Purdue University Indianapolis, 902 W New York St, 4F, Education/Social Work Building, ES 4119, Indianapolis, IN, 46202, United States, 1 201 253 7264, yx18@iu.edu %K suicide %K suicidal prevention %K college %K university %K health disparities %K equity %K suicidal ideation %K suicide attempt %K COVID-19 %K college student %K young adult %K disparity %K review %D 2021 %7 17.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide is the second leading cause of death for college-aged individuals worldwide and in the United States. Recent studies have identified preliminary evidence of widening disparities in suicidal behaviors across sex, sexual orientation, race/ethnicity, age, and socioeconomic status among college students. Few systematic reviews and meta-analyses offer a comprehensive understanding of on-campus and off-campus suicide interventions, nor is collated information available for different types of screening, assessment, treatment, and postvention plans. Further challenges have been identified since the COVID-19 pandemic, calling for cost-effective and innovative interventions to address increased rates of suicidal behaviors among college students facing unprecedented stressors. Objective: This research protocol describes the first systematic review and meta-analysis to identify the most effective and cost-effective intervention components for universal and targeted (indicated and selected) suicide prevention among college students in a global context. Special attention will be placed on disparities in suicide prevention across sociodemographic subgroups, inclusive interventions beyond campus, global context, and intervention responses to the COVID-19 pandemic. Methods: A sensitive search strategy will be executed across MEDLINE (Ovid), EMBASE, PsycINFO (EBSCO), ERIC (EBSCO), Cochrane Library, Dissertations and Theses Global (ProQuest), Scopus, Global Index Medicus, SciELO, African Journals Online, Global Health (CABI), and Google Scholar. Data extraction and evaluation will be conducted by three independent researchers. Risk of bias will be assessed. A multilevel meta-regression model and subgroup analysis will be used to analyze the data and estimate effect sizes. Results: The initial search was completed in December 2020 and updated with additional other-language studies in March 2020. We expect the results to be submitted for publication in mid-2021. Conclusions: Despite increasing rates of suicidal behaviors among college students, few preventative efforts have targeted this population, and fewer focus on factors that might place specific demographic groups at heightened risk. The impact of COVID-19 on suicidal behaviors among college students highlights and exacerbates the urgent need for rapid and effective interventions that might differ from traditional approaches. This equity-focused study will address these gaps and provide a valuable analysis of the effectiveness of suicide prevention programs and interventions. Findings will inform clinicians, researchers, policy makers, families, and organizations about evidence-based interventions for reducing the gaps in the suicide crisis among college students from different sociodemographic groups. Trial Registration: PROSPERO CRD42020225429; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225429 International Registered Report Identifier (IRRID): DERR1-10.2196/26948 %M 33878016 %R 10.2196/26948 %U https://www.researchprotocols.org/2021/5/e26948 %U https://doi.org/10.2196/26948 %U http://www.ncbi.nlm.nih.gov/pubmed/33878016 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26883 %T The Efficacy of Computerized Cognitive Behavioral Therapy for Depressive and Anxiety Symptoms in Patients With COVID-19: Randomized Controlled Trial %A Liu,Zhifen %A Qiao,Dan %A Xu,Yifan %A Zhao,Wentao %A Yang,Yang %A Wen,Dan %A Li,Xinrong %A Nie,Xiaoping %A Dong,Yongkang %A Tang,Shiyou %A Jiang,Yi %A Wang,Ying %A Zhao,Juan %A Xu,Yong %+ Department of Psychiatry, The First Hospital of Shanxi Medical University, 85 Jiefang South Street, Yingze District, Taiyuan, 030001, China, 86 351 4639641, xuyongsmu@vip.163.com %K mental health %K depression %K anxiety %K COVID-19 %K treatment %K cCBT %K computerized cognitive behavioral therapy %D 2021 %7 14.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of depressive and anxiety symptoms in patients with COVID-19 is higher than usual. Previous studies have shown that there are drug-to-drug interactions between antiretroviral drugs and antidepressants. Therefore, an effective and safe treatment method was needed. Cognitive behavioral therapy (CBT) is the first-line psychological therapy in clinical treatment. Computerized CBT (cCBT) was proven to be an effective alternative to CBT and does not require face-to-face therapy between a therapist and the patient, which suited the COVID-19 pandemic response. Objective: This study aims to evaluate the efficacy of the cCBT program we developed in improving depressive and anxiety symptoms among patients with COVID-19. Methods: We customized a cCBT program focused on improving depressive and anxiety symptoms among patients with COVID-19, and then, we assessed its effectiveness. Screening was based on symptoms of depression or anxiety for patients who scored ≥7 on the Hamilton Depression Rating Scale (HAMD17) or the Hamilton Anxiety Scale (HAMA). A total of 252 patients with COVID-19 at five sites were randomized into two groups: cCBT + treatment as usual (TAU; n=126) and TAU without cCBT (n=126). The cCBT + TAU group received the cCBT intervention program for 1 week. The primary efficacy measures were the HAMD17 and HAMA scores. The secondary outcome measures were the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Athens Insomnia Scale (AIS). Assessments were carried out pre- and postintervention. The patients’ symptoms of anxiety and depression in one of the centers were assessed again within 1 month after the postintervention assessment. Results: The cCBT + TAU group displayed a significantly decreased score on the HAMD17, HAMA, SDS, SAS, and AIS after the intervention compared to the TAU group (all P<.001). A mixed-effects repeated measures model revealed significant improvement in symptoms of depression (HAMD17 and SDS scores, both P<.001), anxiety (HAMA and SAS scores, both P<.001), and insomnia (AIS score, P=.002) during the postintervention and follow-up periods in the cCBT + TAU group. Additionally, the improvement of insomnia among females (P=.14) and those with middle school education (P=.48) in the cCBT + TAU group showed no significant differences when compared to the TAU group. Conclusions: The findings of this study suggest that the cCBT program we developed was an effective nonpharmacological treatment for symptoms of anxiety, depression, and insomnia among patients with COVID-19. Further research is warranted to investigate the long-term effects of cCBT for symptoms of anxiety, depression, and insomnia in patients with COVID-19. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000030084; http://www.chictr.org.cn/showprojen.aspx?proj=49952 %M 33900931 %R 10.2196/26883 %U https://www.jmir.org/2021/5/e26883 %U https://doi.org/10.2196/26883 %U http://www.ncbi.nlm.nih.gov/pubmed/33900931 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26186 %T Using Multimodal Assessments to Capture Personalized Contexts of College Student Well-being in 2020: Case Study %A Lai,Jocelyn %A Rahmani,Amir %A Yunusova,Asal %A Rivera,Alexander P %A Labbaf,Sina %A Hu,Sirui %A Dutt,Nikil %A Jain,Ramesh %A Borelli,Jessica L %+ UCI THRIVE Lab, Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 4086565508, jocelyn.lai@uci.edu %K COVID-19 %K emerging adulthood %K multimodal personal chronicles %K case study %K wearable internet of things %K individualized mHealth %K college students %K mental health %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The year 2020 has been challenging for many, particularly for young adults who have been adversely affected by the COVID-19 pandemic. Emerging adulthood is a developmental phase with significant changes in the patterns of daily living; it is a risky phase for the onset of major mental illness. College students during the pandemic face significant risk, potentially losing several protective factors (eg, housing, routine, social support, job, and financial security) that are stabilizing for mental health and physical well-being. Individualized multiple assessments of mental health, referred to as multimodal personal chronicles, present an opportunity to examine indicators of health in an ongoing and personalized way using mobile sensing devices and wearable internet of things. Objective: To assess the feasibility and provide an in-depth examination of the impact of the COVID-19 pandemic on college students through multimodal personal chronicles, we present a case study of an individual monitored using a longitudinal subjective and objective assessment approach over a 9-month period throughout 2020, spanning the prepandemic period of January through September. Methods: The individual, referred to as Lee, completed psychological assessments measuring depression, anxiety, and loneliness across 4 time points in January, April, June, and September. We used the data emerging from the multimodal personal chronicles (ie, heart rate, sleep, physical activity, affect, behaviors) in relation to psychological assessments to understand patterns that help to explicate changes in the individual’s psychological well-being across the pandemic. Results: Over the course of the pandemic, Lee’s depression severity was highest in April, shortly after shelter-in-place orders were mandated. His depression severity remained mildly severe throughout the rest of the months. Associations in positive and negative affect, physiology, sleep, and physical activity patterns varied across time periods. Lee’s positive affect and negative affect were positively correlated in April (r=0.53, P=.04) whereas they were negatively correlated in September (r=–0.57, P=.03). Only in the month of January was sleep negatively associated with negative affect (r=–0.58, P=.03) and diurnal beats per minute (r=–0.54, P=.04), and then positively associated with heart rate variability (resting root mean square of successive differences between normal heartbeats) (r=0.54, P=.04). When looking at his available contextual data, Lee noted certain situations as supportive coping factors and other situations as potential stressors. Conclusions: We observed more pandemic concerns in April and noticed other contextual events relating to this individual’s well-being, reflecting how college students continue to experience life events during the pandemic. The rich monitoring data alongside contextual data may be beneficial for clinicians to understand client experiences and offer personalized treatment plans. We discuss benefits as well as future directions of this system, and the conclusions we can draw regarding the links between the COVID-19 pandemic and college student mental health. %M 33882022 %R 10.2196/26186 %U https://formative.jmir.org/2021/5/e26186 %U https://doi.org/10.2196/26186 %U http://www.ncbi.nlm.nih.gov/pubmed/33882022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23009 %T Learning From the Experiences of COVID-19 Survivors: Web-Based Survey Study %A Prioleau,Temiloluwa %+ Dartmouth College, 9 Maynard Street, Hanover, NH, 03755, United States, 1 6036468730, tprioleau@dartmouth.edu %K patient-reported outcomes %K coronavirus %K COVID-19 %K outcome %K crowdsourcing %K social media %K internet %K survivor %K experience %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There are still many unanswered questions about the novel coronavirus; however, a largely underutilized source of knowledge is the millions of people who have recovered after contracting the virus. This includes a majority of undocumented cases of COVID-19, which were classified as mild or moderate and received little to no clinical care during the course of illness. Objective: This study aims to document and glean insights from the experiences of individuals with a first-hand experience in dealing with COVID-19, especially the so-called mild-to-moderate cases that self-resolved while in isolation. Methods: This web-based survey study called C19 Insider Scoop recruited adult participants aged 18 years or older who reside in the United States and had tested positive for COVID-19 or antibodies. Participants were recruited through various methods, including online support groups for COVID-19 survivors, advertisement in local news outlets, as well as through professional and other networks. The main outcomes measured in this study included knowledge of contraction or transmission of the virus, symptoms, and personal experiences on the road to recovery. Results: A total of 72 participants (female, n=53; male, n=19; age range: 18-73 years; mean age: 41 [SD 14] years) from 22 US states were enrolled in this study. The top known source of how people contracted SARS-CoV-2, the virus known to cause COVID-19, was through a family or household member (26/72, 35%). This was followed by essential workers contracting the virus through the workplace (13/72, 18%). Participants reported up to 27 less-documented symptoms that they experienced during their illness, such as brain or memory fog, palpitations, ear pain or discomfort, and neurological problems. In addition, 47 of 72 (65%) participants reported that their symptoms lasted longer than the commonly cited 2-week period even for mild cases of COVID-19. The mean recovery time of the study participants was 4.5 weeks, and exactly one-half of participants (50%) still experienced lingering symptoms of COVID-19 after an average of 65 days following illness onset. Additionally, 37 (51%) participants reported that they experienced stigma associated with contracting COVID-19. Conclusions: This study presents preliminary findings suggesting that emphasis on family or household spread of COVID-19 may be lacking and that there is a general underestimation of the recovery time even for mild cases of illness with the virus. Although a larger study is needed to validate these results, it is important to note that as more people experience COVID-19, insights from COVID-19 survivors can enable a more informed public, pave the way for others who may be affected by the virus, and guide further research. %M 33878012 %R 10.2196/23009 %U https://formative.jmir.org/2021/5/e23009 %U https://doi.org/10.2196/23009 %U http://www.ncbi.nlm.nih.gov/pubmed/33878012 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e26808 %T Leisure and Problem Gaming Behaviors Among Children and Adolescents During School Closures Caused by COVID-19 in Hong Kong: Quantitative Cross-sectional Survey Study %A Zhu,Shimin %A Zhuang,Yanqiong %A Lee,Paul %A Li,Jessica Chi-Mei %A Wong,Paul W C %+ Department of Social Work and Social Administration, The University of Hong Kong, 511, JC Teaching Tower, Pok Fu Lam, 000, Hong Kong, 852 39175029, paulw@hku.hk %K COVID-19 %K leisure gaming %K excessive gaming %K pathological gaming %K familial factors %K loneliness %K COVID-19 lockdown %K school closure %D 2021 %7 7.5.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: School closures during the COVID-19 pandemic may have exacerbated students’ loneliness, addictive gaming behaviors, and poor mental health. These mental health issues confronting young people are of public concern. Objective: This study aimed to examine the associations between loneliness and gaming addiction behaviors among young people in Hong Kong and to investigate how familial factors, psychological distress, and gender differences moderate these relationships. Methods: This cross-sectional study was conducted in June 2020 when schools reopened after 6 months of school closures. Participants included 2863 children and adolescents in primary (Grades 4 to 6) and secondary (Grades 7 and 8) schools (female participants: 1502/2863, 52.5%). Chi-square tests, one-way analyses of variance, and independent-samples t tests were performed to compare the differences of distribution in gaming addiction behaviors across gender, age, and other sociodemographic characteristics. Multinomial logistic regression analyses were conducted to identify factors that relate to excessive or pathological gaming behaviors separately, in comparison with leisure gaming. Results: A total of 83.0% (2377/2863) of the participants played video games during the COVID-19 pandemic. The prevalence of excessive and pathological game addiction behaviors was 20.9% (597/2863) and 5.3% (153/2863), respectively. More male students had gaming addiction symptoms than female students. The multinomial logistic regressions showed that feeling lonely was associated with more problematic gaming behaviors, and the association was stronger for older female students. Low socioeconomic status, less parental support and less supervision, and poor mental health were risk factors for gaming addiction behaviors, especially among primary school students. Conclusions: Loneliness was associated with gaming addiction behaviors; the findings from this study suggested that this association was similar across gender and age groups among young people. Familial support and supervision during school closures can protect young people from developing problematic gaming behaviors. Results of this study have implications for prevention and early intervention on behalf of policy makers and game developers. %M 33960954 %R 10.2196/26808 %U https://games.jmir.org/2021/2/e26808 %U https://doi.org/10.2196/26808 %U http://www.ncbi.nlm.nih.gov/pubmed/33960954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e21864 %T COVID-19, Social Isolation, and Mental Health Among Older Adults: A Digital Catch-22 %A Cosco,Theodore D %A Fortuna,Karen %A Wister,Andrew %A Riadi,Indira %A Wagner,Kevin %A Sixsmith,Andrew %+ Gerontology Research Center, Simon Fraser University, 2800 Harbour Centre, 515 West Hastings Street, Vancouver, BC, , Canada, 1 778 782 5065, tdcosco@cantab.net %K social isolation %K mental health %K COVID-19 %K technology %K older adult %K psychology %K digital health %D 2021 %7 6.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X One of the most at-risk groups during the COVID-19 crisis is older adults, especially those who live in congregate living settings and seniors’ care facilities, are immune-compromised, and/or have other underlying illnesses. Measures undertaken to contain the spread of the virus are far-reaching, and older adults were among the first groups to experience restrictions on face-to-face contact. Although reducing viral transmission is critical, physical distancing is associated with negative psychosocial implications, such as increased rates of depression and anxiety. Promising evidence suggests that participatory digital co-design, defined as the combination of user-centered design and community engagement models, is associated with increased levels of engagement with mobile technologies among individuals with mental health conditions. The COVID-19 pandemic has highlighted shortcomings of existing technologies and challenges in their uptake and usage; however, strategies such as co-design may be leveraged to address these challenges both in the adaptation of existing technologies and the development of new technologies. By incorporating these strategies, it is hoped that we can offset some of the negative mental health implications for older adults in the context of physical distancing both during and beyond the current pandemic. %M 33891557 %R 10.2196/21864 %U https://www.jmir.org/2021/5/e21864 %U https://doi.org/10.2196/21864 %U http://www.ncbi.nlm.nih.gov/pubmed/33891557 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26590 %T A Resilience-Building App to Support the Mental Health of Health Care Workers in the COVID-19 Era: Design Process, Distribution, and Evaluation %A Golden,Eddye A %A Zweig,Micol %A Danieletto,Matteo %A Landell,Kyle %A Nadkarni,Girish %A Bottinger,Erwin %A Katz,Lindsay %A Somarriba,Ricardo %A Sharma,Vansh %A Katz,Craig L %A Marin,Deborah B %A DePierro,Jonathan %A Charney,Dennis S %+ Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Avenue, 14th Fl, New York, NY, 10065, United States, 1 4014398798, eddye.golden@mssm.edu %K mHealth %K resilience %K mental health %K COVID-19 %K HCWs %K digital health %K health app %K mental health platform %K mobile phone %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has resulted in increased strain on health care systems and negative psychological effects on health care workers (HCWs). This is anticipated to result in long-term negative mental health effects on the population, with HCWs representing a particularly vulnerable group. The scope of the COVID-19 pandemic necessitates the development of a scalable mental health platform to provide services to large numbers of at-risk or affected individuals. The Mount Sinai Health System in New York City was at the epicenter of the pandemic in the United States. Objective: The Center for Stress, Resilience, and Personal Growth (CSRPG) was created to address the current and anticipated psychological impact of the pandemic on the HCWs in the health system. The mission of the Center is to support the resilience and mental health of employees through educational offerings, outreach, and clinical care. Our aim was to build a mobile app to support the newly founded Center in its mission. Methods: We built the app as a standalone digital platform that hosts a suite of tools that users can interact with on a daily basis. With consideration for the Center’s aims, we determined the overall vision, initiatives, and goals for the Wellness Hub app, followed by specific milestone tasks and deliverables for development. We defined the app’s primary features based on the mental health assessment and needs of HCWs. Feature definition was informed by the results of a resilience survey widely distributed to Mount Sinai HCWs and by the resources offered at CSRPG, including workshop content. Results: We launched our app over the course of two phases, the first phase being a “soft” launch and the second being a broader launch to all of Mount Sinai. Of the 231 HCWs who downloaded the app, 173 (74.9%) completed our baseline assessment of all mental health screeners in the app. Results from the baseline assessment show that more than half of the users demonstrate a need for support in at least one psychological area. As of 3 months after the Phase 2 launch, approximately 55% of users re-entered the app after their first opening to explore additional features, with an average of 4 app openings per person. Conclusions: To address the mental health needs of HCWs during the COVID-19 pandemic, the Wellness Hub app was built and deployed throughout the Mount Sinai Health System. To our knowledge, this is the first resilience app of its kind. The Wellness Hub app is a promising proof of concept, with room to grow, for those who wish to build a secure mobile health app to support their employees, communities, or others in managing and improving mental and physical well-being. It is a novel tool offering mental health support broadly. %M 33872189 %R 10.2196/26590 %U https://formative.jmir.org/2021/5/e26590 %U https://doi.org/10.2196/26590 %U http://www.ncbi.nlm.nih.gov/pubmed/33872189 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27341 %T Emotions of COVID-19: Content Analysis of Self-Reported Information Using Artificial Intelligence %A Adikari,Achini %A Nawaratne,Rashmika %A De Silva,Daswin %A Ranasinghe,Sajani %A Alahakoon,Oshadi %A Alahakoon,Damminda %+ Research Centre for Data Analytics and Cognition, La Trobe University, Kingsbury Drive, Melbourne, Australia, 61 394793109, A.Adikari@latrobe.edu.au %K COVID-19 %K pandemic %K lockdown %K human emotions %K affective computing %K human-centric artificial intelligence %K artificial intelligence %K AI %K machine learning %K natural language processing %K language modeling %K infodemiology %K infoveillance %D 2021 %7 30.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has disrupted human societies around the world. This public health emergency was followed by a significant loss of human life; the ensuing social restrictions led to loss of employment, lack of interactions, and burgeoning psychological distress. As physical distancing regulations were introduced to manage outbreaks, individuals, groups, and communities engaged extensively on social media to express their thoughts and emotions. This internet-mediated communication of self-reported information encapsulates the emotional health and mental well-being of all individuals impacted by the pandemic. Objective: This research aims to investigate the human emotions related to the COVID-19 pandemic expressed on social media over time, using an artificial intelligence (AI) framework. Methods: Our study explores emotion classifications, intensities, transitions, and profiles, as well as alignment to key themes and topics, across the four stages of the pandemic: declaration of a global health crisis (ie, prepandemic), the first lockdown, easing of restrictions, and the second lockdown. This study employs an AI framework comprised of natural language processing, word embeddings, Markov models, and the growing self-organizing map algorithm, which are collectively used to investigate social media conversations. The investigation was carried out using 73,000 public Twitter conversations posted by users in Australia from January to September 2020. Results: The outcomes of this study enabled us to analyze and visualize different emotions and related concerns that were expressed and reflected on social media during the COVID-19 pandemic, which could be used to gain insights into citizens’ mental health. First, the topic analysis showed the diverse as well as common concerns people had expressed during the four stages of the pandemic. It was noted that personal-level concerns expressed on social media had escalated to broader concerns over time. Second, the emotion intensity and emotion state transitions showed that fear and sadness emotions were more prominently expressed at first; however, emotions transitioned into anger and disgust over time. Negative emotions, except for sadness, were significantly higher (P<.05) in the second lockdown, showing increased frustration. Temporal emotion analysis was conducted by modeling the emotion state changes across the four stages of the pandemic, which demonstrated how different emotions emerged and shifted over time. Third, the concerns expressed by social media users were categorized into profiles, where differences could be seen between the first and second lockdown profiles. Conclusions: This study showed that the diverse emotions and concerns that were expressed and recorded on social media during the COVID-19 pandemic reflected the mental health of the general public. While this study established the use of social media to discover informed insights during a time when physical communication was impossible, the outcomes could also contribute toward postpandemic recovery and understanding psychological impact via emotion changes, and they could potentially inform health care decision making. This study exploited AI and social media to enhance our understanding of human behaviors in global emergencies, which could lead to improved planning and policy making for future crises. %M 33819167 %R 10.2196/27341 %U https://www.jmir.org/2021/4/e27341 %U https://doi.org/10.2196/27341 %U http://www.ncbi.nlm.nih.gov/pubmed/33819167 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e27164 %T Innovative Virtual Role Play Simulations for Managing Substance Use Conversations: Pilot Study Results and Relevance During and After COVID-19 %A Albright,Glenn %A Khalid,Nikita %A Shockley,Kristen %A Robinson,Kelsey %A Hughes,Kevin %A Pace-Danley,Bethany %+ Peer Assistance Services, Inc, 2170 South Parker Road, Suite 229, Denver, CO, 80231, United States, 1 303 369 0039 ext 245, bpace-danley@peerassist.org %K simulations %K behavior change %K motivational interviewing %K virtual humans %K role play %K substance use %K prevention %K alcohol %K public awareness %K innovation %K interview %K COVID-19 %K pilot study %K simulation %K communication %K problem solving %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use places a substantial burden on our communities, both economically and socially. In light of COVID-19, it is predicted that as many as 75,000 more people will die from alcohol and other substance use and suicide as a result of isolation, new mental health concerns, and various other stressors related to the pandemic. Public awareness campaigns that aim to destigmatize substance use and help individuals have meaningful conversations with friends, coworkers, or family members to address substance use concerns are a timely and cost-effective means of augmenting existing behavioral health efforts related to substance use. These types of interventions can supplement the work being done by existing public health initiatives. Objective: This pilot study examines the impact of the One Degree: Shift the Influence role play simulation, designed to teach family, friends, and coworkers to effectively manage problem-solving conversations with individuals that they are concerned about regarding substance use. Methods: Participants recruited for this mixed methods study completed a presurvey, the simulation, and a postsurvey, and were sent a 6-week follow-up survey. The simulation involves practicing a role play conversation with a virtual human coded with emotions, a memory, and a personality. A virtual coach provides feedback in using evidence-based communication strategies such as motivational interviewing. Results: A matched sample analysis of variance revealed significant increases at follow-up in composite attitudinal constructs of preparedness (P<.001) and self-efficacy (P=.01), including starting a conversation with someone regarding substance use, avoiding upsetting someone while bringing up concerns, focusing on observable facts, and problem solving. Qualitative data provided further evidence of the simulation’s positive impact on the ability to have meaningful conversations about substance use. Conclusions: This study provides preliminary evidence that conversation-based simulations like One Degree: Shift the Influence that use role play practice can teach individuals to use evidence-based communication strategies and can cost-effectively reach geographically dispersed populations to support public health initiatives for primary prevention. %M 33848972 %R 10.2196/27164 %U https://formative.jmir.org/2021/4/e27164 %U https://doi.org/10.2196/27164 %U http://www.ncbi.nlm.nih.gov/pubmed/33848972 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e25407 %T Protocol for the Pregnancy During the COVID-19 Pandemic (PdP) Study: A Longitudinal Cohort Study of Mental Health Among Pregnant Canadians During the COVID-19 Pandemic and Developmental Outcomes in Their Children %A Giesbrecht,Gerald F %A Bagshawe,Mercedes %A van Sloten,Melinda %A MacKinnon,Anna L %A Dhillon,Ashley %A van de Wouw,Marcel %A Vaghef-Mehrabany,Elnaz %A Rojas,Laura %A Cattani,Danielle %A Lebel,Catherine %A Tomfohr-Madsen,Lianne %+ Department of Pediatrics, University of Calgary, 2500 University Drive, Calgary, AB, T2N 1N4, Canada, 1 403 441 8469, ggiesbre@ucalgary.ca %K pregnancy %K anxiety %K depression %K stress %K social support %K resilience %K COVID-19 %K infant development %K pandemic %D 2021 %7 28.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic and countermeasures implemented by governments around the world have led to dramatically increased symptoms of depression and anxiety. Pregnant individuals may be particularly vulnerable to the negative psychological effects of COVID-19 public health measures because they represent a demographic that is most affected by disasters and because pregnancy itself entails significant life changes that require major psychosocial and emotional adjustments. Objective: The PdP study was designed to investigate the associations among exposure to objective hardship caused by the pandemic, perceived stress and psychological distress in pregnant individuals, and developmental outcomes in their offspring. Methods: The PdP study comprises a prospective longitudinal cohort of individuals who were pregnant at enrollment, with repeated follow-ups during pregnancy and the postpartum period. Participants were eligible if they were pregnant, ≥17 years old, at ≤35 weeks of gestation at study enrollment, living in Canada, and able to read and write in English or French. At enrollment, participants completed an initial survey that assessed demographic and socioeconomic characteristics, previous pregnancies and births, prepregnancy health, health conditions during pregnancy, medications, psychological distress, social support, and hardships experienced because of the COVID-19 pandemic (eg, lost employment or a loved one dying). For the first three months following the initial survey, participants received a monthly email link to complete a follow-up survey that asked about their experiences since the previous survey. After three months, follow-up surveys were sent every other month to reduce participant burden. For each of these surveys, participants were first asked if they were still pregnant and then routed either to the next prenatal survey or to the delivery survey. In the postpartum period, surveys were sent at 3, 6, and 12 months of infant age to assess maternal stress, psychological distress, and infant development. Results: Participant recruitment via social media (Facebook and Instagram) began on April 5, 2020, and is ongoing. As of April 2021, more than 11,000 individuals have started the initial survey. Follow-up data collection is ongoing. Conclusions: This longitudinal investigation seeks to elucidate the associations among hardships, maternal psychological distress, child development during the COVID-19 pandemic, and risk and resilience factors that amplify or ameliorate these associations. The findings of this study are intended to generate knowledge about the psychological consequences of pandemics on pregnant individuals and point toward prevention and intervention targets. International Registered Report Identifier (IRRID): DERR1-10.2196/25407 %M 33848971 %R 10.2196/25407 %U https://www.researchprotocols.org/2021/4/e25407 %U https://doi.org/10.2196/25407 %U http://www.ncbi.nlm.nih.gov/pubmed/33848971 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24760 %T Psychological and Coping Strategies Related to Home Isolation and Social Distancing in Children and Adolescents During the COVID-19 Pandemic: Cross-sectional Study %A Zainel,Abduljaleel Abdullatif %A Qotba,Hamda %A Al-Maadeed,Alyaa %A Al-Kohji,Sadriya %A Al Mujalli,Hanan %A Ali,Atif %A Al Mannai,Lolwa %A Aladab,Aisha %A AlSaadi,Hamda %A AlKarbi,Khalid Ali %A Al-Baghdadi,Tholfakhar %+ Primary Health Care Corporation, PO Box 55772, Doha, Qatar, 974 55087676, azainel@phcc.gov.qa %K COVID-19 %K coronavirus %K pandemic %K psychological %K coping strategies %K children %K adolescents %K Qatar %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In December 2019, a novel coronavirus called SARS-CoV-2 was identified as the cause of a cluster of pneumonia cases in Wuhan, China. It rapidly spread due to human-to-human transmission, resulting in a global pandemic. Nearly every country, including Qatar, has established guidelines and regulations to limit the spread of the virus and to preserve public health. However, these procedures have been associated with negative effects on the psychological and intellectual well-being of individuals, including children and adolescents. Objective: The objective of this study was to determine the psychological influence of home isolation and social distancing on children and adolescents during the COVID-19 pandemic in Qatar, and the strategies used to cope with these measures. Methods: This cross-sectional study was undertaken using an online questionnaire administered through SMS text messaging. All home-isolated children and adolescents registered at the Primary Health Care Corporation aged 7-18 years were invited to participate in the study. Children and adolescents with intellectual disadvantages were excluded. A P value of .05 (two-tailed) was considered statistically significant. Results: Data were collected from 6608 participants from June 23 to July 18, 2020. Nearly all participants adhered to the official regulations during the period of home isolation and social distancing; however, 69.1% (n=4568) of parents believed their children were vulnerable to the virus compared to 25% (n=1652) who expressed they were not vulnerable at all. Higher levels of anger, depression, and general anxiety were prevalent among 1.3% (n=84), 3.9% (n=260), and 1.6% (n=104) of participants, respectively. The mean score for the emotional constructs anger and depression decreased with increased compliance with regulations (P=.04 and P=.11, respectively). The differences in mean score for all psychological and coping strategies used among participants across the 3 levels of vulnerability to SARS-CoV-2 were statistically significant. The mean score varied little with increasing reported vulnerability to the virus. This mild variation can make a difference when the sample size is large, as is the case in this study. Conclusions: Screening for psychological and social disruptions is important for the development of strategies by schools and health care providers to assess and monitor behavioral changes and negative psychological impact during post–COVID-19 reintegration. Participants experiencing higher levels of anxiety should be given more attention during reintegration and transitional phases in schools. Although electronic devices and social media platforms may have lowered anxiety levels in some cases, it is important to address how they are used and how content is tailored to children and adolescents. It is also important to maintain an active lifestyle for children and young persons, and encourage them not to neglect their physical health, as this promotes a better psychological state of mind. %M 33851577 %R 10.2196/24760 %U https://formative.jmir.org/2021/4/e24760 %U https://doi.org/10.2196/24760 %U http://www.ncbi.nlm.nih.gov/pubmed/33851577 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24180 %T Mobile Sensing Apps and Self-management of Mental Health During the COVID-19 Pandemic: Web-Based Survey %A Suruliraj,Banuchitra %A Bessenyei,Kitti %A Bagnell,Alexa %A McGrath,Patrick %A Wozney,Lori %A Orji,Rita %A Meier,Sandra %+ Department of Psychiatry, Dalhousie University, 5850/5980 University Avenue, PO Box 970, Halifax, NS, B3K 6R8, Canada, 1 782 414 8054, sandra.m.meier@gmail.com %K app %K awareness %K behavior %K COVID-19 %K helpfulness %K mobile health %K mobile sensing %K self-management %K sensing %K web-based survey %D 2021 %7 26.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, people had to adapt their daily life routines to the currently implemented public health measures, which is likely to have resulted in a lack of in-person social interactions, physical activity, or sleep. Such changes can have a significant impact on mental health. Mobile sensing apps can passively record the daily life routines of people, thus making them aware of maladaptive behavioral adjustments to the pandemic. Objective: This study aimed to explore the views of people on mobile sensing apps that passively record behaviors and their potential to increase awareness and helpfulness for self-managing mental health during the pandemic. Methods: We conducted an anonymous web-based survey including people with and those without mental disorders, asking them to rate the helpfulness of mobile sensing apps for the self-management of mental health during the COVID-19 pandemic. The survey was conducted in May 2020. Results: The majority of participants, particularly those with a mental disorder (n=106/148, 72%), perceived mobile sensing apps as very or extremely helpful for managing their mental health by becoming aware of maladaptive behaviors. The perceived helpfulness of mobile sensing apps was also higher among people who experienced a stronger health impact of the COVID-19 pandemic (β=.24; 95% CI 0.16-0.33; P<.001), had a better understanding of technology (β=.17; 95% CI 0.08-0.25; P<.001), and had a higher education (β=.1; 95% CI 0.02-0.19; P=.02). Conclusions: Our findings highlight the potential of mobile sensing apps to assist in mental health care during the pandemic. %M 33872181 %R 10.2196/24180 %U https://formative.jmir.org/2021/4/e24180 %U https://doi.org/10.2196/24180 %U http://www.ncbi.nlm.nih.gov/pubmed/33872181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24964 %T Decline of Psychological Health Following the Designation of COVID-19 as a Pandemic: Descriptive Study %A Patel,Darpan I %A Gamez,Yazmin %A Shah,Lajja %A Patel,Jaini %+ Biobehavioral Research Laboratory, School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, United States, 1 210 567 0362, pateld7@uthscsa.edu %K anxiety %K COVID-19 %K descriptive study %K mental health %K pandemic %K physical health %K quality of life %K stress %D 2021 %7 22.4.2021 %9 Short Paper %J J Med Internet Res %G English %X Background: COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020, and as of this writing, Texas, United States, has reported >675,000 cases with over 14,000 deaths. Many of the preventive measures implemented during the pandemic can increase sedentary lifestyles, which can lead to the development of chronic diseases, including obesity, among the general population and cause serious threats to people’s physical health and overall quality of life. Individuals with pre-existing comorbidities are at an increased risk of COVID-19 and may hence have higher levels of stress. Objective: This study aimed to investigate the relationship between physical activity levels and mental health status on an individual level and to compare them between those with and those without comorbidities in a cohort of Texas residents, before and after COVID-19 was declared a pandemic. Methods: An electronic survey was disseminated throughout various regions of Texas. In total, 160 individuals were asked questions about their demographic characteristics, time spent on daily physical activities, and daily mental health status before and after COVID-19 was declared a pandemic. Frequency distributions and descriptive statistics were analyzed. Results: Overall, 94 (58%) participants reported having ≥1 medical condition, and 31 (13.1%) had >3 medical conditions. Physical activity levels among participants with ≥1 pre-existing comorbidity drastically—but not significantly—decreased, as evident from a 10% increase in sedentary lifestyles after COVID-19 was declared a pandemic. On the contrary, we observed a 9% increase in the number of individuals without a pre-existing comorbidity who reported 30-60 min of physical activity per week. There was a 2-fold increase in the number of participants reporting more frequent feelings of nervousness, too much worry, trouble relaxing, and the fear of something awful happening after the pandemic. More specifically, individuals with pre-existing medical conditions reported, on average, a 10% higher incidence of feelings of stress, anxiety, and sadness compared to their healthy counterparts after COVID-19 was declared a pandemic. Conclusions: Stressful life conditions and chronic comorbidities are risk factors that can affect mental health and reduce the ability to perform activities of daily life. Therefore, when implementing pandemic protocols, municipalities should consider providing mental health support to their citizens to protect them from this rather inconspicuous adverse effect. %M 33793408 %R 10.2196/24964 %U https://www.jmir.org/2021/4/e24964 %U https://doi.org/10.2196/24964 %U http://www.ncbi.nlm.nih.gov/pubmed/33793408 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e28945 %T One Year of Pandemic Learning Response: Benefits of Massive Online Delivery of the World Health Organization’s Technical Guidance %A Utunen,Heini %A Van Kerkhove,Maria D %A Tokar,Anna %A O'Connell,Gillian %A Gamhewage,Gaya M %A Fall,Ibrahima Socé %+ Health Emergencies Programme, World Health Organization, 20 Avenue Appia, Geneva, 1211, Switzerland, 41 795933476, utunenh@who.int %K COVID-19 %K e-learning %K massive open web-based courses %K OpenWHO %K pandemic %K public health %K web-based learning %K World Health Organization %D 2021 %7 21.4.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The World Health Organization (WHO) launched the first web-based learning course on COVID-19 on January 26, 2020, four days before the director general of the WHO declared a public health emergency of international concern. The WHO is expanding access to web-based learning for COVID-19 through its open-learning platform for health emergencies, OpenWHO. Throughout the pandemic, OpenWHO has continued to publish learning offerings based on the WHO’s emerging evidence-based knowledge for managing the COVID-19 pandemic. This study presents the various findings derived from the analysis of the performance of the OpenWHO platform during the pandemic, along with the core benefits of massive web-based learning formats. %M 33881404 %R 10.2196/28945 %U https://publichealth.jmir.org/2021/4/e28945 %U https://doi.org/10.2196/28945 %U http://www.ncbi.nlm.nih.gov/pubmed/33881404 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23311 %T The Uncounted Casualties of a Hidden COVID-19 Epidemic in China: Cross-sectional Study on Deaths Related to Overwork %A Wang,Zhicheng %A Lin,Leesa %A Guo,Yan %A Xiong,Huayi %A Tang,Kun %+ Vanke School of Public Health, Tsinghua University, No. 30, Shuangqing Road, Haidian District, Beijing, China, 86 13671129425, tangk@mail.tsinghua.edu.cn %K nonpharmaceutical interventions %K on-duty deaths %K COVID-19 %K overwork death %K crowdsourced data %K intervention %K mortality %K casualty %K cross-sectional %K overwork %K stress %D 2021 %7 20.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 response, nonclinical essential workers usually worked overtime and experienced significant work stress, which subsequently increased their risk of mortality due to cardiovascular diseases, stroke, and pre-existing conditions. Deaths on duty, including deaths due to overwork, during the COVID-19 response were usually reported on web-based platforms for public recognition and solidarity. Although no official statistics are available for these casualties, a list of on-duty deaths has been made publicly available on the web by crowdsourcing. Objective: This study aims to understand the trends and characteristics of deaths related to overwork among the frontline nonclinical essential workers participating in nonpharmaceutical interventions during the first wave of COVID-19 in China. Methods: Based on a web-based crowdsourced list of deaths on duty during the first wave of the COVID-19 response in China, we manually verified all overwork-related death records against the full-text web reports from credible sources. After excluding deaths caused by COVID-19 infection and accidents, a total of 340 deaths related to overwork among nonclinical essential workers were attributed to combatting the COVID-19 crisis. We coded the key characteristics of the deceased workers, including sex, age at death, location, causes of death, date of incidence, date of death, containment duties, working area, and occupation. The temporal and spatial correlations between deaths from overwork and COVID-19 cases in China were also examined using Pearson correlation coefficient. Results: From January 20 to April 26, 2020, at least 340 nonclinical frontline workers in China were reported to have died as a result of overwork while combatting COVID-19. The weekly overwork mortality was positively correlated with weekly COVID-19 cases (r=0.79, P<.001). Two-thirds of deceased workers (230/340, 67.6%) were under 55 years old, and two major causes of deaths related to overwork were cardiovascular diseases (138/340, 40.6%) and cerebrovascular diseases (73/340, 21.5%). Outside of Hubei province, there were almost 2.5 times as many deaths caused by COVID-19–related overwork (308/340, 90.6%) than by COVID-19 itself (n=120). Conclusions: The high number of deaths related to overwork among nonclinical essential workers at the frontline of the COVID-19 epidemic is alarming. Policies for occupational health protection against work hazards should therefore be prioritized and enforced. %M 33822735 %R 10.2196/23311 %U https://www.jmir.org/2021/4/e23311 %U https://doi.org/10.2196/23311 %U http://www.ncbi.nlm.nih.gov/pubmed/33822735 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e25097 %T Learning the Mental Health Impact of COVID-19 in the United States With Explainable Artificial Intelligence: Observational Study %A Jha,Indra Prakash %A Awasthi,Raghav %A Kumar,Ajit %A Kumar,Vibhor %A Sethi,Tavpritesh %+ Indraprastha Institute of Information Technology, Room 309, R and D Building, IIIT Campus, Okhla Phase 3, New Delhi, India, 91 01126907533, tavpriteshsethi@iiitd.ac.in %K COVID-19 %K mental health %K Bayesian network %K machine learning %K artificial intelligence %K disorder %K susceptibility %K well-being %K explainable artificial intelligence %D 2021 %7 20.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has affected the health, economic, and social fabric of many nations worldwide. Identification of individual-level susceptibility factors may help people in identifying and managing their emotional, psychological, and social well-being. Objective: This study is focused on learning a ranked list of factors that could indicate a predisposition to a mental disorder during the COVID-19 pandemic. Methods: In this study, we have used a survey of 17,764 adults in the United States from different age groups, genders, and socioeconomic statuses. Through initial statistical analysis and Bayesian network inference, we have identified key factors affecting mental health during the COVID-19 pandemic. Integrating Bayesian networks with classical machine learning approaches led to effective modeling of the level of mental health prevalence. Results: Overall, females were more stressed than males, and people in the age group 18-29 years were more vulnerable to anxiety than other age groups. Using the Bayesian network model, we found that people with a chronic mental illness were more prone to mental disorders during the COVID-19 pandemic. The new realities of working from home; homeschooling; and lack of communication with family, friends, and neighbors induces mental pressure. Financial assistance from social security helps in reducing mental stress during the COVID-19–generated economic crises. Finally, using supervised machine learning models, we predicted the most mentally vulnerable people with ~80% accuracy. Conclusions: Multiple factors such as social isolation, digital communication, and working and schooling from home were identified as factors of mental illness during the COVID-19 pandemic. Regular in-person communication with friends and family, a healthy social life, and social security were key factors, and taking care of people with a history of mental disease appears to be even more important during this time. %M 33877051 %R 10.2196/25097 %U https://mental.jmir.org/2021/4/e25097 %U https://doi.org/10.2196/25097 %U http://www.ncbi.nlm.nih.gov/pubmed/33877051 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26994 %T Rise in Use of Digital Mental Health Tools and Technologies in the United States During the COVID-19 Pandemic: Survey Study %A Sorkin,Dara H %A Janio,Emily A %A Eikey,Elizabeth V %A Schneider,Margaret %A Davis,Katelyn %A Schueller,Stephen M %A Stadnick,Nicole A %A Zheng,Kai %A Neary,Martha %A Safani,David %A Mukamel,Dana B %+ Department of Medicine, University of California, Irvine, 100 Theory, Suite 120, Irvine, CA, 92697, United States, 1 949 824 0149, dsorkin@uci.edu %K COVID-19 %K digital technologies %K mHealth %K mental health %K anxiety %K depression %K MTurk %K e-mental health %K digital health %K distress %K self-management %D 2021 %7 16.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Accompanying the rising rates of reported mental distress during the COVID-19 pandemic has been a reported increase in the use of digital technologies to manage health generally, and mental health more specifically. Objective: The objective of this study was to systematically examine whether there was a COVID-19 pandemic–related increase in the self-reported use of digital mental health tools and other technologies to manage mental health. Methods: We analyzed results from a survey of 5907 individuals in the United States using Amazon Mechanical Turk (MTurk); the survey was administered during 4 week-long periods in 2020 and survey respondents were from all 50 states and Washington DC. The first set of analyses employed two different logistic regression models to estimate the likelihood of having symptoms indicative of clinical depression and anxiety, respectively, as a function of the rate of COVID-19 cases per 10 people and survey time point. The second set employed seven different logistic regression models to estimate the likelihood of using seven different types of digital mental health tools and other technologies to manage one’s mental health, as a function of symptoms indicative of clinical depression and anxiety, rate of COVID-19 cases per 10 people, and survey time point. These models also examined potential interactions between symptoms of clinical depression and anxiety, respectively, and rate of COVID-19 cases. All models controlled for respondent sociodemographic characteristics and state fixed effects. Results: Higher COVID-19 case rates were associated with a significantly greater likelihood of reporting symptoms of depression (odds ratio [OR] 2.06, 95% CI 1.27-3.35), but not anxiety (OR 1.21, 95% CI 0.77-1.88). Survey time point, a proxy for time, was associated with a greater likelihood of reporting clinically meaningful symptoms of depression and anxiety (OR 1.19, 95% CI 1.12-1.27 and OR 1.12, 95% CI 1.05-1.19, respectively). Reported symptoms of depression and anxiety were associated with a greater likelihood of using each type of technology. Higher COVID-19 case rates were associated with a significantly greater likelihood of using mental health forums, websites, or apps (OR 2.70, 95% CI 1.49-4.88), and other health forums, websites, or apps (OR 2.60, 95% CI 1.55-4.34). Time was associated with increased odds of reported use of mental health forums, websites, or apps (OR 1.20, 95% CI 1.11-1.30), phone-based or text-based crisis lines (OR 1.20, 95% CI 1.10-1.31), and online, computer, or console gaming/video gaming (OR 1.12, 95% CI 1.05-1.19). Interactions between COVID-19 case rate and mental health symptoms were not significantly associated with any of the technology types. Conclusions: Findings suggested increased use of digital mental health tools and other technologies over time during the early stages of the COVID-19 pandemic. As such, additional effort is urgently needed to consider the quality of these products, either by ensuring users have access to evidence-based and evidence-informed technologies and/or by providing them with the skills to make informed decisions around their potential efficacy. %M 33822737 %R 10.2196/26994 %U https://www.jmir.org/2021/4/e26994 %U https://doi.org/10.2196/26994 %U http://www.ncbi.nlm.nih.gov/pubmed/33822737 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24577 %T Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study %A Guo,Ziqiu %A Zhao,Sheng Zhi %A Guo,Ningyuan %A Wu,Yongda %A Weng,Xue %A Wong,Janet Yuen-Ha %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, University of Hong Kong, 21 Sassoon Road, Hong Kong, China (Hong Kong), 852 3917 6636, mpwang@hku.hk %K COVID-19 %K eHealth literacy %K preventive behaviors %K socioeconomic disparities %K web-based information seeking %D 2021 %7 14.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy can potentially facilitate web-based information seeking and taking informed measures. Objective: This study aimed to evaluate socioeconomic disparities in eHealth literacy and seeking of web-based information on COVID-19, and their associations with COVID-19 preventive behaviors. Methods: The COVID-19 Health Information Survey (CoVHIns), using telephonic (n=500) and web-based surveys (n=1001), was conducted among adults in Hong Kong in April 2020. The Chinese eHealth literacy scale (eHEALS; score range 8-40) was used to measure eHealth literacy. COVID-19 preventive behaviors included wearing surgical masks, wearing fabric masks, washing hands, social distancing, and adding water or bleach to the household drainage system. Adjusted beta coefficients and the slope indices of inequality for the eHEALS score by socioeconomic status, adjusted odds ratios (aORs) for seeking of web-based information on COVID-19 by socioeconomic status, and aORs for the high adherence to preventive behaviors by the eHEALS score and seeking of web-based information on COVID-19 were calculated. Results: The mean eHEALS score was 26.10 (SD 7.70). Age was inversely associated with the eHEALS score, but education and personal income were positively associated with the eHEALS score and seeking of web-based information on COVID-19 (for all, P for trend<.05). Participants who sought web-based information on COVID-19 showed high adherence to the practice of wearing surgical masks (aOR 1.56, 95% CI 1.15-2.13), washing hands (aOR 1.33, 95% CI 1.05-1.71), social distancing (aOR 1.48, 95% CI 1.14-1.93), and adding water or bleach to the household drainage system (aOR 1.67, 95% CI 1.28-2.18). Those with the highest eHEALS score displayed high adherence to the practice of wearing surgical masks (aOR 3.84, 95% CI 1.63-9.05), washing hands (aOR 4.14, 95% CI 2.46-6.96), social distancing (aOR 2.25, 95% CI 1.39-3.65), and adding water or bleach to the household drainage system (aOR 1.94, 95% CI 1.19-3.16), compared to those with the lowest eHEALS score. Conclusions: Chinese adults with a higher socioeconomic status had higher eHealth literacy and sought more web-based information on COVID-19; both these factors were associated with a high adherence to the guidelines for preventive behaviors during the COVID-19 pandemic. %M 33784240 %R 10.2196/24577 %U https://www.jmir.org/2021/4/e24577 %U https://doi.org/10.2196/24577 %U http://www.ncbi.nlm.nih.gov/pubmed/33784240 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e28479 %T The Effect of Meditation and Physical Activity on the Mental Health Impact of COVID-19–Related Stress and Attention to News Among Mobile App Users in the United States: Cross-sectional Survey %A Green,Jennifer %A Huberty,Jennifer %A Puzia,Megan %A Stecher,Chad %+ College of Health Solutions, Arizona State University, 500 N. 3rd St., Phoenix, AZ, 85004, United States, 1 602 827 2314, jeni.green@asu.edu %K coronavirus %K health behavior %K mindfulness meditation %K mHealth %K COVID-19 %K mental health %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has been declared an international public health emergency, and it may have long-lasting effects on people’s mental health. There is a need to identify effective health behaviors to mitigate the negative mental health impact of COVID-19. Objective: The objectives of this study were to (1) examine the regional differences in mental health and COVID-19–related worry, attention to news, and stress, in light of the state-level prevalence of COVID-19 cases; (2) estimate the associations between mental health and COVID-19–related worry, attention to news, and stress and health behavior engagement (ie, physical activity, mindfulness meditation); and (3) explore the mediating effect of health behavior engagement on the associations between mental health and COVID-19–related worry, attention to news, and stress. Methods: A cross-sectional survey was distributed to a sample of US adult paying subscribers to the Calm app (data were collected from April 22 to June 3, 2020). The survey assessed COVID-19–related worry, attention to news, and stress; health behavior engagement; and mental health (ie, perceived stress, posttraumatic stress disorder, and anxiety and depression). Statistical analyses were performed using R software. Differences in COVID-19–related worry, attention to news, and stress and mental health by location were assessed using t tests and chi-square tests. Logistic and ordinary least squares models were used to regress mental health and health behavior on COVID-19–related worry, attention to news, and stress; moreover, causal mediation analysis was used to estimate the significance of the mediation effects. Results: The median age of the respondents (N=8392) was 47 years (SD 13.8). Participants in the Mid-Atlantic region (New Jersey, New York, and Pennsylvania) reported higher levels of stress, more severe depression symptoms, greater worry about COVID-19, paying more attention to COVID-19–related news, and more stress related to social distancing recommendations than participants living in other regions. The association between worry about COVID-19 and perceived stress was significantly mediated by changes in physical activity (P<.001), strength of meditation habit (P<.001), and stopping meditation (P=.046). The association between worry about COVID-19 and posttraumatic stress disorder symptoms was significantly mediated by changes in physical activity (P<.001) and strength of meditation habit (P<.001). Conclusions: Our findings describe the mental health impact of COVID-19 and outline how continued participation in health behaviors such as physical activity and mindfulness meditation reduce worsening of mental health due to the COVID-19 pandemic. These data have important implications for public health agencies and health organizations to promote the maintenance of health habits to reduce the residual mental health burden of the COVID-19 pandemic. %M 33788698 %R 10.2196/28479 %U https://mental.jmir.org/2021/4/e28479 %U https://doi.org/10.2196/28479 %U http://www.ncbi.nlm.nih.gov/pubmed/33788698 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e26474 %T Impact of the COVID-19 Pandemic on Older Adults: Rapid Review %A Lebrasseur,Audrey %A Fortin-Bédard,Noémie %A Lettre,Josiane %A Raymond,Emilie %A Bussières,Eve-Line %A Lapierre,Nolwenn %A Faieta,Julie %A Vincent,Claude %A Duchesne,Louise %A Ouellet,Marie-Christine %A Gagnon,Eric %A Tourigny,André %A Lamontagne,Marie-Ève %A Routhier,François %+ Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 525 Hamel est, Québec, QC, G1M 2S8, Canada, 1 4185299141 ext 6256, francois.routhier@rea.ulaval.ca %K COVID-19 %K impact %K rapid review %K older adults %K aged individuals %K review %D 2021 %7 12.4.2021 %9 Review %J JMIR Aging %G English %X Background: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. Objective: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. Methods: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework–Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Results: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. Conclusions: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers. %M 33720839 %R 10.2196/26474 %U https://aging.jmir.org/2021/2/e26474 %U https://doi.org/10.2196/26474 %U http://www.ncbi.nlm.nih.gov/pubmed/33720839 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24617 %T Effects of Participating in a Research Project During the COVID-19 Pandemic on Medical Students’ Educational Routines and Mental Health: Protocol for a Web-Based Survey Study %A Calderaro,Débora Cerqueira %A Kahlow,Barbara Stadler %A Munhoz,Gabriela Araújo %A Dias,Samuel Elias Basualto %A Lopes,João Vitor Ziroldo %A Borges,Aline Rizzo %A Mariz,Henrique De Ataíde %A Gomes,Kirla Wagner Poti %A Valadares,Lilian David De Azevedo %A Araújo,Nafice Costa %A Ribeiro,Sandra Lucia Euzébio %A Kakehasi,Adriana Maria %A Reis,Ana Paula Monteiro Gomides %A Marques,Cláudia %A Reis-Neto,Edgard Torres %A Paiva,Eduardo Dos Santos %A Pileggi,Gecilmara Salviato %A Ferreira,Gilda Aparecida %A Provenza,José Roberto %A Mota,Licia Maria Henrique %A Xavier,Ricardo Machado %A Teodoro,Maycoln Leôni Martins %A Pinheiro,Marcelo De Medeiros %A , %+ Universidade Federal de Minas Gerais, 190 Professor Alfredo Balena Avenue, Belo Horizonte, 30130-100, Brazil, 55 3134099757, dccalderaro@gmail.com %K SARS-CoV-2 %K COVID-19 %K medical education %K observational %K cross-sectional %K case-control study %K voluntary %K mental health %K rheumatic disease %K medical student %K protocol %K survey %D 2021 %7 9.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has resulted in social isolation, which has a potential negative impact on the educational routines (eg, the suspension of face-to-face appointments) and mental health of medical students. The Mario Pinotti II (MPII) study is a 24-week observational study that conducted scheduled telephone calls every 2 weeks to verify the occurrence of COVID-19 in patients with rheumatic diseases on chronic hydroxychloroquine therapy (from March 29, 2020, to September 30, 2020). The effects of voluntarily participating in a research project (ie, one that involves interactions via telephone contact with patients, professors, rheumatologists, and colleagues) on the daily lives and mental health of medical students requires evaluation. Objective: As medical students are professionals in training and have a high level of responsibility in terms of handling the emotional and physical aspects of several diseases, this study aims to evaluate the impacts of the COVID-19 pandemic and participation in the MPII study on the educational routines and mental health of medical students. Methods: A web-based survey was carried out to perform a cross-sectional comparative assessment of medical students who participated in the MPII study and their colleagues who were not involved in the MPII study. Participants from both groups were matched based on sex, age, and medical school. The web questionnaire was developed by a panel composed of graduate medical students, rheumatologists, medical school professors, and a psychology professor. The questionnaire included details on demographic and life habits data and evaluated participants' impressions of the MPII study and the impact of the COVID-19 pandemic on their educational routines and medical training. In addition, depression, anxiety, and stress were evaluated using the Brazilian version of the Depression, Anxiety, and Stress Scale (DASS)-21, and currently, the DASS-21 scores are grouped as those that indicate a low, moderate, or high risk of mental distress. This project was approved by the Federal University of São Paulo Ethics Committee (CAAE: 34034620.0.0000.5505). Results: Data were collected from both medical student groups from July 20 to August 31, 2020. Data extraction was completed in September 2020. The data analysis is ongoing. We expect the results to be published in the first semester of 2021. Conclusions: This study will provide insight into the effects of participating in a research project on depression, anxiety, and stress, which will be determined by applying the DASS-21 to a large sample of Brazilian undergraduate medical students. We will also evaluate the impact of the COVID-19 pandemic on medical students’ educational routines and medical training. International Registered Report Identifier (IRRID): DERR1-10.2196/24617 %M 33735094 %R 10.2196/24617 %U https://www.researchprotocols.org/2021/4/e24617 %U https://doi.org/10.2196/24617 %U http://www.ncbi.nlm.nih.gov/pubmed/33735094 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e22734 %T Health, Psychosocial, and Social Issues Emanating From the COVID-19 Pandemic Based on Social Media Comments: Text Mining and Thematic Analysis Approach %A Oyebode,Oladapo %A Ndulue,Chinenye %A Adib,Ashfaq %A Mulchandani,Dinesh %A Suruliraj,Banuchitra %A Orji,Fidelia Anulika %A Chambers,Christine T %A Meier,Sandra %A Orji,Rita %+ Faculty of Computer Science, Dalhousie University, 6050 University Avenue, Halifax, NS, B3H 1W5, Canada, 1 902 494 2093, oladapo.oyebode@dal.ca %K social media %K COVID-19 %K coronavirus %K infodemiology %K infoveillance %K natural language processing %K text mining %K thematic analysis %K interventions %K health issues %K psychosocial issues %K social issues %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has caused a global health crisis that affects many aspects of human lives. In the absence of vaccines and antivirals, several behavioral change and policy initiatives such as physical distancing have been implemented to control the spread of COVID-19. Social media data can reveal public perceptions toward how governments and health agencies worldwide are handling the pandemic, and the impact of the disease on people regardless of their geographic locations in line with various factors that hinder or facilitate the efforts to control the spread of the pandemic globally. Objective: This paper aims to investigate the impact of the COVID-19 pandemic on people worldwide using social media data. Methods: We applied natural language processing (NLP) and thematic analysis to understand public opinions, experiences, and issues with respect to the COVID-19 pandemic using social media data. First, we collected over 47 million COVID-19–related comments from Twitter, Facebook, YouTube, and three online discussion forums. Second, we performed data preprocessing, which involved applying NLP techniques to clean and prepare the data for automated key phrase extraction. Third, we applied the NLP approach to extract meaningful key phrases from over 1 million randomly selected comments and computed sentiment score for each key phrase and assigned sentiment polarity (ie, positive, negative, or neutral) based on the score using a lexicon-based technique. Fourth, we grouped related negative and positive key phrases into categories or broad themes. Results: A total of 34 negative themes emerged, out of which 15 were health-related issues, psychosocial issues, and social issues related to the COVID-19 pandemic from the public perspective. Some of the health-related issues were increased mortality, health concerns, struggling health systems, and fitness issues; while some of the psychosocial issues were frustrations due to life disruptions, panic shopping, and expression of fear. Social issues were harassment, domestic violence, and wrong societal attitude. In addition, 20 positive themes emerged from our results. Some of the positive themes were public awareness, encouragement, gratitude, cleaner environment, online learning, charity, spiritual support, and innovative research. Conclusions: We uncovered various negative and positive themes representing public perceptions toward the COVID-19 pandemic and recommended interventions that can help address the health, psychosocial, and social issues based on the positive themes and other research evidence. These interventions will help governments, health professionals and agencies, institutions, and individuals in their efforts to curb the spread of COVID-19 and minimize its impact, and in reacting to any future pandemics. %M 33684052 %R 10.2196/22734 %U https://medinform.jmir.org/2021/4/e22734 %U https://doi.org/10.2196/22734 %U http://www.ncbi.nlm.nih.gov/pubmed/33684052 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e23593 %T Concerns Discussed on Chinese and French Social Media During the COVID-19 Lockdown: Comparative Infodemiology Study Based on Topic Modeling %A Schück,Stéphane %A Foulquié,Pierre %A Mebarki,Adel %A Faviez,Carole %A Khadhar,Mickaïl %A Texier,Nathalie %A Katsahian,Sandrine %A Burgun,Anita %A Chen,Xiaoyi %+ Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 15 Rue de l'école de médecine, Paris, F-75006, France, 33 171196369, xiaoyi.chen@inserm.fr %K comparative analysis %K content analysis %K topic model %K social media %K COVID-19 %K lockdown %K China %K France %K impact %K population %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, numerous countries, including China and France, have implemented lockdown measures that have been effective in controlling the epidemic. However, little is known about the impact of these measures on the population as expressed on social media from different cultural contexts. Objective: This study aims to assess and compare the evolution of the topics discussed on Chinese and French social media during the COVID-19 lockdown. Methods: We extracted posts containing COVID-19–related or lockdown-related keywords in the most commonly used microblogging social media platforms (ie, Weibo in China and Twitter in France) from 1 week before lockdown to the lifting of the lockdown. A topic model was applied independently for three periods (prelockdown, early lockdown, and mid to late lockdown) to assess the evolution of the topics discussed on Chinese and French social media. Results: A total of 6395; 23,422; and 141,643 Chinese Weibo messages, and 34,327; 119,919; and 282,965 French tweets were extracted in the prelockdown, early lockdown, and mid to late lockdown periods, respectively, in China and France. Four categories of topics were discussed in a continuously evolving way in all three periods: epidemic news and everyday life, scientific information, public measures, and solidarity and encouragement. The most represented category over all periods in both countries was epidemic news and everyday life. Scientific information was far more discussed on Weibo than in French tweets. Misinformation circulated through social media in both countries; however, it was more concerned with the virus and epidemic in China, whereas it was more concerned with the lockdown measures in France. Regarding public measures, more criticisms were identified in French tweets than on Weibo. Advantages and data privacy concerns regarding tracing apps were also addressed in French tweets. All these differences were explained by the different uses of social media, the different timelines of the epidemic, and the different cultural contexts in these two countries. Conclusions: This study is the first to compare the social media content in eastern and western countries during the unprecedented COVID-19 lockdown. Using general COVID-19–related social media data, our results describe common and different public reactions, behaviors, and concerns in China and France, even covering the topics identified in prior studies focusing on specific interests. We believe our study can help characterize country-specific public needs and appropriately address them during an outbreak. %M 33750736 %R 10.2196/23593 %U https://formative.jmir.org/2021/4/e23593 %U https://doi.org/10.2196/23593 %U http://www.ncbi.nlm.nih.gov/pubmed/33750736 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 1 %P e25610 %T The Psychological Impact of Hypertension During COVID-19 Restrictions: Retrospective Case-Control Study %A Bonner,Carissa %A Cvejic,Erin %A Ayre,Julie %A Isautier,Jennifer %A Semsarian,Christopher %A Nickel,Brooke %A Batcup,Carys %A Pickles,Kristen %A Dodd,Rachael %A Cornell,Samuel %A Copp,Tessa %A McCaffery,Kirsten J %+ Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building A27, Rm 128A, Sydney, NSW 2006, Australia, 61 2 9351 7125, carissa.bonner@sydney.edu.au %K public health %K global health %K COVID-19 %K hypertension %K risk %K strategy %K mental health %K behavior %K response %K anxiety %K vaccine %K retrospective %K perception %K prevention %K intention %D 2021 %7 30.3.2021 %9 Original Paper %J JMIRx Med %G English %X Background: It is unclear how people with hypertension are responding to the COVID-19 pandemic given their increased risk, and whether targeted public health strategies are needed. Objective: This retrospective case-control study compared people with hypertension to matched healthy controls during the COVID-19 lockdown to determine whether they have higher risk perceptions, anxiety, and vaccination intentions. Methods: Baseline data from a national survey were collected in April 2020 during the COVID-19 lockdown in Australia. People who reported hypertension with no other chronic conditions were randomly matched to healthy controls of similar age, gender, education, and health literacy level. A subset including participants with hypertension was followed up at 2 months after restrictions were eased. Risk perceptions, anxiety, and vaccination intentions were measured in April and June. Results: Of the 4362 baseline participants, 466 (10.7%) reported hypertension with no other chronic conditions. A subset of 1369 people were followed up at 2 months, which included 147 (10.7%) participants with hypertension. At baseline, perceived seriousness was high for both hypertension and control groups. The hypertension group reported greater anxiety compared to the controls and were more willing to vaccinate against influenza, but COVID-19 vaccination intentions were similar. At follow-up, these differences were no longer present in the longitudinal subsample. Perceived seriousness and anxiety had decreased, but vaccination intentions for both influenza and COVID-19 remained high across groups (>80%). Conclusions: Anxiety was above normal levels during the COVID-19 lockdown. It was higher in the hypertension group, which also had higher vaccination intentions. Groups that are more vulnerable to COVID-19 may require targeted mental health screening during periods of greater risk. Despite a decrease in perceived risk and anxiety after 2 months of lockdown restrictions, vaccination intentions remained high, which is encouraging for the future prevention of COVID-19. %M 34076628 %R 10.2196/25610 %U https://xmed.jmir.org/2021/1/e25610 %U https://doi.org/10.2196/25610 %U http://www.ncbi.nlm.nih.gov/pubmed/34076628 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e26811 %T Digital Mental Health Challenges and the Horizon Ahead for Solutions %A Balcombe,Luke %A De Leo,Diego %+ Australian Institute for Suicide Research and Prevention, Griffith University, Messines Ridge Rd, Brisbane, 4122, Australia, 61 0447505709, lukebalcombe@gmail.com %K challenges %K COVID-19 %K digital mental health implementation %K explainable artificial intelligence %K hybrid model of care %K human-computer interaction %K resilience %K technology %D 2021 %7 29.3.2021 %9 Commentary %J JMIR Ment Health %G English %X The demand outstripping supply of mental health resources during the COVID-19 pandemic presents opportunities for digital technology tools to fill this new gap and, in the process, demonstrate capabilities to increase their effectiveness and efficiency. However, technology-enabled services have faced challenges in being sustainably implemented despite showing promising outcomes in efficacy trials since the early 2000s. The ongoing failure of these implementations has been addressed in reconceptualized models and frameworks, along with various efforts to branch out among disparate developers and clinical researchers to provide them with a key for furthering evaluative research. However, the limitations of traditional research methods in dealing with the complexities of mental health care warrant a diversified approach. The crux of the challenges of digital mental health implementation is the efficacy and evaluation of existing studies. Web-based interventions are increasingly used during the pandemic, allowing for affordable access to psychological therapies. However, a lagging infrastructure and skill base has limited the application of digital solutions in mental health care. Methodologies need to be converged owing to the rapid development of digital technologies that have outpaced the evaluation of rigorous digital mental health interventions and strategies to prevent mental illness. The functions and implications of human-computer interaction require a better understanding to overcome engagement barriers, especially with predictive technologies. Explainable artificial intelligence is being incorporated into digital mental health implementation to obtain positive and responsible outcomes. Investment in digital platforms and associated apps for real-time screening, tracking, and treatment offer the promise of cost-effectiveness in vulnerable populations. Although machine learning has been limited by study conduct and reporting methods, the increasing use of unstructured data has strengthened its potential. Early evidence suggests that the advantages outweigh the disadvantages of incrementing such technology. The limitations of an evidence-based approach require better integration of decision support tools to guide policymakers with digital mental health implementation. There is a complex range of issues with effectiveness, equity, access, and ethics (eg, privacy, confidentiality, fairness, transparency, reproducibility, and accountability), which warrant resolution. Evidence-informed policies, development of eminent digital products and services, and skills to use and maintain these solutions are required. Studies need to focus on developing digital platforms with explainable artificial intelligence–based apps to enhance resilience and guide the treatment decisions of mental health practitioners. Investments in digital mental health should ensure their safety and workability. End users should encourage the use of innovative methods to encourage developers to effectively evaluate their products and services and to render them a worthwhile investment. Technology-enabled services in a hybrid model of care are most likely to be effective (eg, specialists using these services among vulnerable, at-risk populations but not severe cases of mental ill health). %M 33779570 %R 10.2196/26811 %U https://mental.jmir.org/2021/3/e26811 %U https://doi.org/10.2196/26811 %U http://www.ncbi.nlm.nih.gov/pubmed/33779570 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e25779 %T Health Impacts of the Stay-at-Home Order on Community-Dwelling Older Adults and How Technologies May Help: Focus Group Study %A Daly,Jessica R %A Depp,Colin %A Graham,Sarah A %A Jeste,Dilip V %A Kim,Ho-Cheol %A Lee,Ellen E %A Nebeker,Camille %+ Research Center for Optimal Digital Ethics in Health, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0811, United States, 1 8585347786, nebeker@eng.ucsd.edu %K aging %K quarantine %K mental health %K physical health %K social isolation %K COVID-19 pandemic %K continued care senior housing community %K CCSHC %K qualitative research %K videoconferencing %K older adults %K gerontechnology %K loneliness %K housing for the elderly %K independent living %D 2021 %7 22.3.2021 %9 Original Paper %J JMIR Aging %G English %X Background: As of March 2021, in the USA, the COVID-19 pandemic has resulted in over 500,000 deaths, with a majority being people over 65 years of age. Since the start of the pandemic in March 2020, preventive measures, including lockdowns, social isolation, quarantine, and social distancing, have been implemented to reduce viral spread. These measures, while effective for risk prevention, may contribute to increased social isolation and loneliness among older adults and negatively impact their mental and physical health. Objective: This study aimed to assess the impact of the COVID-19 pandemic and the resulting “Stay-at-Home” order on the mental and physical health of older adults and to explore ways to safely increase social connectedness among them. Methods: This qualitative study involved older adults living in a Continued Care Senior Housing Community (CCSHC) in southern California, USA. Four 90-minute focus groups were convened using the Zoom Video Communications platform during May 2020, involving 21 CCSHC residents. Participants were asked to describe how they were managing during the “stay-at-home” mandate that was implemented in March 2020, including its impact on their physical and mental health. Transcripts of each focus group were analyzed using qualitative methods. Results: Four themes emerged from the qualitative data: (1) impact of the quarantine on health and well-being, (2) communication innovation and technology use, (3) effective ways of coping with the quarantine, and (4) improving access to technology and training. Participants reported a threat to their mental and physical health directly tied to the quarantine and exacerbated by social isolation and decreased physical activity. Technology was identified as a lifeline for many who are socially isolated from their friends and family. Conclusions: Our study findings suggest that technology access, connectivity, and literacy are potential game-changers to supporting the mental and physical health of older adults and must be prioritized for future research. %M 33690146 %R 10.2196/25779 %U https://aging.jmir.org/2021/1/e25779 %U https://doi.org/10.2196/25779 %U http://www.ncbi.nlm.nih.gov/pubmed/33690146 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27015 %T Social Media and Emotional Burnout Regulation During the COVID-19 Pandemic: Multilevel Approach %A Shao,Ruosi %A Shi,Zhen %A Zhang,Di %+ The Research Center for Journalism and Social Development, Renmin University of China, RM713 Mingde Journalism Building, 59 Zhongguancun Rd, Haidian Dist, Beijing, 100872, China, 86 13801247280, zhangdi204@gmail.com %K COVID-19 %K pandemic %K emotion regulation %K emotional exhaustion %K multilevel approach %K well-being %K emotion %K mental health %K social media %K perspective %K strategy %K effective %K modeling %K buffer %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In February 2020, the Chinese government imposed a complete lockdown of Wuhan and other cities in Hubei Province to contain a spike of COVID-19 cases. Although such measures are effective in preventing the spread of the virus, medical professionals strongly voiced a caveat concerning the pandemic emotional burnout at the individual level. Although the lockdown limited individuals’ interpersonal communication with people in their social networks, it is common that individuals turn to social media to seek and share health information, exchange social support, and express pandemic-generated feelings. Objective: Based on a holistic and multilevel perspective, this study examines how pandemic-related emotional exhaustion enacts intrapersonal, interpersonal, and hyperpersonal emotional regulation strategies, and then evaluates the effectiveness of these strategies, with a particular interest in understanding the role of hyperpersonal-level regulation or social media–based regulation. Methods: Using an online panel, this study sampled 538 Chinese internet users from Hubei Province, the epicenter of the COVID-19 outbreak in China. Survey data collection lasted for 12 days from February 7-18, 2020, two weeks after Hubei Province was placed under quarantine. The sample had an average age of 35 (SD 10.65, range 18-78) years, and a majority were married (n=369, 68.6%). Results: Using structural equation modeling, this study found that intrapersonal-level (B=0.22; β=.24; P<.001) and interpersonal-level (B=0.35; β=.49; P<.001) emotional regulation strategies were positively associated with individuals’ outcome reappraisal. In contrast with intrapersonal and interpersonal regulations, hyperpersonal (social media–based) regulation strategies, such as disclosing and retweeting negative emotions, were negatively related to the outcome reappraisal (B=–1.00; β=–.80; P<.001). Conclusions: Consistent with previous literature, intrapersonal-level regulation (eg, cognitive reappraisal, mindfulness, and self-kindness) and interpersonal-level supportive interaction may generate a buffering effect on emotional exhaustion and promote individuals’ reappraisal toward the stressful situation. However, hyperpersonal-level regulation may exacerbate the experienced negative emotions and impede reappraisal of the pandemic situation. It is speculated that retweeting content that contains pandemic-related stress and anxiety may cause a digital emotion contagion. Individuals who share other people’s negative emotional expressions on social media are likely to be affected by the negative affect contagion. More importantly, the possible benefits of intrapersonal and interpersonal emotion regulations may be counteracted by social media or hyperpersonal regulation. This suggests the necessity to conduct social media–based health communication interventions to mitigate the social media–wide negative affect contagion if lockdown policies related to highly infectious diseases are initiated. %M 33661753 %R 10.2196/27015 %U https://www.jmir.org/2021/3/e27015 %U https://doi.org/10.2196/27015 %U http://www.ncbi.nlm.nih.gov/pubmed/33661753 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e21757 %T Effects of Web-Based Group Mindfulness Training on Stress and Sleep Quality in Singapore During the COVID-19 Pandemic: Retrospective Equivalence Analysis %A Lim,Julian %A Leow,Zaven %A Ong,Jason %A Pang,Ly-Shan %A Lim,Eric %+ Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Tahir Foundation Building, MD1, Level 13 South, 12 Science Drive 2, Singapore, 117549, Singapore, 65 66011956, julian.lim@nus.edu.sg %K mindfulness %K COVID-19 %K videoconference %K perceived stress %K sleep quality %K intervention %K telehealth %K mental health %K psychology %D 2021 %7 15.3.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has negatively impacted psychological health. Mindfulness training, which helps individuals attend to the present moment with a nonjudgmental attitude, improves sleep and reduces stress during regular times. Mindfulness training may also be relevant to the mitigation of harmful health consequences during acute crises. However, certain restrictions may necessitate the web-based delivery of mindfulness training (ie, rather than in-person group training settings). Objective: The objective of our study was to examine the effects of mindfulness interventions during the COVID-19 pandemic and to evaluate the effectiveness of web-based interventions. Methods: Data from an ongoing study were used for this retrospective equivalence analysis. Recruited participants were enrollees from mindfulness courses at a local charity organization that promoted mental wellness. This study had no exclusion criteria. We created three groups; two groups received their training during the COVID-19 pandemic (in-person training group: n=36; videoconferencing group: n=38), and a second control group included participants who were trained before the pandemic (n=86). Our primary outcomes were self-reported stress and sleep quality. Baseline levels and changes in these variables due to mindfulness training were compared among the groups via an analysis of covariance test and two one-tailed t tests. Results: Baseline perceived stress (P=.50) and sleep quality (P=.22) did not differ significantly among the three groups. Mindfulness training significantly reduced stress in all three groups (P<.001), and this effect was statistically significant when comparing videoconferencing to in-person training (P=.002). Sleep quality improved significantly in the prepandemic training group (P<.001). However, sleep quality did not improve in the groups that received training during the pandemic. Participants reported that they required shorter times to initiate sleep following prepandemic mindfulness training (P<.001), but this was not true for those who received training during the pandemic. Course attendance was high and equivalent across the videoconferencing and comparison groups (P=.02), and participants in the videoconferencing group engaged in marginally more daily practice than the in-person training group. Conclusions: Web-based mindfulness training via videoconferencing may be a useful intervention for reducing stress during times when traditional, in-person training is not feasible. However, it may not be useful for improving sleep quality. %M 33482627 %R 10.2196/21757 %U https://mental.jmir.org/2021/3/e21757 %U https://doi.org/10.2196/21757 %U http://www.ncbi.nlm.nih.gov/pubmed/33482627 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e25542 %T Feasibility and Initial Outcomes of a Group-Based Teletherapy Psychiatric Day Program for Adults With Serious Mental Illness: Open, Nonrandomized Trial in the Context of COVID-19 %A Puspitasari,Ajeng J %A Heredia,Dagoberto %A Coombes,Brandon J %A Geske,Jennifer R %A Gentry,Melanie T %A Moore,Wendy R %A Sawchuk,Craig N %A Schak,Kathryn M %+ Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 538 8730, puspitasari.ajeng@mayo.edu %K COVID-19 %K teletherapy %K intensive outpatient %K serious mental illness %K mental health %K therapy %K telemedicine %K telehealth %K feasibility %K outcome %K behavioral science %K pilot %K implementation %K effective %D 2021 %7 11.3.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: In the context of the COVID-19 pandemic, many behavioral health services have transitioned to teletherapy to continue delivering care for patients with mental illness. Studies that evaluate the outcome of this rapid teletherapy adoption and implementation are pertinent. Objective: This single-arm, nonrandomized pilot study aimed to assess the feasibility and initial patient-level outcomes of a psychiatric transitional day program that switched from an in-person group to a video teletherapy group during the COVID-19 pandemic. Methods: Patients with transdiagnostic conditions who were at risk of psychiatric hospitalization were referred to the Adult Transitions Program (ATP) at a large academic medical center in the United States. ATP was a 3-week intensive outpatient program that implemented group teletherapy guided by cognitive and behavioral principles delivered daily for 3 hours per day. Feasibility was assessed via retention, attendance rate, and rate of securing aftercare appointments prior to ATP discharge. Patients completed standardized patient-reported outcome measures at admission and discharge to assess the effectiveness of the program for improving quality of mental health, depression, anxiety, and suicide risk. Results: Patients (N=76) started the program between March and August of 2020. Feasibility was established, with 70 of the 76 patients (92%) completing the program and a mean attendance of 14.43 days (SD 1.22); also, 71 patients (95%) scheduled at least one behavioral health aftercare service prior to ATP discharge. All patient-level reported outcomes demonstrated significant improvements in depression (95% CI –3.6 to –6.2; Cohen d=0.77; P<.001), anxiety (95% CI –3.0 to –4.9; Cohen d=0.74; P<.001), overall suicide risk (95% CI –0.5 to –0.1; Cohen d=0.41; P=.02), wish to live (95% CI 0.3 to 1.0; Cohen d=0.39; P<.001), wish to die (95% CI –0.2 to –1.4; Cohen d=0.52; P=.01), and overall mental health (95% CI 1.5 to 4.5; Cohen d=0.39; P<.001) from admission to discharge. Conclusions: Rapid adoption and implementation of a group-based teletherapy day program for adults at risk of psychiatric hospitalization appeared to be feasible and effective. Patients demonstrated high completion and attendance rates and reported significant improvements in psychosocial outcomes. Larger trials should be conducted to further evaluate the efficacy and effectiveness of the program through randomized controlled trials. %M 33651706 %R 10.2196/25542 %U https://mental.jmir.org/2021/3/e25542 %U https://doi.org/10.2196/25542 %U http://www.ncbi.nlm.nih.gov/pubmed/33651706 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23365 %T Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review %A Rauschenberg,Christian %A Schick,Anita %A Hirjak,Dusan %A Seidler,Andreas %A Paetzold,Isabell %A Apfelbacher,Christian %A Riedel-Heller,Steffi G %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 62117031929, christian.rauschenberg@zi-mannheim.de %K COVID-19 %K mHealth %K eHealth %K telemedicine %K prevention %K mental health promotion %K intervention %K digital mental health %K digital intervention %K public mental health %D 2021 %7 10.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Accumulating evidence suggests the COVID-19 pandemic has negative effects on public mental health. Digital interventions that have been developed and evaluated in recent years may be used to mitigate the negative consequences of the pandemic. However, evidence-based recommendations on the use of existing telemedicine and internet-based (eHealth) and app-based mobile health (mHealth) interventions are lacking. Objective: The aim of this study was to investigate the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (ie, mental health promotion, prevention, and treatment of mental disorders) that may help to reduce the consequences of the COVID-19 pandemic. Methods: A rapid meta-review was conducted. The MEDLINE, PsycINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews and meta-analyses that investigated digital tools for health promotion, prevention, or treatment of mental health conditions and determinants likely affected by the COVID-19 pandemic. Results: Overall, 815 peer-reviewed systematic reviews and meta-analyses were identified, of which 83 met the inclusion criteria. Our findings suggest that there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions. Evidence on mHealth apps is promising, especially if social components (eg, blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on process quality, cost-effectiveness, and long-term effects is very limited. Conclusions: There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. In times of physical distancing, quarantine, and restrictions on social contacts, decision makers should develop digital strategies for continued mental health care and invest time and efforts in the development and implementation of mental health promotion and prevention programs. %M 33606657 %R 10.2196/23365 %U https://www.jmir.org/2021/3/e23365 %U https://doi.org/10.2196/23365 %U http://www.ncbi.nlm.nih.gov/pubmed/33606657 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e26340 %T A New Tool for Detecting COVID-19 Psychological Burden Among Postacute and Long-term Care Residents (Mood-5 Scale): Observational Study %A Mansbach,William E %A Mace,Ryan A %A Tanner,Melissa A %+ Mansbach Health Tools, LLC, PO Box 307, Simpsonville, MD, 21150, United States, 1 4438967409, wmansbach@thebcat.com %K nursing homes %K long-term care %K COVID-19 %K depression %K stress %K coping %K burden %K mental health %K elderly %K older adults %K risk %K telehealth %K self-assessment %K scale %K mood %D 2021 %7 10.3.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults are at high risk for developing serious somatic and psychological symptoms associated with COVID-19. Currently available instruments may not be sensitive to the concerns about COVID-19 in postacute and long-term care and their applications in telehealth remain to be clarified. Objective: We investigated the psychometric properties of the Mood-5 Scale (M5) as a rapid self-assessment of the COVID-19 psychological burden among postacute and long-term care residents. Methods: Residents (N=131), aged 50 years and above, from 20 postacute and long-term care facilities in Maryland, USA, were evaluated in-person or via telehealth (43/131, 32.8%) across a 4-week period (May 11 to June 5, 2020) during the COVID-19 pandemic. The COVID-19 psychological burden experienced by the residents was rated by geriatric psychologists who independently reviewed their clinical documentation. Psychometric analyses were performed on the M5 in relation to psychological tests, COVID-19 psychological burden, and diagnostic data collected during the evaluation. Results: The M5 demonstrated acceptable internal consistency (Cronbach α=.77). M5 scores were not confounded by demographic variables or telehealth administration (P>.08). Convergent validity for the M5 was established via positive associations with anxiety (r=0.56, P<.001) and depressive (r=0.49, P<.001) symptoms. An M5 cutoff score of 3 demonstrated strong sensitivity (0.92) and adequate specificity (0.75) for identifying COVID-19 psychological distress among postacute and long-term care residents (area under the curve of 0.89, positive predictive value=0.79, negative predictive value=0.91). Conclusions: The M5 is a reliable and valid tool for self-assessment of mood that can help identify postacute and long-term care residents with significant psychological burden associated with COVID-19. It can be completed in less than 1 minute and is appropriate for use in both in-person and virtual visits. %M 33640866 %R 10.2196/26340 %U https://aging.jmir.org/2021/1/e26340 %U https://doi.org/10.2196/26340 %U http://www.ncbi.nlm.nih.gov/pubmed/33640866 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e27107 %T An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study %A Mira,Jose Joaquin %A Cobos,Angel %A Martínez García,Olga %A Bueno Domínguez,María José %A Astier-Peña,María Pilar %A Pérez Pérez,Pastora %A Carrillo,Irene %A Guilabert,Mercedes %A Perez-Jover,Virtudes %A Fernandez,Cesar %A Vicente,María Asuncion %A Lahera-Martin,Matilde %A Silvestre Busto,Carmen %A Lorenzo Martínez,Susana %A Sanchez Martinez,Ascension %A Martin-Delgado,Jimmy %A Mula,Aurora %A Marco-Gomez,Barbara %A Abad Bouzan,Cristina %A Aibar-Remon,Carlos %A Aranaz-Andres,Jesus %A , %+ Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Hermanos López de Osaba, Alicante, Spain, 34 606433599, jose.mira@umh.es %K SARS-CoV-2 virus %K COVID-19 outbreak %K medical staff %K acute stress %K moral injury %K posttraumatic stress %K COVID-19 %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. Objective: In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). Methods: Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach α and McDonald ω. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. Results: A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald ω). Goodness-of-fit indices confirmed a two-factor structure, explaining 55% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P<.05). Conclusions: The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic. %M 33687343 %R 10.2196/27107 %U https://formative.jmir.org/2021/3/e27107 %U https://doi.org/10.2196/27107 %U http://www.ncbi.nlm.nih.gov/pubmed/33687343 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e26168 %T Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol %A Lewis,Matthew %A Palmer,Victoria J %A Kotevski,Aneta %A Densley,Konstancja %A O'Donnell,Meaghan L %A Johnson,Caroline %A Wohlgezogen,Franz %A Gray,Kathleen %A Robins-Browne,Kate %A Burchill,Luke %+ Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 4th Floor, Clinical Sciences Building, Parkville, 3050, Australia, 61 3 8344 7161, blj@unimelb.edu.au %K mental health %K mobile applications %K COVID-19 %K health personnel %K experience-based co-design %K impact %K evaluation %K digital interventions %K app %K intervention %K health care worker %K design %K delivery %K support %D 2021 %7 9.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has highlighted the importance of health care workers’ mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. Objective: RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. Methods: The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. Results: The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. Conclusions: The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. International Registered Report Identifier (IRRID): DERR1-10.2196/26168 %M 33635823 %R 10.2196/26168 %U https://www.researchprotocols.org/2021/3/e26168 %U https://doi.org/10.2196/26168 %U http://www.ncbi.nlm.nih.gov/pubmed/33635823 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e26550 %T Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review %A Strudwick,Gillian %A Sockalingam,Sanjeev %A Kassam,Iman %A Sequeira,Lydia %A Bonato,Sarah %A Youssef,Alaa %A Mehta,Rohan %A Green,Nadia %A Agic,Branka %A Soklaridis,Sophie %A Impey,Danielle %A Wiljer,David %A Crawford,Allison %+ Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501, gillian.strudwick@camh.ca %K digital health %K psychiatry %K mental health %K informatics %K pandemic %K COVID-19 %K telemedicine %K eHealth %K public health %K virtual care %K mobile apps %K population health %D 2021 %7 2.3.2021 %9 Review %J JMIR Ment Health %G English %X 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. %M 33650985 %R 10.2196/26550 %U https://mental.jmir.org/2021/3/e26550 %U https://doi.org/10.2196/26550 %U http://www.ncbi.nlm.nih.gov/pubmed/33650985 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25775 %T Assessing the Mental Health of Emerging Adults Through a Mental Health App: Protocol for a Prospective Pilot Study %A Yunusova,Asal %A Lai,Jocelyn %A Rivera,Alexander P %A Hu,Sirui %A Labbaf,Sina %A Rahmani,Amir M %A Dutt,Nikil %A Jain,Ramesh C %A Borelli,Jessica L %+ Department of Psychological Science, University of California, Irvine, 4552 Social and Behavioral Sciences Gateway, Irvine, CA, United States, 1 9498243002, Jessica.borelli@uci.edu %K ecological momentary assessment %K stress %K digital mental health %K college student %K mental health %K protocol %K prospective %K feasibility %K individual %K factors %K sleepy %K physiology %K activity %K COVID-19 %D 2021 %7 2.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33513124 %R 10.2196/25775 %U https://www.researchprotocols.org/2021/3/e25775 %U https://doi.org/10.2196/25775 %U http://www.ncbi.nlm.nih.gov/pubmed/33513124 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26559 %T Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data %A Jaworski,Beth K %A Taylor,Katherine %A Ramsey,Kelly M %A Heinz,Adrienne %A Steinmetz,Sarah %A Pagano,Ian %A Moraja,Giovanni %A Owen,Jason E %+ National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 650 308 9437, beth.jaworski@va.gov %K COVID-19 %K coronavirus %K mobile app %K mHealth %K digital health %K mental health %K public mental health %K stress %K coping %K public health %K app %D 2021 %7 1.3.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33606656 %R 10.2196/26559 %U https://www.jmir.org/2021/3/e26559 %U https://doi.org/10.2196/26559 %U http://www.ncbi.nlm.nih.gov/pubmed/33606656 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e25834 %T Improving Mood Through Community Connection and Resources Using an Interactive Digital Platform: Development and Usability Study %A Ortiz,Robin %A Southwick,Lauren %A Schneider,Rachelle %A Klinger,Elissa V %A Pelullo,Arthur %A Guntuku,Sharath Chandra %A Merchant,Raina M %A Agarwal,Anish K %+ Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Bvld, Philadelphia, PA, 19104, United States, 1 9145826995, robin.ortiz@pennmedicine.upenn.edu %K community %K COVID-19 %K digital health %K digital tool %K mental health %K mood %K prospective %K thematic analysis %K virtual support %K well-being %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33635280 %R 10.2196/25834 %U https://mental.jmir.org/2021/2/e25834 %U https://doi.org/10.2196/25834 %U http://www.ncbi.nlm.nih.gov/pubmed/33635280 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e22705 %T Factors Influencing Depression and Mental Distress Related to COVID-19 Among University Students in China: Online Cross-sectional Mediation Study %A Yu,Yanqiu %A She,Rui %A Luo,Sitong %A Xin,Meiqi %A Li,Lijuan %A Wang,Suhua %A Ma,Le %A Tao,Fangbiao %A Zhang,Jianxin %A Zhao,Junfeng %A Li,Liping %A Hu,Dongsheng %A Zhang,Guohua %A Gu,Jing %A Lin,Danhua %A Wang,Hongmei %A Cai,Yong %A Wang,Zhaofen %A You,Hua %A Hu,Guoqing %A Lau,Joseph Tak-Fai %+ Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince Whales Hospital, Sha Tin, Hong Kong, Hong Kong, 852 22528727, jlau@cuhk.edu.hk %K COVID-19 %K depression %K mental distress %K psychological responses %K mediation %K China %K online survey %D 2021 %7 22.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33616541 %R 10.2196/22705 %U https://mental.jmir.org/2021/2/e22705 %U https://doi.org/10.2196/22705 %U http://www.ncbi.nlm.nih.gov/pubmed/33616541 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25232 %T Impact of the COVID-19 Pandemic on the Psychological Distress of Medical Students in Japan: Cross-sectional Survey Study %A Nishimura,Yoshito %A Ochi,Kanako %A Tokumasu,Kazuki %A Obika,Mikako %A Hagiya,Hideharu %A Kataoka,Hitomi %A Otsuka,Fumio %+ Department of General Medicine, Okayama University Hospital, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, Japan, 81 86 235 7342, nishimura-yoshito@okayama-u.ac.jp %K COVID-19 %K online education %K depression %K pandemic %K anxiety %K medical student %D 2021 %7 18.2.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33556033 %R 10.2196/25232 %U http://www.jmir.org/2021/2/e25232/ %U https://doi.org/10.2196/25232 %U http://www.ncbi.nlm.nih.gov/pubmed/33556033 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e26715 %T Impact of the COVID-19 Pandemic on Online Obsessive-Compulsive Disorder Support Community Members: Survey Study %A Kaveladze,Benjamin %A Chang,Katherine %A Siev,Jedidiah %A Schueller,Stephen M %+ Department of Psychological Science, University of California, Irvine, School of Social Ecology (Attn: Irice Castro), 5315 Social and Behavioral Sciences Gateway, Irvine, CA, 92697-7050, United States, 1 (949) 342 6253, bkavelad@uci.edu %K obsessive-compulsive disorder %K COVID-19 pandemic %K online support communities %K mental health %D 2021 %7 17.2.2021 %9 Short Paper %J JMIR Ment Health %G English %X 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. %M 33595449 %R 10.2196/26715 %U http://mental.jmir.org/2021/2/e26715/ %U https://doi.org/10.2196/26715 %U http://www.ncbi.nlm.nih.gov/pubmed/33595449 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25363 %T Exposure to COVID-19-Related Information and its Association With Mental Health Problems in Thailand: Nationwide, Cross-sectional Survey Study %A Mongkhon,Pajaree %A Ruengorn,Chidchanok %A Awiphan,Ratanaporn %A Thavorn,Kednapa %A Hutton,Brian %A Wongpakaran,Nahathai %A Wongpakaran,Tinakon %A Nochaiwong,Surapon %+ Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, 239, Suthep Road, Chiang Mai, 50200, Thailand, 66 899973365, surapon.nochaiwong@gmail.com %K coronavirus %K COVID-19 %K insomnia %K mental health %K social media %K depression %K anxiety %K stress %K psychosocial problem %D 2021 %7 12.2.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33523828 %R 10.2196/25363 %U http://www.jmir.org/2021/2/e25363/ %U https://doi.org/10.2196/25363 %U http://www.ncbi.nlm.nih.gov/pubmed/33523828 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e26683 %T 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 %A Al-Alawi,Mohammed %A McCall,Roopa K %A Sultan,Alya %A Al Balushi,Naser %A Al-Mahrouqi,Tamadhir %A Al Ghailani,Abdullah %A Al Sabti,Hilal %A Al-Maniri,Abdullah %A Panchatcharam,Sathiya M %A Al Sinawi,Hamed %+ Department of Behavioral Medicine, Sultan Qaboos University Hospital, Al Khoud, Muscat, 123, Oman, 968 92281145, alalawim@squ.edu.om %K COVID-19 %K depression %K anxiety %K Oman %K online therapy %K randomized controlled trial %K telehealth %K therapy %K mental health %K e-mental health %K self-help %K distress %D 2021 %7 12.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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 (β=−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 (β=−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 %M 33512323 %R 10.2196/26683 %U http://mental.jmir.org/2021/2/e26683/ %U https://doi.org/10.2196/26683 %U http://www.ncbi.nlm.nih.gov/pubmed/33512323 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e24162 %T 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 %A Wang,Qian %A Song,Bo %A Di,Jiangli %A Yang,Xue %A Wu,Anise %A Lau,Joseph %A Xin,Meiqi %A Wang,Linhong %A Mo,Phoenix Kit-Han %+ Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, JC School of Public Health and Primary Care, Room 508, 30-32 Ngan Shing St, Hong Kong, Hong Kong, 852 22528765, phoenix.mo@cuhk.edu.hk %K pregnant women %K COVID-19 %K depression %K anxiety %K help-seeking %K mental health services %K social support %K trust %K intention %K mental health %K pregnancy %K survey %D 2021 %7 11.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33570500 %R 10.2196/24162 %U http://mental.jmir.org/2021/2/e24162/ %U https://doi.org/10.2196/24162 %U http://www.ncbi.nlm.nih.gov/pubmed/33570500 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e23917 %T 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 %A Liu,Guihua %A Wang,Shuo %A Liao,Jinhua %A Ou,Ping %A Huang,Longsheng %A Xie,Namei %A He,Yingshuang %A Lin,Jinling %A He,Hong-Gu %A Hu,Rongfang %+ The School of Nursing, Fujian Medical University, 1 Xuefu Road, Shangjie Zhen, Minhou County, Fuzhou, 350000, China, 86 13509366729, hulu2886@sina.com %K coronavirus disease 2019 %K autism spectrum disorder %K parenting training %K psychological well-being %K social media %K WeChat %K COVID-19 %K autism %K parenting %K mental health %K well-being %K anxiety %K depression %K stress %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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 × 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 %M 33481751 %R 10.2196/23917 %U https://mental.jmir.org/2021/2/e23917 %U https://doi.org/10.2196/23917 %U http://www.ncbi.nlm.nih.gov/pubmed/33481751 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25118 %T Efficiency and Quality of Data Collection Among Public Mental Health Surveys Conducted During the COVID-19 Pandemic: Systematic Review %A Lin,Yu-Hsuan %A Chen,Chung-Yen %A Wu,Shiow-Ing %+ Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan, 886 37 206166 ext 36383, yuhsuanlin@nhri.edu.tw %K COVID-19 %K mental health %K Newcastle-Ottawa Scale %K review %K data collection %K survey %K surveillance %K literature %K research %D 2021 %7 10.2.2021 %9 Review %J J Med Internet Res %G English %X 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. %M 33481754 %R 10.2196/25118 %U http://www.jmir.org/2021/2/e25118/ %U https://doi.org/10.2196/25118 %U http://www.ncbi.nlm.nih.gov/pubmed/33481754 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e26190 %T Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages %A Hull,Thomas D %A Levine,Jacob %A Bantilan,Niels %A Desai,Angel N %A Majumder,Maimuna S %+ Talkspace, 2578 Broadway #607, New York, NY, 10025, United States, 1 4802548815, tdh732@mail.harvard.edu %K digital phenotyping %K COVID-19 %K telehealth %K digital mental health %K natural language processing %K machine learning %K mental health %K phenotyping %K burden %K treatment %K symptom %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33502999 %R 10.2196/26190 %U http://formative.jmir.org/2021/2/e26190/ %U https://doi.org/10.2196/26190 %U http://www.ncbi.nlm.nih.gov/pubmed/33502999 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e26617 %T The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group %A Boucher,Eliane M %A McNaughton,Emily C %A Harake,Nicole %A Stafford,Julia L %A Parks,Acacia C %+ Happify Health, 51 East 12th Street, New York, NY, 10003, United States, 1 432 258 5233, eliane@happify.com %K loneliness %K digital interventions %K COVID-19 %K qualitative research %K perspective %K impact %K intervention %K lonely %K mental health %K e-mental health %K digital health %K focus group %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33498011 %R 10.2196/26617 %U http://mental.jmir.org/2021/2/e26617/ %U https://doi.org/10.2196/26617 %U http://www.ncbi.nlm.nih.gov/pubmed/33498011 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e25835 %T Use of Telehealth in Substance Use Disorder Services During and After COVID-19: Online Survey Study %A Molfenter,Todd %A Roget,Nancy %A Chaple,Michael %A Behlman,Stephanie %A Cody,Olivia %A Hartzler,Bryan %A Johnson,Edward %A Nichols,Maureen %A Stilen,Patricia %A Becker,Sara %+ Center for Health Enhancement System Studies, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI, 53706, United States, 1 16082203556, todd.molfenter@chess.wisc.edu %K COVID-19 %K substance use disorders %K technology acceptance model %K telehealth %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33481760 %R 10.2196/25835 %U http://mental.jmir.org/2021/2/e25835/ %U https://doi.org/10.2196/25835 %U http://www.ncbi.nlm.nih.gov/pubmed/33481760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21156 %T COVID-19–Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results %A Geronikolou,Styliani %A Chrousos,George %+ University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Levadias 1, Athens, Greece, 30 2132013362, sgeronik@gmail.com %K COVID-19 %K social media %K misinformation %K infodemics %K infodemiology %K infoveillance %K fear %K meta-analysis %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33400681 %R 10.2196/21156 %U https://formative.jmir.org/2021/2/e21156 %U https://doi.org/10.2196/21156 %U http://www.ncbi.nlm.nih.gov/pubmed/33400681 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23126 %T Geographic Distribution of Mental Health Problems Among Chinese College Students During the COVID-19 Pandemic: Nationwide, Web-Based Survey Study %A Wu,Xiaoyan %A Tao,Shuman %A Zhang,Yi %A Li,Shiyue %A Ma,Le %A Yu,Yizhen %A Sun,Guilong %A Li,Tingting %A Tao,Fangbiao %+ Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Anhui, China, 86 055165161169, fbtao@ahmu.edu.cn %K COVID-19 pandemic %K college students %K mental health problems %K geographic location %D 2021 %7 29.1.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33439853 %R 10.2196/23126 %U http://www.jmir.org/2021/1/e23126/ %U https://doi.org/10.2196/23126 %U http://www.ncbi.nlm.nih.gov/pubmed/33439853 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e26011 %T Impact of the COVID-19 Pandemic on Disordered Eating Behavior: Qualitative Analysis of Social Media Posts %A Nutley,Sara K %A Falise,Alyssa M %A Henderson,Rebecca %A Apostolou,Vasiliki %A Mathews,Carol A %A Striley,Catherine W %+ Department of Epidemiology, University of Florida, Room 4240, 2004 Mowry Road, Gainesville, FL, 32610, United States, 1 7086921336, snutley@ufl.edu %K eating disorders %K anorexia nervosa %K binge eating disorder %K COVID-19 %K coronavirus %K Reddit %K social media %K disorder %K eating %K qualitative %K experience %K mental health %K theme %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33465035 %R 10.2196/26011 %U http://mental.jmir.org/2021/1/e26011/ %U https://doi.org/10.2196/26011 %U http://www.ncbi.nlm.nih.gov/pubmed/33465035 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e25456 %T It Is Time to REACT: Opportunities for Digital Mental Health Apps to Reduce Mental Health Disparities in Racially and Ethnically Minoritized Groups %A Friis-Healy,Elsa A %A Nagy,Gabriela A %A Kollins,Scott H %+ Department of Psychiatry and Behavioral Services, Duke University School of Medicine, 2608 Erwin Road, Durham, NC, 27705, United States, 1 919 681 0014, eaf23@duke.edu %K digital health %K app %K public mental health %K health disparities %K COVID-19 %K pandemic %K mental health %K disparity %K behavior %D 2021 %7 26.1.2021 %9 Viewpoint %J JMIR Ment Health %G English %X The behavioral health toll of the COVID-19 pandemic and systemic racism has directed increased attention to the potential of digital health as a way of improving access to and quality of behavioral health care. However, as the pandemic continues to widen health disparities in racially and ethnically minoritized groups, concerns arise around an increased reliance on digital health technologies exacerbating the digital divide and reinforcing rather than mitigating systemic health inequities in communities of color. As funding for digital mental health continues to surge, we offer five key recommendations on how the field can “REACT” to ensure the development of approaches that increase health equity by increasing real-world evidence, educating consumers and providers, utilizing adaptive interventions to optimize care, creating for diverse populations, and building trust. Recommendations highlight the need to take a strengths-based view when designing for racially and ethnically diverse populations and embracing the potential of digital approaches to address complex challenges. %M 33406050 %R 10.2196/25456 %U http://mental.jmir.org/2021/1/e25456/ %U https://doi.org/10.2196/25456 %U http://www.ncbi.nlm.nih.gov/pubmed/33406050 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24495 %T 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 %A Yang,Xue %A Song,Bo %A Wu,Anise %A Mo,Phoenix K H %A Di,Jiangli %A Wang,Qian %A Lau,Joseph T F %A Wang,Linhong %+ National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No 12 Dahuisi Road, Haidan District, Beijing, 100081, China, 86 01062170871, qianawang@chinawch.org.cn %K eHealth %K lockdown %K quarantine %K depression %K anxiety %K pregnant women %D 2021 %7 22.1.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 (χ214=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; β=.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; β=.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. %M 33302251 %R 10.2196/24495 %U http://www.jmir.org/2021/1/e24495/ %U https://doi.org/10.2196/24495 %U http://www.ncbi.nlm.nih.gov/pubmed/33302251 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e21409 %T 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 %A Tai,Yu-Lin %A Chi,Hsin %A Chiu,Nan-Chang %A Tseng,Cheng-Yin %A Huang,Ya-Ning %A Lin,Chien-Yu %+ Hsinchu MacKay Memorial Hospital, Department of Pediatrics and Infectious Disease, 690 Guanfu Rd, East District, Hsinchu, 300, Taiwan, 886 6119595 ext 2582, mmhped.lin@gmail.com %K coronavirus %K COVID-19 %K novel coronavirus %K SARS-CoV-2 %K mask %K rationing %K Taiwan %K anxiety %K mental health %K observational %K crisis %K plan %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33400678 %R 10.2196/21409 %U http://formative.jmir.org/2021/1/e21409/ %U https://doi.org/10.2196/21409 %U http://www.ncbi.nlm.nih.gov/pubmed/33400678 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e23125 %T Psychological Impact of the COVID-19 Pandemic on Chinese Health Care Workers: Cross-Sectional Survey Study %A Ni,Jie %A Wang,Fang %A Liu,Yihai %A Wu,Mingyue %A Jiang,Yan %A Zhou,Yujie %A Sha,Dujuan %+ General Medical Department, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210000, China, 86 13951980866, tbwen0912@126.com %K 2019-nCoV %K COVID-19 %K frontline clinician %K medical students %K psychology %D 2021 %7 20.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33341754 %R 10.2196/23125 %U http://mental.jmir.org/2021/1/e23125/ %U https://doi.org/10.2196/23125 %U http://www.ncbi.nlm.nih.gov/pubmed/33341754 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e24298 %T 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 %A Pinho,Rebeca Da Nóbrega Lucena %A Costa,Thais Ferreira %A Silva,Nayane Miranda %A Barros-Areal,Adriana F %A Salles,André De Mattos %A Oliveira,Andrea Pedrosa %A Rassi,Carlos %A Valero,Caroline Elizabeth Brero %A Gomes,Ciro Martins %A Mendonça-Silva,Dayde %A Oliveira,Fernando %A Jochims,Isadora %A Ranulfo,Ivan %A Neves,Juliana De Brito Seixas %A Oliveira,Lucas %A Dantas,Maria Nogueira %A Rosal,Marta %A Soares,Mayra %A Kurizky,Patrícia %A Peterle,Viviane Uliana %A Faro,Yasmin Furtado %A Gomides,Ana Paula %A da Mota,Licia %A Albuquerque,Cleandro %A Simaan,Cezar Kozak %A Amado,Veronica M %+ Programa de Pós-Graduação em Ciências Médicas FM-UnB, SGAN 605, Av. L2 Norte, Brasília, Brazil, 55 61 98343 6834, nlp.rebeca@gmail.com %K burnout syndrome %K medical residency %K multidisciplinary residency %K COVID-19 %K mental health %K burnout %K stress %K anxiety %K prospective %K cohort %K health care professional %K medical student %D 2021 %7 19.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33290246 %R 10.2196/24298 %U https://www.researchprotocols.org/2021/1/e24298 %U https://doi.org/10.2196/24298 %U http://www.ncbi.nlm.nih.gov/pubmed/33290246 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24983 %T Mental Health Among Medical Professionals During the COVID-19 Pandemic in Eight European Countries: Cross-sectional Survey Study %A Hummel,Svenja %A Oetjen,Neele %A Du,Junfeng %A Posenato,Elisabetta %A Resende de Almeida,Rosa Maria %A Losada,Raquel %A Ribeiro,Oscar %A Frisardi,Vincenza %A Hopper,Louise %A Rashid,Asarnusch %A Nasser,Habib %A König,Alexandra %A Rudofsky,Gottfried %A Weidt,Steffi %A Zafar,Ali %A Gronewold,Nadine %A Mayer,Gwendolyn %A Schultz,Jobst-Hendrik %+ Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany, 49 62215632408, Neele.Oetjen@med.uni-heidelberg.de %K mental health %K COVID-19 %K Europe %K medical professionals %K stress %K depression %K anxiety %K coping %K stressors %D 2021 %7 18.1.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33411670 %R 10.2196/24983 %U http://www.jmir.org/2021/1/e24983/ %U https://doi.org/10.2196/24983 %U http://www.ncbi.nlm.nih.gov/pubmed/33411670 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e18722 %T Maternal Mental Health Status and Approaches for Accessing Antenatal Care Information During the COVID-19 Epidemic in China: Cross-Sectional Study %A Jiang,Hong %A Jin,Longmei %A Qian,Xu %A Xiong,Xu %A La,Xuena %A Chen,Weiyi %A Yang,Xiaoguang %A Yang,Fengyun %A Zhang,Xinwen %A Abudukelimu,Nazhakaiti %A Li,Xingying %A Xie,Zhenyu %A Zhu,Xiaoling %A Zhang,Xiaohua %A Zhang,Lifeng %A Wang,Li %A Li,Lingling %A Li,Mu %+ School of Public Health, Fudan University, Mailbox 175, 138 Yixueyuan Road, Shanghai, 200032, China, 86 2154237267, h_jiang@fudan.edu.cn %K COVID-19 %K mental health %K perceived stress %K anxiety %K depression %K antenatal care information %K social media platform %K pregnancy %K women %D 2021 %7 18.1.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33347423 %R 10.2196/18722 %U http://www.jmir.org/2021/1/e18722/ %U https://doi.org/10.2196/18722 %U http://www.ncbi.nlm.nih.gov/pubmed/33347423 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24069 %T Investigating and Improving the Accuracy of US Citizens’ Beliefs About the COVID-19 Pandemic: Longitudinal Survey Study %A van Stekelenburg,Aart %A Schaap,Gabi %A Veling,Harm %A Buijzen,Moniek %+ Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, Netherlands, 31 024 3615723, a.vanstekelenburg@bsi.ru.nl %K infodemic %K infodemiology %K misinformation %K COVID-19 pandemic %K belief accuracy %K boosting %K trust in scientists %K political orientation %K media use %D 2021 %7 12.1.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33351776 %R 10.2196/24069 %U http://www.jmir.org/2021/1/e24069/ %U https://doi.org/10.2196/24069 %U http://www.ncbi.nlm.nih.gov/pubmed/33351776 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e23699 %T The Effects of Downloading a Government-Issued COVID-19 Contact Tracing App on Psychological Distress During the Pandemic Among Employed Adults: Prospective Study %A Kawakami,Norito %A Sasaki,Natsu %A Kuroda,Reiko %A Tsuno,Kanami %A Imamura,Kotaro %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 358413521, nkawakami@m.u-tokyo.ac.jp %K coronavirus disease %K digital contact tracing %K mental health %K working population %K longitudinal study %K COVID-19 %K contact tracing %K surveillance %K tracking %K anxiety %K distress %D 2021 %7 12.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33347424 %R 10.2196/23699 %U http://mental.jmir.org/2021/1/e23699/ %U https://doi.org/10.2196/23699 %U http://www.ncbi.nlm.nih.gov/pubmed/33347424 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e25372 %T A Novel Artificial Intelligence-Powered Emotional Intelligence and Mindfulness App (Ajivar) for the College Student Population During the COVID-19 Pandemic: Quantitative Questionnaire Study %A Sturgill,Ronda %A Martinasek,Mary %A Schmidt,Trine %A Goyal,Raj %+ Department of Health Sciences and Human Performance, The University of Tampa, 401 West Kennedy Blvd, Box 30F, Tampa, FL, 33606, United States, 1 8132573445, rsturgill@ut.edu %K mindfulness %K COVID-19 %K college students %K emotional intelligence %D 2021 %7 5.1.2021 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33320822 %R 10.2196/25372 %U http://formative.jmir.org/2021/1/e25372/ %U https://doi.org/10.2196/25372 %U http://www.ncbi.nlm.nih.gov/pubmed/33320822 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23696 %T Association of Social Media Use With Mental Health Conditions of Nonpatients During the COVID-19 Outbreak: Insights from a National Survey Study %A Zhong,Bu %A Jiang,Zhibin %A Xie,Wenjing %A Qin,Xuebing %+ School of Communication, East China Normal University, 500 Dongchuan Road, Minhang District, Shanghai, 200062, China, 86 13818950148, xbqin@comm.ecnu.edu.cn %K COVID-19 %K mental health %K social media %K health information support %K secondary traumatic stress %K vicarious trauma %K social support %D 2020 %7 31.12.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=.175; P<.001), anxiety (β=.224; P<.001), depression (β=.201; P<.001), STS (β=.307; P<.001), and VT (β=.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 (β=.165; P<.001) and emotional support (β=.144; P<.001) via social media increased their VT levels. Peer support received via social media increased both VT (β=.332; P<.001) and STS (β=.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. %M 33302256 %R 10.2196/23696 %U https://www.jmir.org/2020/12/e23696 %U https://doi.org/10.2196/23696 %U http://www.ncbi.nlm.nih.gov/pubmed/33302256 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24868 %T Use of Asynchronous Virtual Mental Health Resources for COVID-19 Pandemic–Related Stress Among the General Population in Canada: Cross-Sectional Survey Study %A Richardson,Chris G %A Slemon,Allie %A Gadermann,Anne %A McAuliffe,Corey %A Thomson,Kimberly %A Daly,Zachary %A Salway,Travis %A Currie,Leanne M %A David,Anita %A Jenkins,Emily %+ School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6B 2B5, Canada, 1 604 822 4980, emily.jenkins@ubc.ca %K virtual health %K digital health %K virtual mental health %K mental health %K public health %K COVID-19 %K coping %K stress %K implementation %K utilization %D 2020 %7 30.12.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33315583 %R 10.2196/24868 %U http://www.jmir.org/2020/12/e24868/ %U https://doi.org/10.2196/24868 %U http://www.ncbi.nlm.nih.gov/pubmed/33315583 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e24694 %T Time Trends of the Public’s Attention Toward Suicide During the COVID-19 Pandemic: Retrospective, Longitudinal Time-Series Study %A Burnett,Dayle %A Eapen,Valsamma %A Lin,Ping-I %+ School of Psychiatry, University of New South Wales, Level 1, Australian Graduate School of Management Building Gate, 11 Botany St, Kensington, 2052, Australia, 61 421315320, pingi.lin@gmail.com %K COVID-19 %K suicide %K infodemiology %K infoveillance %K Google Trends %K time trend %K school closure %K attention %K mental health %K crisis %K time series %D 2020 %7 30.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33326407 %R 10.2196/24694 %U http://publichealth.jmir.org/2020/4/e24694/ %U https://doi.org/10.2196/24694 %U http://www.ncbi.nlm.nih.gov/pubmed/33326407 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24487 %T Anxiety and Suicidal Thoughts During the COVID-19 Pandemic: Cross-Country Comparative Study Among Indonesian, Taiwanese, and Thai University Students %A Pramukti,Iqbal %A Strong,Carol %A Sitthimongkol,Yajai %A Setiawan,Agus %A Pandin,Moses Glorino Rumambo %A Yen,Cheng-Fang %A Lin,Chung-Ying %A Griffiths,Mark D %A Ko,Nai-Ying %+ Institute of Allied Health Sciences, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan, 886 6 2353535 ext 5720, cylin36933@gmail.com %K anxiety %K COVID-19 %K cross-country %K suicidal thoughts %K university students %D 2020 %7 24.12.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33296867 %R 10.2196/24487 %U http://www.jmir.org/2020/12/e24487/ %U https://doi.org/10.2196/24487 %U http://www.ncbi.nlm.nih.gov/pubmed/33296867 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22740 %T 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 %A Cheng,Cecilia %A Lau,Yan-Ching %A Luk,Jeremy W %+ Social and Health Psychology Laboratory, Department of Psychology, The University of Hong Kong, Centennial Campus, Pokfulam Road, Hong Kong, Hong Kong, 852 39174224, ceci-cheng@hku.hk %K coping %K coronavirus %K COVID-19 %K cyberaggression %K cybervictimization %K epidemic %K gaming %K mental health %K psychological well-being %K social networking %K social support %D 2020 %7 24.12.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33320824 %R 10.2196/22740 %U http://www.jmir.org/2020/12/e22740/ %U https://doi.org/10.2196/22740 %U http://www.ncbi.nlm.nih.gov/pubmed/33320824 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e24761 %T Patient Attitudes Toward Telepsychiatry During the COVID-19 Pandemic: A Nationwide, Multisite Survey %A Guinart,Daniel %A Marcy,Patricia %A Hauser,Marta %A Dwyer,Michael %A Kane,John M %+ Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, 7559 263rd St, New York, NY, United States, 1 7184704139, daniguinart@gmail.com %K telehealth %K telepsychiatry %K telemedicine %K attitude %K patients %K survey %K COVID-19 %K mental health %D 2020 %7 22.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33302254 %R 10.2196/24761 %U http://mental.jmir.org/2020/12/e24761/ %U https://doi.org/10.2196/24761 %U http://www.ncbi.nlm.nih.gov/pubmed/33302254 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e23776 %T Ethics of Digital Mental Health During COVID-19: Crisis and Opportunities %A Martinez-Martin,Nicole %A Dasgupta,Ishan %A Carter,Adrian %A Chandler,Jennifer A %A Kellmeyer,Philipp %A Kreitmair,Karola %A Weiss,Anthony %A Cabrera,Laura Y %+ Department of Pediatrics, Center for Biomedical Ethics, School of Medicine, Stanford University, 1215 Welch Road, Modular A, Stanford, CA, 94305, United States, 1 6507235760, nicolemz@stanford.edu %K ethics %K digital mental health %K neuroethics %K mental health %K COVID-19 %K crisis %K opportunity %K implementation %K online tool %K telehealth %D 2020 %7 22.12.2020 %9 Viewpoint %J JMIR Ment Health %G English %X Social distancing measures due to the COVID-19 pandemic have accelerated the adoption and implementation of digital mental health tools. Psychiatry and therapy sessions are being conducted via videoconferencing platforms, and the use of digital mental health tools for monitoring and treatment has grown. This rapid shift to telehealth during the pandemic has given added urgency to the ethical challenges presented by digital mental health tools. Regulatory standards have been relaxed to allow this shift to socially distanced mental health care. It is imperative to ensure that the implementation of digital mental health tools, especially in the context of this crisis, is guided by ethical principles and abides by professional codes of conduct. This paper examines key areas for an ethical path forward in this digital mental health revolution: privacy and data protection, safety and accountability, and access and fairness. %M 33156811 %R 10.2196/23776 %U https://mental.jmir.org/2020/12/e23776 %U https://doi.org/10.2196/23776 %U http://www.ncbi.nlm.nih.gov/pubmed/33156811 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e25469 %T Factors Influencing Patients’ Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey %A Severe,Jennifer %A Tang,Ruiqi %A Horbatch,Faith %A Onishchenko,Regina %A Naini,Vidisha %A Blazek,Mary Carol %+ Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Rachel Upjohn Building, Floor 1, Door 1, Ann Arbor, MI, 48109, United States, 1 617 416 8275, severej@med.umich.edu %K telepsychiatry %K COVID-19 %K video visit %K telephone visit %K telehealth %K mental health %K United States %K decision making %K virtual care %D 2020 %7 22.12.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33320823 %R 10.2196/25469 %U https://formative.jmir.org/2020/12/e25469 %U https://doi.org/10.2196/25469 %U http://www.ncbi.nlm.nih.gov/pubmed/33320823 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e22423 %T 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 %A Agyapong,Vincent Israel Ouoku %A Hrabok,Marianne %A Vuong,Wesley %A Shalaby,Reham %A Noble,Jasmine Marie %A Gusnowski,April %A Mrklas,Kelly J %A Li,Daniel %A Urichuk,Liana %A Snaterse,Mark %A Surood,Shireen %A Cao,Bo %A Li,Xin-Min %A Greiner,Russell %A Greenshaw,Andrew James %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 780 215 7771, agyapong@ualberta.ca %K COVID-19 %K mobile technology %K text %K anxiety %K depression %K stress %K outbreak %K pandemic %K mental health %K outreach %D 2020 %7 18.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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 %M 33296330 %R 10.2196/22423 %U http://mental.jmir.org/2020/12/e22423/ %U https://doi.org/10.2196/22423 %U http://www.ncbi.nlm.nih.gov/pubmed/33296330 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e24913 %T 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 %A Alavi,Nazanin %A Yang,Megan %A Stephenson,Callum %A Nikjoo,Niloofar %A Malakouti,Niloufar %A Layzell,Gina %A Jagayat,Jasleen %A Shirazi,Amirhossein %A Groll,Dianne %A Omrani,Mohsen %A O'Riordan,Anne %A Khalid-Khan,Sarosh %A Freire,Rafael %A Brietzke,Elisa %A Gomes,Fabiano Alves %A Milev,Roumen %A Soares,Claudio N %+ Department of Psychiatry, Faculty of Health Sciences, Queen's University, Providence Care Hospital, 752 King Street W, Kingston, ON, K7L 7X3, Canada, 1 6135444900 ext 73002, nazanin.alavitabari@kingstonhsc.ca %K mental health %K COVID-19 %K depression %K anxiety %K psychotherapy %K cognitive behavioural therapy %K online %K internet %K electronic %K mental health care %D 2020 %7 18.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33290245 %R 10.2196/24913 %U http://www.researchprotocols.org/2020/12/e24913/ %U https://doi.org/10.2196/24913 %U http://www.ncbi.nlm.nih.gov/pubmed/33290245 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e22500 %T Online and Recovery-Oriented Support Groups Facilitated by Peer Support Workers in Times of COVID-19: Protocol for a Feasibility Pre-Post Study %A Pelletier,Jean-Francois %A Houle,Janie %A Goulet,Marie-Hélène %A Juster,Robert-Paul %A Giguère,Charles-Édouard %A Bordet,Jonathan %A Hénault,Isabelle %A Lesage,Alain %A De Benedictis,Luigi %A Denis,Frédéric %A Ng,Roger %+ Department of Psychiatry and Addictology, Montreal Mental Health University Institute – Research Centre, University of Montreal, 7401 Hochelaga Street, Montreal, QC, H1N 3M5, Canada, 1 1 514 574 5879, jean-francois.pelletier@yale.edu %K peer support workers %K internet-based peer support groups %K personal-civic recovery %K clinical recovery %K COVID-19 Stress Scales %K peer support %K feasibility %K mental health %K COVID-19 %K intervention %K recovery %D 2020 %7 18.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33259326 %R 10.2196/22500 %U http://www.researchprotocols.org/2020/12/e22500/ %U https://doi.org/10.2196/22500 %U http://www.ncbi.nlm.nih.gov/pubmed/33259326 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24775 %T Subjective Well-Being of Chinese Sina Weibo Users in Residential Lockdown During the COVID-19 Pandemic: Machine Learning Analysis %A Wang,Yilin %A Wu,Peijing %A Liu,Xiaoqian %A Li,Sijia %A Zhu,Tingshao %A Zhao,Nan %+ Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, , China, 86 010 64101377, zhaonan@psych.ac.cn %K COVID-19 %K residential lockdown %K subjective well-being %K online ecological recognition %D 2020 %7 17.12.2020 %9 Original Paper %J J Med Internet Res %G English %X 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) × 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) × 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. %M 33290247 %R 10.2196/24775 %U http://www.jmir.org/2020/12/e24775/ %U https://doi.org/10.2196/24775 %U http://www.ncbi.nlm.nih.gov/pubmed/33290247 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e24815 %T Real-time Mental Health Impact of the COVID-19 Pandemic on College Students: Ecological Momentary Assessment Study %A Kleiman,Evan M %A Yeager,April L %A Grove,Jeremy L %A Kellerman,John K %A Kim,Joanne S %+ Rutgers, The State University of New Jersey, 53 Avenue E, Tillett Hall Room 627, Piscataway, NJ, 08854, United States, 1 2153596148, evan.kleiman@rutgers.edu %K ecological momentary assessment %K college students %K COVID-19, anxiety %K real-time %K mental health %K impact %K student %D 2020 %7 15.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33207308 %R 10.2196/24815 %U http://mental.jmir.org/2020/12/e24815/ %U https://doi.org/10.2196/24815 %U http://www.ncbi.nlm.nih.gov/pubmed/33207308 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e24776 %T Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study %A Ngoc Cong Duong,Khanh %A Nguyen Le Bao,Tien %A Thi Lan Nguyen,Phuong %A Vo Van,Thanh %A Phung Lam,Toi %A Pham Gia,Anh %A Anuratpanich,Luerat %A Vo Van,Bay %+ Department of Pharmacy, Thong Nhat Hospital, 1 Ly Thuong Kiet Street, Ward 7, Tan Binh District, Ho Chi Minh City, 70000, Vietnam, 84 988889315, vovanbay2005@yahoo.com.vn %K COVID-19 %K mental health %K psychological distress %K depression %K anxiety %K Vietnam %K psychology %K distress %K lockdown %K survey %D 2020 %7 15.12.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33284778 %R 10.2196/24776 %U http://formative.jmir.org/2020/12/e24776/ %U https://doi.org/10.2196/24776 %U http://www.ncbi.nlm.nih.gov/pubmed/33284778 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e24430 %T Psychological Effects of the COVID-19 Imposed Lockdown on Adults with Attention Deficit/Hyperactivity Disorder: Cross-Sectional Survey Study %A Adamou,Marios %A Fullen,Tim %A Galab,Nazmeen %A Mackintosh,Isobel %A Abbott,Karl %A Lowe,Deborah %A Smith,Claire %+ School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, United Kingdom, 44 1924316492, m.adamou@hud.ac.uk %K adult ADHD %K pandemic %K lockdown %K COVID-19 %K well-being %K psychological %K intervention %K ADHD %D 2020 %7 15.12.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33108312 %R 10.2196/24430 %U https://formative.jmir.org/2020/12/e24430 %U https://doi.org/10.2196/24430 %U http://www.ncbi.nlm.nih.gov/pubmed/33108312 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e24578 %T Flip the Clinic: A Digital Health Approach to Youth Mental Health Service Delivery During the COVID-19 Pandemic and Beyond %A Davenport,Tracey A %A Cheng,Vanessa Wan Sze %A Iorfino,Frank %A Hamilton,Blake %A Castaldi,Eva %A Burton,Amy %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Sydney, 2050, Australia, 61 404 83 9897, tracey.davenport@sydney.edu.au %K health information technologies %K clinical staging %K youth %K mental health %K transdiagnostic %K eHealth %K routine outcome monitoring %K adolescent %K mental health services %K health services %K telemedicine %K monitoring %K outcome %K young adult %K COVID-19 %D 2020 %7 15.12.2020 %9 Viewpoint %J JMIR Ment Health %G English %X The demand for mental health services is projected to rapidly increase as a direct and indirect result of the COVID-19 pandemic. Given that young people are disproportionately disadvantaged by mental illness and will face further challenges related to the COVID-19 pandemic, it is crucial to deliver appropriate mental health care to young people as early as possible. Integrating digital health solutions into mental health service delivery pathways has the potential to greatly increase efficiencies, enabling the provision of “right care, first time.” We propose an innovative digital health solution for demand management intended for use by primary youth mental health services, comprised of (1) a youth mental health model of care (ie, the Brain and Mind Centre Youth Model) and (2) a health information technology specifically designed to deliver this model of care (eg, the InnoWell Platform). We also propose an operational protocol of how this solution could be applied to primary youth mental health service delivery processes. By “flipping” the conventional service delivery models of majority in-clinic and minority web-delivered care to a model where web-delivered care is the default, this digital health solution offers a scalable way of delivering quality youth mental health care both in response to public health crises (such as the COVID-19 pandemic) and on an ongoing basis in the future. %M 33206051 %R 10.2196/24578 %U http://mental.jmir.org/2020/12/e24578/ %U https://doi.org/10.2196/24578 %U http://www.ncbi.nlm.nih.gov/pubmed/33206051 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21418 %T Social Media Insights Into US Mental Health During the COVID-19 Pandemic: Longitudinal Analysis of Twitter Data %A Valdez,Danny %A ten Thij,Marijn %A Bathina,Krishna %A Rutter,Lauren A %A Bollen,Johan %+ Department of Applied Health Science, School of Public Health, Indiana University, 1033 E 3rd Street, Office 143, Bloomington, IN, United States, 1 812 855 1561, danvald@iu.edu %K social media %K analytics %K infodemiology %K infoveillance %K COVID-19 %K United States %K mental health %K informatics %K sentiment analysis %K Twitter %D 2020 %7 14.12.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33284783 %R 10.2196/21418 %U http://www.jmir.org/2020/12/e21418/ %U https://doi.org/10.2196/21418 %U http://www.ncbi.nlm.nih.gov/pubmed/33284783 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e22755 %T Psychological Screening and Tracking of Athletes and Digital Mental Health Solutions in a Hybrid Model of Care: Mini Review %A Balcombe,Luke %A De Leo,Diego %+ School of Health and Sport Science, University of the Sunshine Coast, 90 Sippy Downs Drive, Sunshine Coast, Australia, 61 0447505709, lukebalcombe@gmail.com %K athletes %K screening %K tracking %K engagement %K well-being %K stress %K adjustment %K COVID-19 %K hybrid model of care %K digital mental health %K machine learning %K artificial intelligence %D 2020 %7 14.12.2020 %9 Viewpoint %J JMIR Form Res %G English %X 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. %M 33271497 %R 10.2196/22755 %U http://formative.jmir.org/2020/12/e22755/ %U https://doi.org/10.2196/22755 %U http://www.ncbi.nlm.nih.gov/pubmed/33271497 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e24021 %T Videoconferencing-Based Telemental Health: Important Questions for the COVID-19 Era From Clinical and Patient-Centered Perspectives %A Chiauzzi,Emil %A Clayton,Ashley %A Huh-Yoo,Jina %+ Department of Information Science, College of Computing and Informatics, Drexel University, 3675 Market St, Philadelphia, PA, 19104, United States, 1 7346453664, jh3767@drexel.edu %K telehealth %K telemental health %K COVID-19 %K videoconferencing %K ethics %K privacy %K mental health %K psychotherapy %K patient-centered %K lived experience %D 2020 %7 8.12.2020 %9 Viewpoint %J JMIR Ment Health %G English %X The COVID-19 pandemic has intensified the search for digital approaches in mental health treatment, particularly due to patients and clinicians practicing social distancing. This has resulted in the dramatic growth of videoconferencing-based telemental health (V-TMH) services. It is critical for behavioral health providers and those in the mental health field to understand the implications of V-TMH expansion on the stakeholders who use such services, such as patients and clinicians, to provide the service that addresses both patient and clinical needs. Several key questions arise as a result, such as the following: (1) in what ways does V-TMH affect the practice of psychotherapy (ie, clinical needs), (2) to what extent are ethical and patient-centered concerns warranted in terms of V-TMH services (ie, patient needs), and (3) how do factors related to user experience affect treatment dynamics for both the patient and therapist (ie, patient and clinical needs)? We discuss how behavioral health providers can consider the future delivery of mental health care services based on these questions, which pose strong implications for technological innovation, the adaptation of treatments to new technologies, and training professionals in the delivery of V-TMH services and other digital health interventions. %M 33180739 %R 10.2196/24021 %U http://mental.jmir.org/2020/12/e24021/ %U https://doi.org/10.2196/24021 %U http://www.ncbi.nlm.nih.gov/pubmed/33180739 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e24507 %T Measuring COVID-19 Related Anxiety in Parents: Psychometric Comparison of Four Different Inventories %A Kubb,Christian %A Foran,Heather M %+ Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Universitätsstr 65-67, Klagenfurt, 9020, Austria, 43 463 2700 1631, christian.kubb@aau.at %K COVID-19 %K coronavirus %K anxiety %K parents %K parenting %K scale %K inventory %K well-being %K mental health %K stress %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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 (α=.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. %M 33197233 %R 10.2196/24507 %U https://mental.jmir.org/2020/12/e24507 %U https://doi.org/10.2196/24507 %U http://www.ncbi.nlm.nih.gov/pubmed/33197233 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e22757 %T Web-Based Relaxation Intervention for Stress During Social Isolation: Randomized Controlled Trial %A Pizzoli,Silvia Francesca Maria %A Marzorati,Chiara %A Mazzoni,Davide %A Pravettoni,Gabriella %+ University of Milan, Department of Oncology and Hematology-Oncology, Via Festa del Perdono 7, Milan, 20122, Italy, 39 0294372099, silviafrancescamaria.pizzoli@ieo.it %K relaxation %K guided meditation %K web-based intervention %K social isolation %K intervention %K COVID-19 %K anxiety %K stress %K internet %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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 %M 33200990 %R 10.2196/22757 %U https://mental.jmir.org/2020/12/e22757 %U https://doi.org/10.2196/22757 %U http://www.ncbi.nlm.nih.gov/pubmed/33200990 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24240 %T Mental Health Burden in Different Professions During the Final Stage of the COVID-19 Lockdown in China: Cross-sectional Survey Study %A Du,Junfeng %A Mayer,Gwendolyn %A Hummel,Svenja %A Oetjen,Neele %A Gronewold,Nadine %A Zafar,Ali %A Schultz,Jobst-Hendrik %+ Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 62215635685, gwendolyn.mayer@med.uni-heidelberg.de %K mental health %K COVID-19 %K China %K depression %K anxiety %K lockdown %K coping strategies %K stressors %K stress %K doctors %K nurses %K students %K media consumption %K WeChat %D 2020 %7 2.12.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33197231 %R 10.2196/24240 %U https://www.jmir.org/2020/12/e24240 %U https://doi.org/10.2196/24240 %U http://www.ncbi.nlm.nih.gov/pubmed/33197231 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21886 %T Real-Time Communication: Creating a Path to COVID-19 Public Health Activism in Adolescents Using Social Media %A Sobowale,Kunmi %A Hilliard,Heather %A Ignaszewski,Martha J %A Chokroverty,Linda %+ Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Suite 37-384, Los Angeles, CA, 90024, United States, 1 310 794 7035, osobowale@mednet.ucla.edu %K social media %K digital health %K COVID-19 %K adolescent %K public health %K disaster %K communication %K affordances %D 2020 %7 1.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic and related public health efforts limiting in-person social interactions present unique challenges to adolescents. Social media, which is widely used by adolescents, presents an opportunity to counteract these challenges and promote adolescent health and public health activism. However, public health organizations and officials underuse social media to communicate with adolescents. Using well-established risk communication strategies and insights from adolescent development and human-computer interaction literature, we identify current efforts and gaps, and propose recommendations to advance the use of social media risk communication for adolescents during the COVID-19 pandemic and future disasters. %M 33226956 %R 10.2196/21886 %U https://www.jmir.org/2020/12/e21886 %U https://doi.org/10.2196/21886 %U http://www.ncbi.nlm.nih.gov/pubmed/33226956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20246 %T Experiences of Psychotherapists With Remote Psychotherapy During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study %A Humer,Elke %A Stippl,Peter %A Pieh,Christoph %A Pryss,Rüdiger %A Probst,Thomas %+ Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Dr-Karl-Dorrek-Straße 30, Krems, 3500, Austria, 43 27328932676, thomas.probst@donau-uni.ac.at %K psychotherapists %K remote psychotherapy %K telephone %K internet %K experiences %K expectations %K COVID-19 %K telehealth %K therapy %K psychology %D 2020 %7 27.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33151896 %R 10.2196/20246 %U http://www.jmir.org/2020/11/e20246/ %U https://doi.org/10.2196/20246 %U http://www.ncbi.nlm.nih.gov/pubmed/33151896 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e23748 %T A Mental Health Surveillance System for the General Population During the COVID-19 Pandemic: Protocol for a Multiwave Cross-sectional Survey Study %A BinDhim,Nasser F %A Althumiri,Nora A %A Basyouni,Mada H %A Alageel,Asem A %A Alghnam,Suliman %A Al-Qunaibet,Ada M %A Almubark,Rasha A %A Aldhukair,Shahla %A Ad-Dab'bagh,Yasser %+ Sharik Association for Health Research, 4 Ans Ibn Malik St, Riyadh, , Saudi Arabia, 966 580033299, nd@nasserdhim.com %K mental health %K depression %K anxiety %K screening %K surveillance %K COVID-19 %D 2020 %7 26.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33156802 %R 10.2196/23748 %U http://www.researchprotocols.org/2020/11/e23748/ %U https://doi.org/10.2196/23748 %U http://www.ncbi.nlm.nih.gov/pubmed/33156802 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22600 %T Psychosocial Effects of the COVID-19 Pandemic: Large-scale Quasi-Experimental Study on Social Media %A Saha,Koustuv %A Torous,John %A Caine,Eric D %A De Choudhury,Munmun %+ School of Interactive Computing, Georgia Institute of Technology, North Ave NW, Atlanta, GA, 30332, United States, 1 4046929496, koustuv.saha@gatech.edu %K social media %K Twitter %K language %K psychosocial effects %K mental health %K transfer learning %K depression %K anxiety %K stress %K social support %K emotions %K COVID-19 %K coronavirus %K crisis %D 2020 %7 24.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33156805 %R 10.2196/22600 %U http://www.jmir.org/2020/11/e22600/ %U https://doi.org/10.2196/22600 %U http://www.ncbi.nlm.nih.gov/pubmed/33156805 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e24012 %T The Relationships of Deteriorating Depression and Anxiety With Longitudinal Behavioral Changes in Google and YouTube Use During COVID-19: Observational Study %A Zhang,Boyu %A Zaman,Anis %A Silenzio,Vincent %A Kautz,Henry %A Hoque,Ehsan %+ Department of Computer Science, University of Rochester, 2513 Wegmans Hall, Rochester, NY, 14627, United States, 1 6262981861, azaman2@cs.rochester.edu %K mental health %K anxiety %K depression %K Google Search %K YouTube %K pandemic %K COVID-19 %D 2020 %7 23.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33180743 %R 10.2196/24012 %U http://mental.jmir.org/2020/11/e24012/ %U https://doi.org/10.2196/24012 %U http://www.ncbi.nlm.nih.gov/pubmed/33180743 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20656 %T Psychological Impact of Health Risk Communication and Social Media on College Students During the COVID-19 Pandemic: Cross-Sectional Study %A Li,Mengyao %A Liu,Li %A Yang,Yilong %A Wang,Yang %A Yang,Xiaoshi %A Wu,Hui %+ China Medical University, No 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China, 86 18900910568, hwu@cmu.edu.cn %K COVID-19 %K anxiety %K panic %K health risk %K communication %K social media %D 2020 %7 18.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33108308 %R 10.2196/20656 %U http://www.jmir.org/2020/11/e20656/ %U https://doi.org/10.2196/20656 %U http://www.ncbi.nlm.nih.gov/pubmed/33108308 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e24136 %T The Effect of the COVID-19 Pandemic on Health Care Workers’ Anxiety Levels: Protocol for a Meta-Analysis %A Zhang,Lunbo %A Yan,Ming %A Takashima,Kaito %A Guo,Wenru %A Yamada,Yuki %+ Graduate School of Human–Environment Studies, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan, 81 092 802 5251, zhanglunbo014@gmail.com %K COVID-19 %K health care worker %K anxiety %K meta-analysis %K review %K protocol %K mental health %K literature %K bias %D 2020 %7 18.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33170800 %R 10.2196/24136 %U http://www.researchprotocols.org/2020/11/e24136/ %U https://doi.org/10.2196/24136 %U http://www.ncbi.nlm.nih.gov/pubmed/33170800 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e23117 %T A Self-Administered Multicomponent Web-Based Mental Health Intervention for the Mexican Population During the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial %A Dominguez-Rodriguez,Alejandro %A De La Rosa-Gómez,Anabel %A Hernández Jiménez,M Jesús %A Arenas-Landgrave,Paulina %A Martínez-Luna,Sofía Cristina %A Alvarez Silva,Joabian %A García Hernández,José Ernesto %A Arzola-Sánchez,Carlos %A Acosta Guzmán,Victoria %+ Valencian International University, Carrer del Pintor Sorolla, 21, Valencia, 46002, Spain, 34 961 92 49 50, alejandro.dominguez.r@campusviu.es %K e-health %K positive psychology %K cognitive behavioral therapy, behavioral activation therapy, COVID-19 %K internet %K intervention %K telepsychology, Mexican sample %D 2020 %7 16.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 Psicología-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 (α) 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 %M 33196449 %R 10.2196/23117 %U http://www.researchprotocols.org/2020/11/e23117/ %U https://doi.org/10.2196/23117 %U http://www.ncbi.nlm.nih.gov/pubmed/33196449 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e22984 %T Behavior of Callers to a Crisis Helpline Before and During the COVID-19 Pandemic: Quantitative Data Analysis %A Turkington,Robin %A Mulvenna,Maurice %A Bond,Raymond %A Ennis,Edel %A Potts,Courtney %A Moore,Ciaran %A Hamra,Louise %A Morrissey,Jacqui %A Isaksen,Mette %A Scowcroft,Elizabeth %A O'Neill,Siobhan %+ School of Computing, Ulster University, Shore Road, Newtownabbey, United Kingdom, 44 28 9036 6129, Turkington-R@ulster.ac.uk %K COVID-19 %K coronavirus %K pandemic %K mental health %K crisis helplines %K machine learning %K clustering %K caller behavior %D 2020 %7 6.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 33112759 %R 10.2196/22984 %U http://mental.jmir.org/2020/11/e22984/ %U https://doi.org/10.2196/22984 %U http://www.ncbi.nlm.nih.gov/pubmed/33112759 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e24361 %T The Hidden Pandemic of Family Violence During COVID-19: Unsupervised Learning of Tweets %A Xue,Jia %A Chen,Junxiang %A Chen,Chen %A Hu,Ran %A Zhu,Tingshao %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada, 1 416 946 5429, jia.xue@utoronto.ca %K Twitter %K family violence %K COVID-19 %K machine learning %K big data %K infodemiology %K infoveillance %D 2020 %7 6.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33108315 %R 10.2196/24361 %U http://www.jmir.org/2020/11/e24361/ %U https://doi.org/10.2196/24361 %U http://www.ncbi.nlm.nih.gov/pubmed/33108315 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22287 %T The COVID-19 Pandemic: A Pandemic of Lockdown Loneliness and the Role of Digital Technology %A Shah,Syed Ghulam Sarwar %A Nogueras,David %A van Woerden,Hugo Cornelis %A Kiparoglou,Vasiliki %+ NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 10865 221262, sarwar.shah@ouh.nhs.uk %K COVID-19 %K coronavirus %K pandemic %K social isolation %K loneliness %K lockdown %K social distancing %K digital technology %K social connectedness %K social networking %K online digital tools %D 2020 %7 5.11.2020 %9 Viewpoint %J J Med Internet Res %G English %X The focus of this perspective is on lockdown loneliness, which we define as loneliness resulting from social disconnection as a result of enforced social distancing and lockdowns during the COVID-19 pandemic. We also explore the role of digital technology in tackling lockdown loneliness amid the pandemic. In this regard, we highlight and discuss a number of the key relevant issues: a description of lockdown loneliness, the burden of lockdown loneliness during the COVID-19 pandemic, characteristics of people who are more likely to be affected by lockdown loneliness, factors that could increase the risk of loneliness, lockdown loneliness as an important public health issue, tackling loneliness during the pandemic, digital technology tools for social connection and networking during the pandemic, assessment of digital technology tools from the end users’ perspectives, and access to and use of digital technology for tackling lockdown loneliness during the COVID-19 pandemic. We suggest that the most disadvantaged and vulnerable people who are more prone to lockdown loneliness are provided with access to digital technology so that they can connect socially with their loved ones and others; this could reduce loneliness resulting from social distancing and lockdowns during the COVID-19 crisis. Nonetheless, some key issues such as access to and knowledge of digital technology tools must be considered. In addition, the involvement of all key stakeholders (family and friends, social care providers, and clinicians and health allied professionals) should be ensured. %M 33108313 %R 10.2196/22287 %U http://www.jmir.org/2020/11/e22287/ %U https://doi.org/10.2196/22287 %U http://www.ncbi.nlm.nih.gov/pubmed/33108313 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22835 %T Depression, Anxiety, and Lifestyle Among Essential Workers: A Web Survey From Brazil and Spain During the COVID-19 Pandemic %A De Boni,Raquel Brandini %A Balanzá-Martínez,Vicent %A Mota,Jurema Correa %A Cardoso,Taiane De Azevedo %A Ballester,Pedro %A Atienza-Carbonell,Beatriz %A Bastos,Francisco I %A Kapczinski,Flavio %+ Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Av Brasil 4365 Pavilhao Haity Moussatche, Room 229, Rio de Janeiro, 21040-360, Brazil, 55 21 3865 3231, raqueldeboni@gmail.com %K COVID-19 %K depression %K anxiety %K lifestyle %K Brazil %K Spain %D 2020 %7 30.10.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33038075 %R 10.2196/22835 %U http://www.jmir.org/2020/10/e22835/ %U https://doi.org/10.2196/22835 %U http://www.ncbi.nlm.nih.gov/pubmed/33038075 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e21814 %T Digital Phenotyping to Enhance Substance Use Treatment During the COVID-19 Pandemic %A Hsu,Michael %A Ahern,David K %A Suzuki,Joji %+ Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, United States, 1 617 732 5000, mhsu7@partners.org %K digital phenotyping %K digital psychiatry %K addiction %K psychiatry %K coronavirus %K COVID-19 %K digital health %K treatment %K drugs %K substance use disorder %D 2020 %7 26.10.2020 %9 Viewpoint %J JMIR Ment Health %G English %X Due to the COVID-19 pandemic, many clinical addiction treatment programs have been required to transition to telephonic or virtual visits. Novel solutions are needed to enhance substance use treatment during a time when many patients are disconnected from clinical care and social support. Digital phenotyping, which leverages the unique functionality of smartphone sensors (GPS, social behavior, and typing patterns), can buttress clinical treatment in a remote, scalable fashion. Specifically, digital phenotyping has the potential to improve relapse prediction and intervention, relapse detection, and overdose intervention. Digital phenotyping may enhance relapse prediction through coupling machine learning algorithms with the enormous amount of collected behavioral data. Activity-based analysis in real time can potentially be used to prevent relapse by warning substance users when they approach locational triggers such as bars or liquor stores. Wearable devices detect when a person has relapsed to substances through measuring physiological changes such as electrodermal activity and locomotion. Despite the initial promise of this approach, privacy, security, and barriers to access are important issues to address. %M 33031044 %R 10.2196/21814 %U http://mental.jmir.org/2020/10/e21814/ %U https://doi.org/10.2196/21814 %U http://www.ncbi.nlm.nih.gov/pubmed/33031044 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e22043 %T Mental Health During the COVID-19 Pandemic in the United States: Online Survey %A Jewell,Jennifer S %A Farewell,Charlotte V %A Welton-Mitchell,Courtney %A Lee-Winn,Angela %A Walls,Jessica %A Leiferman,Jenn A %+ Colorado School of Public Health, Building 500, 13001 E 17th Place, Aurora, CO , United States, 1 303 519 6620, jennifer.jewell@cuanschutz.edu %K COVID-19 %K mental health %K pandemic %K depression %K anxiety %K well-being %K stress %D 2020 %7 23.10.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33006939 %R 10.2196/22043 %U http://formative.jmir.org/2020/10/e22043/ %U https://doi.org/10.2196/22043 %U http://www.ncbi.nlm.nih.gov/pubmed/33006939 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22635 %T Natural Language Processing Reveals Vulnerable Mental Health Support Groups and Heightened Health Anxiety on Reddit During COVID-19: Observational Study %A Low,Daniel M %A Rumker,Laurie %A Talkar,Tanya %A Torous,John %A Cecchi,Guillermo %A Ghosh,Satrajit S %+ Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 43 Vassar St, Cambridge, MA, 02139, United States, 1 6176317230, dlow@mit.edu %K COVID-19 %K mental health %K psychiatry %K infodemiology %K infoveillance %K infodemic %K social media %K Reddit %K natural language processing %K ADHD %K eating disorders %K anxiety %K suicidality %D 2020 %7 12.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is impacting mental health, but it is not clear how people with different types of mental health problems were differentially impacted as the initial wave of cases hit. Objective: The aim of this study is to leverage natural language processing (NLP) with the goal of characterizing changes in 15 of the world’s largest mental health support groups (eg, r/schizophrenia, r/SuicideWatch, r/Depression) found on the website Reddit, along with 11 non–mental health groups (eg, r/PersonalFinance, r/conspiracy) during the initial stage of the pandemic. Methods: We created and released the Reddit Mental Health Dataset including posts from 826,961 unique users from 2018 to 2020. Using regression, we analyzed trends from 90 text-derived features such as sentiment analysis, personal pronouns, and semantic categories. Using supervised machine learning, we classified posts into their respective support groups and interpreted important features to understand how different problems manifest in language. We applied unsupervised methods such as topic modeling and unsupervised clustering to uncover concerns throughout Reddit before and during the pandemic. Results: We found that the r/HealthAnxiety forum showed spikes in posts about COVID-19 early on in January, approximately 2 months before other support groups started posting about the pandemic. There were many features that significantly increased during COVID-19 for specific groups including the categories “economic stress,” “isolation,” and “home,” while others such as “motion” significantly decreased. We found that support groups related to attention-deficit/hyperactivity disorder, eating disorders, and anxiety showed the most negative semantic change during the pandemic out of all mental health groups. Health anxiety emerged as a general theme across Reddit through independent supervised and unsupervised machine learning analyses. For instance, we provide evidence that the concerns of a diverse set of individuals are converging in this unique moment of history; we discovered that the more users posted about COVID-19, the more linguistically similar (less distant) the mental health support groups became to r/HealthAnxiety (ρ=–0.96, P<.001). Using unsupervised clustering, we found the suicidality and loneliness clusters more than doubled in the number of posts during the pandemic. Specifically, the support groups for borderline personality disorder and posttraumatic stress disorder became significantly associated with the suicidality cluster. Furthermore, clusters surrounding self-harm and entertainment emerged. Conclusions: By using a broad set of NLP techniques and analyzing a baseline of prepandemic posts, we uncovered patterns of how specific mental health problems manifest in language, identified at-risk users, and revealed the distribution of concerns across Reddit, which could help provide better resources to its millions of users. We then demonstrated that textual analysis is sensitive to uncover mental health complaints as they appear in real time, identifying vulnerable groups and alarming themes during COVID-19, and thus may have utility during the ongoing pandemic and other world-changing events such as elections and protests. %M 32936777 %R 10.2196/22635 %U http://www.jmir.org/2020/10/e22635/ %U https://doi.org/10.2196/22635 %U http://www.ncbi.nlm.nih.gov/pubmed/32936777 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e23463 %T Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward? %A Stull,Samuel W %A McKnight,Erin R %A Bonny,Andrea E %+ Department of Biobehavioral Health, The Pennsylvania State University, Biobehavioral Health Building, University Park, PA, 16802, United States, 1 6145518640, sws6084@psu.edu %K adolescent %K opioid use disorder %K treatment %K telehealth %K drug %K perspective %K opioid %K COVID-19 %K young adult %D 2020 %7 9.10.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Opioid use disorder (OUD) is one of the most pressing public health problems in the United States and is highly prevalent among adolescents and young adults (AYAs). However, only a small percentage of AYAs with OUD ever receive treatment. Further, among those that do receive treatment, a substantial proportion of patients continue to struggle with OUD, and many prematurely drop out of treatment. These challenges have only been heightened in the face of the COVID-19 pandemic, but greater utilization of telehealth and mobile technologies by OUD patients may help counter these barriers, which ultimately may improve AYA OUD treatment in the postpandemic period. This viewpoint presents the perspective of a person in OUD recovery using online and mobile technology to support his own OUD recovery combined with thoughts from two clinicians supporting AYAs with OUD. Their perspectives may provide insights to help counter COVID-19–related consequences and offer clues to improving AYA OUD treatment in the long term. %M 33016885 %R 10.2196/23463 %U http://pediatrics.jmir.org/2020/2/e23463/ %U https://doi.org/10.2196/23463 %U http://www.ncbi.nlm.nih.gov/pubmed/33016885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22596 %T 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 %A Pan,Yihang %A Xin,Meiqi %A Zhang,Changhua %A Dong,Willa %A Fang,Yuan %A Wu,Wenhui %A Li,Mingzhe %A Pang,Jun %A Zheng,Zilong %A Wang,Zixin %A Yuan,Jinqiu %A He,Yulong %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, 666888, Hong Kong, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K information exposure %K risk %K communication %K mental health %K personal preventive measures %K China %K cross-sectional %K public health %K prevention %D 2020 %7 8.10.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32936776 %R 10.2196/22596 %U http://www.jmir.org/2020/10/e22596/ %U https://doi.org/10.2196/22596 %U http://www.ncbi.nlm.nih.gov/pubmed/32936776 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e21344 %T Integration of Online Treatment Into the “New Normal” in Mental Health Care in Post–COVID-19 Times: Exploratory Qualitative Study %A Bierbooms,Joyce J P A %A van Haaren,Monique %A IJsselsteijn,Wijnand A %A de Kort,Yvonne A W %A Feijt,Milou %A Bongers,Inge M B %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, Tilburg, 5000 LE, Netherlands, 31 630642496, J.J.P.A.Bierbooms@tilburguniversity.edu %K online treatment %K sustainability %K mental health care %K COVID-19 %D 2020 %7 8.10.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33001835 %R 10.2196/21344 %U http://formative.jmir.org/2020/10/e21344/ %U https://doi.org/10.2196/21344 %U http://www.ncbi.nlm.nih.gov/pubmed/33001835 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e23716 %T Coping Skills Mobile App to Support the Emotional Well-Being of Young People During the COVID-19 Pandemic: Protocol for a Mixed Methods Study %A Serlachius,Anna %A Schache,Kiralee %A Boggiss,Anna %A Lim,David %A Wallace-Boyd,Kate %A Brenton-Peters,Jennifer %A Buttenshaw,Elise %A Chadd,Stephanie %A Cavadino,Alana %A Cao,Nicholas %A Morunga,Eva %A Thabrew,Hiran %+ Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand, 64 09 923 3073, a.serlachius@auckland.ac.nz %K COVID-19 %K pandemic %K mental health %K mobile applications %K apps %K mHealth %K coping skills %K wellbeing %K adolescent %K young adult %K coping %D 2020 %7 8.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 Māori 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 %M 32991303 %R 10.2196/23716 %U https://www.researchprotocols.org/2020/10/e23716 %U https://doi.org/10.2196/23716 %U http://www.ncbi.nlm.nih.gov/pubmed/32991303 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21301 %T Association of Web-Based Physical Education With Mental Health of College Students in Wuhan During the COVID-19 Outbreak: Cross-Sectional Survey Study %A Deng,Cheng-Hu %A Wang,Jing-Qiang %A Zhu,Li-Ming %A Liu,He-Wang %A Guo,Yu %A Peng,Xue-Hua %A Shao,Jian-Bo %A Xia,Wei %+ Department of Imaging Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430015, China, 86 1 338 755 3260, 176778380@qq.com %K COVID-19 %K college students %K mental status %K physical education %K young adults %K web-based education %K global health %K web-based survey %K physical activity %K mental health %D 2020 %7 5.10.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32997639 %R 10.2196/21301 %U http://www.jmir.org/2020/10/e21301/ %U https://doi.org/10.2196/21301 %U http://www.ncbi.nlm.nih.gov/pubmed/32997639 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22523 %T Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective %A Sasangohar,Farzan %A Bradshaw,Major R %A Carlson,Marianne Millen %A Flack,James N %A Fowler,James C %A Freeland,Diana %A Head,John %A Marder,Kate %A Orme,William %A Weinstein,Benjamin %A Kolman,Jacob M %A Kash,Bita %A Madan,Alok %+ Center for Outcomes Research, Houston Methodist Hospital, 6565 Fannin St, Houston, TX, United States, 1 979 458 2337, sasangohar@tamu.edu %K telemedicine %K psychiatry %K preventive psychiatry %K SARS virus %K pandemic %K prevention %K COVID-19 %K telehealth %K perspective %D 2020 %7 1.10.2020 %9 Viewpoint %J J Med Internet Res %G English %X As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients’ home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients’ home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter. %M 32936768 %R 10.2196/22523 %U https://www.jmir.org/2020/10/e22523 %U https://doi.org/10.2196/22523 %U http://www.ncbi.nlm.nih.gov/pubmed/32936768 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 9 %P e21237 %T Mental Health Practitioners’ Immediate Practical Response During the COVID-19 Pandemic: Observational Questionnaire Study %A Reilly,Shannon E %A Zane,Katherine L %A McCuddy,William T %A Soulliard,Zachary A %A Scarisbrick,David M %A Miller,Liv E %A Mahoney III,James J %+ Department of Behavioral Medicine and Psychiatry, West Virginia University, 930 Chestnut Ridge Road, Morgantown, WV, 26508, United States, 1 9737384736, shannon.reilly596@gmail.com %K COVID-19 %K clinical practice %K tele–mental health %K mental health %K survey %D 2020 %7 1.10.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 32931440 %R 10.2196/21237 %U https://mental.jmir.org/2020/10/e21237/ %U https://doi.org/10.2196/21237 %U http://www.ncbi.nlm.nih.gov/pubmed/32931440 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22767 %T 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 %A Tsai,Jiun-Yi %A Phua,Joe %A Pan,Shuya %A Yang,Chia-chen %+ School of Journalism and Communication, Renmin University of China, No. 59 Zhongguancun Street, Haidian District, Beijing, 100872, China, 86 10 62511081, shuya@ruc.edu.cn %K COVID-19 %K prejudice %K news exposure %K news trust %K infodemic %K media bias %K racism %K social media use %K intergroup contact %K regression %K moderation analysis %K cross-sectional survey %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=.08, P=.02), had a personal infection history (β=.10, P=.004), and interacted with Asian people frequently in their daily lives (β=.46, P<.001) reported more negative attitudes toward Asians after controlling for sociodemographic variables. Relying more on traditional news media (β=.08, P=.04) and higher levels of trust in social media (β=.13, P=.007) were positively associated with prejudice against Asians. In contrast, consuming news from left-leaning outlets (β=–.15, P=.001) and neutral outlets (β=–.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. %M 32924948 %R 10.2196/22767 %U http://www.jmir.org/2020/9/e22767/ %U https://doi.org/10.2196/22767 %U http://www.ncbi.nlm.nih.gov/pubmed/32924948 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22142 %T The Relation Between Official WhatsApp-Distributed COVID-19 News Exposure and Psychological Symptoms: Cross-Sectional Survey Study %A Liu,Jean C J %A Tong,Eddie M W %+ Yale-NUS College, 02-221, 16 College Avenue West, Singapore, 138527, Singapore, 65 66013694, jeanliu@yale-nus.edu.sg %K mental health %K social media %K pandemic %K depression %K anxiety %K stress %K COVID-19 %K app %K risk factor %K psychology %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 32877349 %R 10.2196/22142 %U http://www.jmir.org/2020/9/e22142/ %U https://doi.org/10.2196/22142 %U http://www.ncbi.nlm.nih.gov/pubmed/32877349 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 9 %P e22408 %T 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 %A Mrklas,Kelly %A Shalaby,Reham %A Hrabok,Marianne %A Gusnowski,April %A Vuong,Wesley %A Surood,Shireen %A Urichuk,Liana %A Li,Daniel %A Li,Xin-Min %A Greenshaw,Andrew James %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 2047 Hilliard Place NW, Edmonton, AB, T6R 3P5, Canada, 1 7807144315, agyapong@ualberta.ca %K health care worker %K COVID-19 %K pandemic %K mental health %K depression %K anxiety %K stress %K obsessive compulsive %D 2020 %7 25.9.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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 %M 32915764 %R 10.2196/22408 %U http://mental.jmir.org/2020/9/e22408/ %U https://doi.org/10.2196/22408 %U http://www.ncbi.nlm.nih.gov/pubmed/32915764 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e23153 %T 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 %A Clavier,Thomas %A Popoff,Benjamin %A Selim,Jean %A Beuzelin,Marion %A Roussel,Melanie %A Compere,Vincent %A Veber,Benoit %A Besnier,Emmanuel %+ Department of Anesthesiology and Critical Care, Rouen University Hospital, 1 rue de Germont, Rouen, 76000, France, 33 685656293, thomasclavier76@gmail.com %K social network %K nurse %K physician %K anxiety %K emergency medicine, anesthesiology, critical care medicine %K coronavirus disease 2019 %K mental health %K COVID-19 %D 2020 %7 24.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32924946 %R 10.2196/23153 %U http://mhealth.jmir.org/2020/9/e23153/ %U https://doi.org/10.2196/23153 %U http://www.ncbi.nlm.nih.gov/pubmed/32924946 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22181 %T Increased Internet Searches for Insomnia as an Indicator of Global Mental Health During the COVID-19 Pandemic: Multinational Longitudinal Study %A Lin,Yu-Hsuan %A Chiang,Ting-Wei %A Lin,Yu-Lun %+ Institute of Population Health Sciences, National Health Research Institutes, Room A3234, No 35 Keyan Road, Zhunan Town, Miaoli County, 35053, Taiwan, 1 886 37206166 ext 36383, yuhsuanlin@nhri.edu.tw %K internet search %K Google Trends %K infodemiology %K infoveillance %K COVID-19 %K insomnia %K mental health %D 2020 %7 21.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 (ρ=0.64, P=.003). By contrast, there was no significant correlation between the number of deaths and increases in searches for depression (ρ=–0.12, P=.63) or suicide (ρ=–0.07, P=.79). Conclusions: Our analysis suggests that insomnia could be a part of routine mental health screening during the COVID-19 pandemic. %M 32924951 %R 10.2196/22181 %U http://www.jmir.org/2020/9/e22181/ %U https://doi.org/10.2196/22181 %U http://www.ncbi.nlm.nih.gov/pubmed/32924951 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e20606 %T Knowledge and Psychological Stress Related to COVID-19 Among Nursing Staff in a Hospital in China: Cross-Sectional Survey Study %A Huang,Huaping %A Zhao,Wen-Jun %A Li,Gui-Rong %+ Department of Nursing, Mianyang Central Hospital, No.12, Changjia Alley, Jingzhogn Street, Fucheng District, Mianyang, 621000, China, 86 0816 2239671, 384895848@qq.com %K COVID-19 %K nursing staff %K knowledge %K psychological stress %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 32640419 %R 10.2196/20606 %U https://formative.jmir.org/2020/9/e20606 %U https://doi.org/10.2196/20606 %U http://www.ncbi.nlm.nih.gov/pubmed/32640419 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 9 %P e20157 %T Pediatric Telebehavioral Health: A Transformational Shift in Care Delivery in the Era of COVID-19 %A Ramtekkar,Ujjwal %A Bridge,Jeffrey A %A Thomas,Glenn %A Butter,Eric %A Reese,Jennifer %A Logan,Erica %A Lin,Simon %A Axelson,David %+ Department of Psychiatry, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, United States, 1 614 722 6811, ujjwal.ramtekkar@nationwidechildrens.org %K telepsychiatry %K telebehavioral health %K child and adolescent psychiatry %K COVID-19 %D 2020 %7 18.9.2020 %9 Viewpoint %J JMIR Ment Health %G English %X The use of telebehavioral health has been expanding in the past decade to improve access to psychiatric care and address critical shortages in the psychiatric workforce. The coronavirus (COVID-19) pandemic forced a sudden shift from traditional in-person visits to alternative modalities. There are key factors associated with successful transitional and large-scale implementation of telehealth with existing resources. We describe the experience of a large health care system using telehealth technology, and we identify strategies and discuss considerations for long-term sustainability after the pandemic. %M 32525485 %R 10.2196/20157 %U https://mental.jmir.org/2020/9/e20157 %U https://doi.org/10.2196/20157 %U http://www.ncbi.nlm.nih.gov/pubmed/32525485 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21490 %T Association Between Generalized Anxiety Disorder Scores and Online Activity Among US Adults During the COVID-19 Pandemic: Cross-Sectional Analysis %A Singh,Parvati %A Cumberland,William G %A Ugarte,Dominic %A Bruckner,Tim-Allen %A Young,Sean D %+ University of California Institute for Prediction Technology, University of California, Irvine, Irvine, CA, United States, 1 310 794 8530, parvatis@uci.edu %K online activity %K COVID-19 %K anxiety %K generalized anxiety disorder %K GAD %K scores %K stress %K anxiety %K internet %K survey %K cross-sectional %D 2020 %7 10.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32841152 %R 10.2196/21490 %U http://www.jmir.org/2020/9/e21490/ %U https://doi.org/10.2196/21490 %U http://www.ncbi.nlm.nih.gov/pubmed/32841152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22002 %T Perinatal Distress During COVID-19: Thematic Analysis of an Online Parenting Forum %A Chivers,Bonnie R %A Garad,Rhonda M %A Boyle,Jacqueline A %A Skouteris,Helen %A Teede,Helena J %A Harrison,Cheryce L %+ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Wellington Rd, Clayton, Australia, 61 3 8572 2662, cheryce.harrison@monash.edu %K pregnancy %K perinatal %K maternal %K COVID-19 %K communication %K social support %K qualitative research %K mental health %K health information %K online support %K thematic analysis %K sentiment analysis %K word frequency %D 2020 %7 7.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32857707 %R 10.2196/22002 %U http://www.jmir.org/2020/9/e22002/ %U https://doi.org/10.2196/22002 %U http://www.ncbi.nlm.nih.gov/pubmed/32857707 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21279 %T Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study %A Son,Changwon %A Hegde,Sudeep %A Smith,Alec %A Wang,Xiaomei %A Sasangohar,Farzan %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 979 458 2337, sasangohar@tamu.edu %K COVID-19 %K pandemic %K college student %K mental health %K stress %K anxiety %K self-management %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32805704 %R 10.2196/21279 %U https://www.jmir.org/2020/9/e21279 %U https://doi.org/10.2196/21279 %U http://www.ncbi.nlm.nih.gov/pubmed/32805704 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 8 %P e23023 %T Comment on "Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow" %A Jain,Nikhil %A Jayaram,Mahesh %+ Northwestern Mental Health, Melbourne Health, Harvester Clinic, 4a Devonshire Road, Sunshine, Melbourne, 3020, Australia, 61 392887000, nikhil.jain@mh.org.au %K telepsychiatry %K COVID-19 %K Australia %D 2020 %7 21.8.2020 %9 Letter to the Editor %J JMIR Ment Health %G English %X %M 32750003 %R 10.2196/23023 %U https://mental.jmir.org/2020/8/e23023 %U https://doi.org/10.2196/23023 %U http://www.ncbi.nlm.nih.gov/pubmed/32750003 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19706 %T Digital Tools to Ameliorate Psychological Symptoms Associated With COVID-19: Scoping Review %A Zhang,Melvyn %A Smith,Helen Elizabeth %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Level 11, Family Medicine and Primary Care, 308322, Singapore, 65 98556631, melvynzhangweibin@gmail.com %K COVID-19 %K digital tool %K psychiatry %K mental health %K digital health %K psychology %K distress %K stress %K anxiety %K depression %D 2020 %7 21.8.2020 %9 Review %J J Med Internet Res %G English %X 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. %M 32721922 %R 10.2196/19706 %U http://www.jmir.org/2020/8/e19706/ %U https://doi.org/10.2196/19706 %U http://www.ncbi.nlm.nih.gov/pubmed/32721922 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20961 %T Impact of the COVID-19 Pandemic on Partner Relationships and Sexual and Reproductive Health: Cross-Sectional, Online Survey Study %A Li,Guanjian %A Tang,Dongdong %A Song,Bing %A Wang,Chao %A Qunshan,Shen %A Xu,Chuan %A Geng,Hao %A Wu,Huan %A He,Xiaojin %A Cao,Yunxia %+ Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, 81 Meishan Road, Hefei, 230000, China, 86 15395104659, caoyunxia6@126.com %K COVID-19 %K survey %K novel coronavirus %K sexual behavior %K sexual health %K reproductive health %K young adults %K youth %K China %D 2020 %7 6.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 0.27-0.73); sexual desire (P=.02; OR 2.01; 95% CI 1.38-2.97); and sexual satisfaction (P<.001; OR 1.92; 95% CI 1.54-2.50). 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. %M 32716895 %R 10.2196/20961 %U https://www.jmir.org/2020/8/e20961 %U https://doi.org/10.2196/20961 %U http://www.ncbi.nlm.nih.gov/pubmed/32716895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20186 %T 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 %A Pahayahay,Amber %A Khalili-Mahani,Najmeh %+ PERFORM Centre, Concordia University, PC 2.207 PERFORM Centre, 7200 Rue Sherbrooke O, Montreal, QC, H4B 1R6, Canada, 1 514 848 2424 ext 5370, najmeh.khalili-mahani@concordia.ca %K Netflix %K social network %K stress %K COVID-19 %K information and communication technologies %K survey %K media %K coping %K infodemic %K infodemiology %D 2020 %7 6.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 (χ23=11.76, P=.008), television (χ23=12.40, P=.006), YouTube (χ23=8.577, P=.04), and streaming services such as Netflix (χ23=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. %M 32701459 %R 10.2196/20186 %U https://www.jmir.org/2020/8/e20186 %U https://doi.org/10.2196/20186 %U http://www.ncbi.nlm.nih.gov/pubmed/32701459 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e20429 %T Strategies to Increase Peer Support Specialists’ Capacity to Use Digital Technology in the Era of COVID-19: Pre-Post Study %A Fortuna,Karen L %A Myers,Amanda L %A Walsh,Danielle %A Walker,Robert %A Mois,George %A Brooks,Jessica M %+ Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Suite 401, 2 Pillsbury Street, Concord, NH, 03301, United States, 1 6037225727, karen.l.fortuna@dartmouth.edu %K COVID-19 %K peer support %K telemental health %K mental health %K training %D 2020 %7 23.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 32629424 %R 10.2196/20429 %U http://mental.jmir.org/2020/7/e20429/ %U https://doi.org/10.2196/20429 %U http://www.ncbi.nlm.nih.gov/pubmed/32629424 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e21718 %T An Integrated Blueprint for Digital Mental Health Services Amidst COVID-19 %A Balcombe,Luke %A De Leo,Diego %+ Australian Institute for Suicide Research and Prevention, Griffith University, Messines Ridge Rd, Brisbane, Australia, 61 447505709, lukebalcombe@gmail.com %K digital mental health %K mental well-being online assessments %K machine learning %K automation %K COVID-19 %K well-being services %D 2020 %7 22.7.2020 %9 Commentary %J JMIR Ment Health %G English %X In-person traditional approaches to mental health care services are facing difficulties amidst the coronavirus disease (COVID-19) crisis. The recent implementation of social distancing has redirected attention to nontraditional mental health care delivery to overcome hindrances to essential services. Telehealth has been established for several decades but has only been able to play a small role in health service delivery. Mobile and teledigital health solutions for mental health are well poised to respond to the upsurge in COVID-19 cases. Screening and tracking with real-time automation and machine learning are useful for both assisting psychological first-aid resources and targeting interventions. However, rigorous evaluation of these new opportunities is needed in terms of quality of interventions, effectiveness, and confidentiality. Service delivery could be broadened to include trained, unlicensed professionals, who may help health care services in delivering evidence-based strategies. Digital mental health services emerged during the pandemic as complementary ways of assisting community members with stress and transitioning to new ways of living and working. As part of a hybrid model of care, technologies (mobile and online platforms) require consolidated and consistent guidelines as well as consensus, expert, and position statements on the screening and tracking (with real-time automation and machine learning) of mental health in general populations as well as considerations and initiatives for underserved and vulnerable subpopulations. %M 32668402 %R 10.2196/21718 %U https://mental.jmir.org/2020/7/e21718 %U https://doi.org/10.2196/21718 %U http://www.ncbi.nlm.nih.gov/pubmed/32668402 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e19246 %T Digital Health Management During and Beyond the COVID-19 Pandemic: Opportunities, Barriers, and Recommendations %A Inkster,Becky %A O’Brien,Ross %A Selby,Emma %A Joshi,Smriti %A Subramanian,Vinod %A Kadaba,Madhura %A Schroeder,Knut %A Godson,Suzi %A Comley,Kerstyn %A Vollmer,Sebastian J %A Mateen,Bilal A %+ University of Cambridge, Wolfson College, Cambridge, United Kingdom, 44 07738478045, becky@beckyinkster.com %K digital mental health %K call to action %K due diligence %K data insights %K COVID-19 %D 2020 %7 6.7.2020 %9 Viewpoint %J JMIR Ment Health %G English %X During the coronavirus disease (COVID-19) crisis, digital technologies have become a major route for accessing remote care. Therefore, the need to ensure that these tools are safe and effective has never been greater. We raise five calls to action to ensure the safety, availability, and long-term sustainability of these technologies: (1) due diligence: remove harmful health apps from app stores; (2) data insights: use relevant health data insights from high-quality digital tools to inform the greater response to COVID-19; (3) freely available resources: make high-quality digital health tools available without charge, where possible, and for as long as possible, especially to those who are most vulnerable; (4) digital transitioning: transform conventional offline mental health services to make them digitally available; and (5) population self-management: encourage governments and insurers to work with developers to look at how digital health management could be subsidized or funded. We believe this should be carried out at the population level, rather than at a prescription level. %M 32484783 %R 10.2196/19246 %U https://mental.jmir.org/2020/7/e19246 %U https://doi.org/10.2196/19246 %U http://www.ncbi.nlm.nih.gov/pubmed/32484783 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e20696 %T Using Internet-Based Psychological Measurement to Capture the Deteriorating Community Mental Health Profile During COVID-19: Observational Study %A van Agteren,Joep %A Bartholomaeus,Jonathan %A Fassnacht,Daniel B %A Iasiello,Matthew %A Ali,Kathina %A Lo,Laura %A Kyrios,Michael %+ Wellbeing and Resilience Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000, Australia, 61 81284944, joep.vanagteren@sahmri.com %K psychological measurement %K positive mental health %K resilience %K mental health %K psychological distress %K internet %K COVID-19 %K pandemic %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 32490845 %R 10.2196/20696 %U http://mental.jmir.org/2020/6/e20696/ %U https://doi.org/10.2196/20696 %U http://www.ncbi.nlm.nih.gov/pubmed/32490845 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e19347 %T Flattening the Mental Health Curve: COVID-19 Stay-at-Home Orders Are Associated With Alterations in Mental Health Search Behavior in the United States %A Jacobson,Nicholas C %A Lekkas,Damien %A Price,George %A Heinz,Michael V %A Song,Minkeun %A O’Malley,A James %A Barr,Paul J %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Suite 300, Office #333S, Lebanon, NH, 03766, United States, 1 6036467037, Nicholas.C.Jacobson@dartmouth.edu %K COVID-19 %K coronavirus %K stay-at-home orders %K mental health %K suicide %K anxiety %K infodemiology %K infoveillance %K search trends %K health information needs %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 32459186 %R 10.2196/19347 %U https://mental.jmir.org/2020/6/e19347 %U https://doi.org/10.2196/19347 %U http://www.ncbi.nlm.nih.gov/pubmed/32459186 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 5 %P e19009 %T 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 %A Ni,Michael Y %A Yang,Lin %A Leung,Candi M C %A Li,Na %A Yao,Xiaoxin I %A Wang,Yishan %A Leung,Gabriel M %A Cowling,Benjamin J %A Liao,Qiuyan %+ School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39179280, nimy@hku.hk %K COVID-19 %K nonpharmaceutical interventions %K population mental health %K depression %K anxiety %K community %K health professionals %K social media %K WeChat %K pandemic %K outbreak %K public health %K mental health %K intervention %D 2020 %7 12.5.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 32365044 %R 10.2196/19009 %U https://mental.jmir.org/2020/5/e19009 %U https://doi.org/10.2196/19009 %U http://www.ncbi.nlm.nih.gov/pubmed/32365044 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 4 %P e19547 %T Comment on “Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow”: A UK Perspective %A Whelan,Pauline %A Stockton-Powdrell,Charlotte %A Jardine,Jenni %A Sainsbury,John %+ Centre for Health Informatics, University of Manchester, Vaughan House, Manchester, M13 9PL, United Kingdom, 44 7554227474, pauline.whelan@manchester.ac.uk %K digital mental health %K digital psychiatry %K COVID-19 %K mhealth %K mobile apps %K learning health system %D 2020 %7 27.4.2020 %9 Letter to the Editor %J JMIR Ment Health %G English %X %M 32330113 %R 10.2196/19547 %U http://mental.jmir.org/2020/4/e19547/ %U https://doi.org/10.2196/19547 %U http://www.ncbi.nlm.nih.gov/pubmed/32330113 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 3 %P e18848 %T Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow %A Torous,John %A Jän Myrick,Keris %A Rauseo-Ricupero,Natali %A Firth,Joseph %+ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Rabb 2, 330 Brookline Ave, Boston, MA, 02215, United States, 1 61766700, jtorous@bidmc.harvard.edu %K digital health %K emergency response %K telehealth %K apps %D 2020 %7 26.3.2020 %9 Editorial %J JMIR Ment Health %G English %X As interest in and use of telehealth during the COVID-19 global pandemic increase, the potential of digital health to increase access and quality of mental health is becoming clear. Although the world today must “flatten the curve” of spread of the virus, we argue that now is the time to “accelerate and bend the curve” on digital health. Increased investments in digital health today will yield unprecedented access to high-quality mental health care. Focusing on personal experiences and projects from our diverse authorship team, we share selected examples of digital health innovations while acknowledging that no single piece can discuss all the impressive global efforts past and present. Exploring the success of telehealth during the present crisis and how technologies like apps can soon play a larger role, we discuss the need for workforce training, high-quality evidence, and digital equity among other factors critical for bending the curve further. %M 32213476 %R 10.2196/18848 %U http://mental.jmir.org/2020/3/e18848/ %U https://doi.org/10.2196/18848 %U http://www.ncbi.nlm.nih.gov/pubmed/32213476