TY - JOUR AU - Glover, Audrey Nicole AU - Sathar, Farzana AU - Mokome, Pride AU - Mathabela, Nkululeko AU - Taleni, Sipokazi AU - van Blydenstein, Alexandra Sarah AU - Mekota, Anna-Maria AU - Charalambous, Salome AU - Rachow, Andrea AU - Ivanova, Olena PY - 2025/4/10 TI - Improving Health and Well-Being of People With Post?COVID-19 Consequences in South Africa: Situation Analysis and Pilot Intervention Design JO - JMIR Form Res SP - e58436 VL - 9 KW - post?COVID-19 KW - rehabilitation KW - support KW - quality of life KW - group care KW - well-being KW - South Africa KW - COVID-19 KW - situation analysis KW - pilot KW - intervention KW - context-adapted KW - physical health KW - mental health KW - cross-sectional KW - mixed method KW - questionnaire KW - in-depth KW - interviews KW - survey KW - focus group KW - quantitative KW - qualitative KW - support group KW - hospital KW - patients KW - health care workers KW - health worker N2 - Background: Multisystemic complications post?COVID-19 infection are increasingly described in the literature, yet guidance on the management remains limited. Objectives: This study aimed to assess the needs, preferences, challenges, and existing interventions for individuals with post?COVID-19 symptoms. Based on this, we aimed to develop a context-adapted intervention to improve the overall health and well-being of individuals with post?COVID-19 complications. Methods: We conducted a cross-sectional mixed-methods situation analysis assessing the needs, preferences, challenges, and existing interventions for patients with post?COVID-19 symptoms. We collected data through questionnaires, semistructured in-depth interviews, and focus group discussions (FGDs) from individuals diagnosed with COVID-19 within the previous 18-month period and health care providers who managed patients with COVID-19 in both inpatient and outpatient settings. Quantitative data were summarized using descriptive statistics, qualitative data were transcribed, and deductive analysis focused on suggestions for future interventions. Findings guided the development of a group intervention. Results: We conducted 60 questionnaires, 13 interviews, and 3 FGDs. Questionnaires showed limited knowledge of post?COVID-19 complications at 26.7% (16/60). Of those who received any rehabilitation for COVID-19 (19/60, 31.7%), 94.7% (18/19) found it helpful for their recovery. Just over half (23/41, 56%) of those who did not receive rehabilitation reported that they would have liked to. The majority viewed rehabilitation as an important adjunct to post?COVID-19 care (56/60, 93.3%) and that support groups would be helpful (53/60, 88.3%). Qualitative results highlighted the need for mental health support, structured post?COVID-19 follow-up, and financial aid in post?COVID-19 care. Based on the insights from the situation analysis, the theory of change framework, and existing post?COVID-19 evidence, we designed and conducted a pilot support group and rehabilitation intervention for individuals with post?COVID-19 complications. Our main objective was to assess the change in physical and psychological well-being pre- and postintervention. The intervention included 8 weekly themed group sessions supplemented by home tasks. Effectiveness of the intervention was evaluated by questionnaires pre- and postintervention on post?COVID-19 symptoms, quality of life with the EuroQoL 5-Dimension 5-Level, short Warwick-Edinburgh Mental Wellbeing Scale, and physical function by spirometry and 1-minute sit-to-stand test. We also assessed the feasibility and acceptability of the intervention by questionnaires and semistructured in-depth interviews. The intervention outcome analysis is yet to be conducted. Conclusions: Insights from patients and health care providers on the characteristics of post?COVID-19 complications helped guide the development of a context-adapted intervention program with potential to improve health and well-being post?COVID-19. UR - https://formative.jmir.org/2025/1/e58436 UR - http://dx.doi.org/10.2196/58436 ID - info:doi/10.2196/58436 ER - TY - JOUR AU - Wight, Lisa AU - Tenove, Chris AU - Hirani, Saima AU - Tworek, Heidi PY - 2025/4/2 TI - Mental Health and Coping Strategies of Health Communicators Who Faced Online Abuse During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Infodemiology SP - e68483 VL - 5 KW - mental health KW - online harassment KW - online abuse KW - coping strategies KW - resilience KW - social media KW - online advocacy KW - public health communication KW - health communication N2 - Background: During the COVID-19 pandemic, health experts used social media platforms to share information and advocate for policies. Many of them faced online abuse, which some reported took a toll on their mental health and well-being. Variation in the impacts of online abuse on mental health, well-being, and professional efficacy suggest that health communicators may differ in their coping strategies and ultimately their resilience to such abuse. Objective: We aimed to explore the impacts of online abuse on health communicators? mental health and well-being as well as their emotion- and problem-focused coping strategies. Methods: We recruited health communicators (public health officials, medical practitioners, and university-based researchers) in Canada who engaged in professional online communication during the COVID-19 pandemic. In phase 1, semistructured interviews were conducted with 35 health communicators. In phase 2, online questionnaires were completed by 34 individuals before participating in workshops. Purposive recruitment resulted in significant inclusion of those who self-identified as racialized or women. Interview and workshop data were subjected to inductive and deductive coding techniques to generate themes. Descriptive statistics were calculated for selected questionnaire questions. Results: In total, 94% (33/35) of interviewees and 82% (28/34) of questionnaire respondents reported experiencing online abuse during the study period (2020-2022). Most health communicators mentioned facing an emotional and psychological toll, including symptoms of depression and anxiety. Racialized and women health communicators faced abuse that emphasized their ethnicity, gender identity, and physical appearance. Health communicators? most common emotion-focused coping strategies were withdrawing from social media platforms, avoiding social media platforms altogether, and accepting online abuse as unavoidable. Common problem-focused coping strategies included blocking or unfriending hostile accounts, changing online behavior, formal help-seeking, and seeking peer support. Due to the impacts of online abuse on participants? mental health and well-being, 41% (14/34) of the questionnaire respondents seriously contemplated quitting health communication, while 53% (18/34) reduced or suspended their online presence. Our findings suggest that health communicators who used problem-focused coping strategies were more likely to remain active online, demonstrating significant professional resilience. Conclusions: Although health communicators in our study implemented various emotion- and problem-focused coping strategies, they still faced challenges in dealing with the impacts of online abuse. Our findings reveal the limitations of individual coping strategies, suggesting the need for effective formal organizational policies to support those who receive online abuse and to sanction those who perpetrate it. Organizational policies could improve long-term outcomes for health communicators? mental health and well-being by mitigating online abuse and supporting its targets. Such policies would bolster professional resilience, ensuring that important health information can still reach the public and is not silenced by online abuse. More research is needed to determine whether gender, race, or other factors shape coping strategies and their effectiveness. UR - https://infodemiology.jmir.org/2025/1/e68483 UR - http://dx.doi.org/10.2196/68483 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68483 ER - TY - JOUR AU - Labrosse, David AU - Vié, Clara AU - Harb, Mireille AU - Montagni, Ilaria PY - 2025/4/2 TI - Escape Game to Promote Students? Mental Health Outcomes in the Aftermaths of COVID-19 Pandemic: Protocol for a Mixed Methods Study Evaluating a Cocreated Intervention JO - JMIR Res Protoc SP - e64068 VL - 14 KW - Escape game KW - pilot randomized controlled trial KW - Covid-19 KW - cocreation KW - students KW - mobile phone N2 - Background: The COVID-19 pandemic and the protracted lockdowns have heavily impacted university students? mental health. Digital Escape Games represent a good means to reach students and propose them solutions for their psychological well-being. Objective: This study aimed to evaluate a cocreated digital Escape Game on students? mental health in the aftermath of the COVID-19 pandemic, called EscapeCovid Game. The evaluation of the effectiveness of this stand-alone intervention concerns mental health outcomes (mental health literacy, appraisal and change of beliefs about mental health, management of emotions, and development of coping strategies) and the appreciation and relevance of the game. Methods: A randomized controlled trial with pre- and posttest data collection (online questionnaires with validated scales) is conducted among 500 students in Bordeaux, France, to evaluate the EscapeCovid Game cocreated with students, researchers, health professionals, and web developers. A subsample of students is randomly selected for responding to a semistructured interview following a mixed methods design. Recruitment is done through mail invitations from student associations and presentations in university classes. Half of the sample of the trial plays the Escape Game, while the other half receives an email with mental health?related information. Within the game, students discuss their personal experiences. The text is further used for the qualitative analyses. The whole study is carried out online. Results: The EscapeCovid Game has been developed, tested, and finalized by the end of March 2023. As of November 4, 2024, a total of 191 students have answered the baseline questionnaire (90 intervention vs 101 control). A total of 23 students have played the game and 53 are in the control arm. Among participants, by the end of September 20, 2023, twenty were interviewed (10 intervention and 10 control) reaching sample saturation. According to preliminary results, the EscapeCovid Game has had a positive impact on all defined outcomes, while the email has been effective in increasing knowledge on resources available and on coping strategies and meditation techniques. We expect the trial to be completed by the end of June 2025. Conclusions: The mixed methods findings of this study are due to demonstrate the effectiveness of the EscapeCovid Game in improving students? mental health outcomes. Preliminary results from the qualitative substudy are promising: in the aftermath of the COVID-19 crisis, this intervention is intended to promote players? mental health through gamification, knowledge transfer, and a learning-by-doing approach. Trial Registration: ClinicalTrials.gov NCT06720792; https://clinicaltrials.gov/study/NCT06720792 International Registered Report Identifier (IRRID): DERR1-10.2196/64068 UR - https://www.researchprotocols.org/2025/1/e64068 UR - http://dx.doi.org/10.2196/64068 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64068 ER - TY - JOUR AU - Schulz, Johannes Peter AU - Boldi, Marc-Olivier AU - van Ackere, Ann PY - 2025/3/25 TI - Adolescent Cyberbullying and Cyber Victimization: Longitudinal Study Before and During COVID-19 JO - J Med Internet Res SP - e70508 VL - 27 KW - cyberbullying and cyber victimization among adolescents KW - COVID-19 KW - panel study KW - longitudinal data analysis KW - parental communication KW - exposure to violent media content N2 - 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. UR - https://www.jmir.org/2025/1/e70508 UR - http://dx.doi.org/10.2196/70508 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/70508 ER - TY - JOUR AU - Alexander, D. Jordan AU - Duffy, A. Kelly AU - Freis, M. Samantha AU - Chow, Sy-Miin AU - Friedman, P. Naomi AU - Vrieze, I. Scott PY - 2025/3/17 TI - 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 JO - J Med Internet Res SP - e64965 VL - 27 KW - adolescence KW - emerging adulthood KW - intensive longitudinal assessment KW - COVID-19 KW - affect KW - GPS KW - mobility patterns KW - smartphone data KW - respiratory KW - infectious KW - pulmonary KW - pandemic KW - adolescents KW - teens KW - teenagers KW - mobility KW - apps KW - smartphones KW - intensive longitudinal panel studies KW - emotional well-being KW - well-being KW - daily routines KW - affect survey N2 - 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 ?=?0.10; P<.001). Average positive affect similarly remained slightly below (standardized ?=?0.20; P<.001) and negative affect slightly above (standardized ?=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. UR - https://www.jmir.org/2025/1/e64965 UR - http://dx.doi.org/10.2196/64965 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64965 ER - TY - JOUR AU - Kim, Seokjun AU - Jo, Hyesu AU - Son, Yejun AU - Shin, Kyung Min AU - Lee, Kyeongmin AU - Park, Jaeyu AU - Lee, Hayeon AU - Smith, Lee AU - Dragioti, Elena AU - Fond, Guillaume AU - Boyer, Laurent AU - López Sánchez, F. Guillermo AU - Tully, A. Mark AU - Rahmati, Masoud AU - Pizzol, Damiano AU - Woo, Selin AU - Yon, Keon Dong PY - 2025/3/10 TI - Nationwide Trends in Screen Time and Associated Risk Factors by Family Structures Among Adolescents, 2008-2022: Nationwide Cross-Sectional Study JO - JMIR Public Health Surveill SP - e57962 VL - 11 KW - adolescents KW - family type KW - pandemic KW - screen time KW - South Korea KW - sedentary activity KW - risk factor KW - mobile phone N2 - 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 (?=8.06, 95% CI 7.74-8.39), with a notable increase observed at the onset of the pandemic (?=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 (?diff=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. UR - https://publichealth.jmir.org/2025/1/e57962 UR - http://dx.doi.org/10.2196/57962 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57962 ER - TY - JOUR AU - Zhang, Chunyan AU - Wang, Ting AU - Dong, Caixia AU - Dai, Duwei AU - Zhou, Linyun AU - Li, Zongfang AU - Xu, Songhua PY - 2025/3/5 TI - Exploring Psychological Trends in Populations With Chronic Obstructive Pulmonary Disease During COVID-19 and Beyond: Large-Scale Longitudinal Twitter Mining Study JO - J Med Internet Res SP - e54543 VL - 27 KW - COVID-19 KW - chronic obstructive pulmonary disease (COPD) KW - psychological trends KW - Twitter KW - data mining KW - deep learning N2 - 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. UR - https://www.jmir.org/2025/1/e54543 UR - http://dx.doi.org/10.2196/54543 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053739 ID - info:doi/10.2196/54543 ER - TY - JOUR AU - Li, Yadi AU - Zhou, Jianlong AU - Wei, Zheng AU - Liang, Lizhu AU - Xu, Hualing AU - Lv, Caihong AU - Liu, Gang AU - Li, Wenlin AU - Wu, Xin AU - Xiao, Yunhui AU - Sunzi, Kejimu PY - 2025/3/3 TI - Efficacy and Safety of Acupuncture for Post?COVID-19 Insomnia: Protocol for a Systematic Review and Meta-Analysis JO - JMIR Res Protoc SP - e69417 VL - 14 KW - acupuncture KW - traditional Chinese medicine KW - post?COVID-19 condition KW - long COVID-19 KW - insomnia KW - sleep disorder KW - depression KW - complementary and alternative medicine KW - treatment KW - public health KW - study protocol KW - systematic review N2 - 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 UR - https://www.researchprotocols.org/2025/1/e69417 UR - http://dx.doi.org/10.2196/69417 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053784 ID - info:doi/10.2196/69417 ER - TY - JOUR AU - Parsons, Marie E. AU - Figueroa, G. Zoë AU - Hiserodt, Michele AU - Cornelius, Talea AU - Otto, W. Michael PY - 2025/2/13 TI - Relative Preference for In-Person, Telehealth, Digital, and Pharmacologic Mental Health Care After the COVID-19 Pandemic: Cross-Sectional Questionnaire Study JO - J Med Internet Res SP - e54608 VL - 27 KW - stigma KW - digital CBT KW - age KW - generalized anxiety disorder KW - insomnia KW - adult KW - telehealth KW - digital health N2 - 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. UR - https://www.jmir.org/2025/1/e54608 UR - http://dx.doi.org/10.2196/54608 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54608 ER - TY - JOUR AU - Kim, I. Sol AU - Jin, Jae-Chan AU - Yoo, Seo-Koo AU - Han, Hyun Doug PY - 2025/2/11 TI - Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study JO - JMIR Pediatr Parent SP - e66448 VL - 8 KW - coronavirus pandemic KW - internet use pattern KW - internet games KW - short-form videos KW - social network system KW - depressed mood KW - internet use KW - pandemic KW - internet KW - COVID-19 KW - video KW - internet behavior KW - social media KW - internet addiction KW - depression KW - anxiety KW - digital platforms KW - mobile phone N2 - 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 (?23=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. UR - https://pediatrics.jmir.org/2025/1/e66448 UR - http://dx.doi.org/10.2196/66448 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66448 ER - TY - JOUR AU - Saito, Ryuichi AU - Tsugawa, Sho PY - 2025/2/11 TI - 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 JO - J Med Internet Res SP - e63824 VL - 27 KW - COVID-19 KW - restriction KW - United States KW - X KW - Twitter KW - sentiment analysis KW - large language model KW - LLM KW - GPT-3.5 KW - fine-tuning N2 - 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. UR - https://www.jmir.org/2025/1/e63824 UR - http://dx.doi.org/10.2196/63824 UR - http://www.ncbi.nlm.nih.gov/pubmed/39932775 ID - info:doi/10.2196/63824 ER - TY - JOUR AU - Davoody, Nadia AU - Stathakarou, Natalia AU - Swain, Cara AU - Bonacina, Stefano PY - 2025/2/10 TI - 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 JO - JMIR Med Educ SP - e63708 VL - 11 KW - COVID-19 pandemic KW - eHealth KW - blended learning KW - health informatics KW - higher education adaptation N2 - 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. UR - https://mededu.jmir.org/2025/1/e63708 UR - http://dx.doi.org/10.2196/63708 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63708 ER - TY - JOUR AU - Lambert, Jeffrey AU - Loades, Maria AU - Marshall, Noah AU - Higson-Sweeney, Nina AU - Chan, Stella AU - Mahmud, Arif AU - Pile, Victoria AU - Maity, Ananya AU - Adam, Helena AU - Sung, Beatrice AU - Luximon, Melanie AU - MacLennan, Keren AU - Berry, Clio AU - Chadwick, Paul PY - 2025/1/31 TI - Investigating the Efficacy of the Web-Based Common Elements Toolbox (COMET) Single-Session Interventions in Improving UK University Student Well-Being: Randomized Controlled Trial JO - J Med Internet Res SP - e58164 VL - 27 KW - Common Elements Toolbox KW - mental well-being KW - online interventions KW - single-session interventions KW - university students N2 - 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 UR - https://www.jmir.org/2025/1/e58164 UR - http://dx.doi.org/10.2196/58164 UR - http://www.ncbi.nlm.nih.gov/pubmed/39888663 ID - info:doi/10.2196/58164 ER - TY - JOUR AU - Rojas, K. Natalia AU - Martin, Sam AU - Cortina-Borja, Mario AU - Shafran, Roz AU - Fox-Smith, Lana AU - Stephenson, Terence AU - Ching, F. Brian C. AU - d'Oelsnitz, Anaïs AU - Norris, Tom AU - Xu, Yue AU - McOwat, Kelsey AU - Dalrymple, Emma AU - Heyman, Isobel AU - Ford, Tamsin AU - Chalder, Trudie AU - Simmons, Ruth AU - AU - Pinto Pereira, M. Snehal PY - 2025/1/28 TI - 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 JO - J Med Internet Res SP - e63634 VL - 27 KW - children and young people KW - text mining KW - free-text responses KW - experiences KW - COVID-19 KW - long COVID KW - InfraNodus KW - sentiment analysis KW - discourse analysis KW - AI KW - artificial intelligence N2 - 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. UR - https://www.jmir.org/2025/1/e63634 UR - http://dx.doi.org/10.2196/63634 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63634 ER - TY - JOUR AU - Kahlawi, Adham AU - Masri, Firas AU - Ahmed, Wasim AU - Vidal-Alaball, Josep PY - 2025/1/27 TI - 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 JO - J Med Internet Res SP - e58656 VL - 27 KW - COVID-19 KW - SARS-CoV-2 KW - pandemic KW - citizen opinion KW - text mining KW - LDA KW - health crisis KW - developing economies KW - Italy KW - Egypt KW - UK KW - dataset KW - content analysis KW - social media KW - twitter KW - tweet KW - sentiment KW - attitude KW - perception KW - perspective KW - machine learning KW - latent Dirichlet allocation KW - vaccine KW - vaccination KW - public health KW - infectious N2 - 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. UR - https://www.jmir.org/2025/1/e58656 UR - http://dx.doi.org/10.2196/58656 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58656 ER - TY - JOUR AU - Engelke, Lara AU - Calvano, Claudia AU - Pohl, Steffi AU - Winter, Maria Sibylle AU - Renneberg, Babette PY - 2025/1/24 TI - Parental Mental Health and Child Maltreatment in the COVID-19 Pandemic: Importance of Sampling in a Quantitative Statistical Study JO - J Med Internet Res SP - e52043 VL - 27 KW - COVID-19 KW - parental stress KW - parental mental health KW - child maltreatment KW - data collection methods KW - web-based surveys KW - convenience sample KW - sampling methods N2 - 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 (?2=0.024); decreased subjective health (?2=0.016); more anxiety and depression symptoms (?2=0.055); more general stress (?2=0.044); more occurrences of verbal emotional abuse (VEA; ?=0.12), witnessing domestic violence (WDV; ?=0.13), nonverbal emotional abuse (NEA; ?=0.03), physical abuse (?=0.10), and emotional neglect (?=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: ?2=0.002) and subjective health (remaining difference between samples after controlling for covariates: ?2=0.004) and partially explained differences in parental mental health (remaining: ?2=0.016), general stress (remaining: ?2=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. UR - https://www.jmir.org/2025/1/e52043 UR - http://dx.doi.org/10.2196/52043 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52043 ER - TY - JOUR AU - Kakon, Hafiz Shahria AU - Soron, Rashid Tanjir AU - Hossain, Sharif Mohammad AU - Haque, Rashidul AU - Tofail, Fahmida PY - 2025/1/14 TI - Supervised and Unsupervised Screen Time and Its Association With Physical, Mental, and Social Health of School-Going Children in Dhaka, Bangladesh: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e62943 VL - 8 KW - screen time KW - parental supervision KW - Strength and Difficulties Questionnaire KW - Spencer Children Anxiety Scale KW - Pittsburgh Sleep Quality Scale KW - children KW - sleep quality KW - headache KW - behavioral problems N2 - 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. UR - https://pediatrics.jmir.org/2025/1/e62943 UR - http://dx.doi.org/10.2196/62943 ID - info:doi/10.2196/62943 ER - TY - JOUR AU - Jayaraj, Gautham AU - Cao, Xiao AU - Horwitz, Adam AU - Rozwadowski, Michelle AU - Shea, Skyla AU - Hanauer, N. Shira AU - Hanauer, A. David AU - Tewari, Muneesh AU - Shedden, Kerby AU - Choi, Won Sung PY - 2025/1/9 TI - Trends in Mental Health Outcomes of College Students Amid the Pandemic (Roadmap mHealth App): Longitudinal Observational Study JO - J Med Internet Res SP - e67627 VL - 27 KW - mHealth KW - college KW - student KW - mental health KW - positive psychology KW - flourishing KW - COVID-19 KW - wellbeing KW - mobile phone KW - SARS-CoV-2 KW - coronavirus KW - pandemic KW - COVID KW - app KW - digital health KW - smartphone KW - eHealth KW - telehealth KW - telemedicine KW - longitudinal KW - higher education KW - depression KW - anxiety KW - loneliness N2 - 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 (?=.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 UR - https://www.jmir.org/2025/1/e67627 UR - http://dx.doi.org/10.2196/67627 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67627 ER - TY - JOUR AU - Xian, Xuechang AU - Zhang, Xiaoran AU - Zheng, Danhe AU - Wang, Yanlin PY - 2024/12/16 TI - Mental Health Benefits of Listening to Music During COVID-19 Quarantine: Cross-Sectional Study JO - JMIR Form Res SP - e46497 VL - 8 KW - COVID-19 KW - quarantine KW - social connectedness KW - sense of security KW - mental well-being KW - cross-sectional study KW - contagion KW - treatment KW - music KW - security KW - mental health KW - questionnaire KW - China KW - intervention KW - relaxation KW - meditation KW - mental illness KW - stimuli KW - environmental N2 - 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. UR - https://formative.jmir.org/2024/1/e46497 UR - http://dx.doi.org/10.2196/46497 ID - info:doi/10.2196/46497 ER - TY - JOUR AU - Shao, Heng AU - Chen, Hui AU - Xu, Kewang AU - Gan, Quan AU - Chen, Meiling AU - Zhao, Yanyu AU - Yu, Shun AU - Li, Kelly Yutong AU - Chen, Lihua AU - Cai, Bibo PY - 2024/12/13 TI - Investigating the Associations Between COVID-19, Long COVID, and Sleep Disturbances: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e53522 VL - 10 KW - COVID-19 KW - long COVID KW - sleep disturbances KW - psychological outcomes KW - socioeconomic factors KW - cross-sectional study N2 - 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. UR - https://publichealth.jmir.org/2024/1/e53522 UR - http://dx.doi.org/10.2196/53522 ID - info:doi/10.2196/53522 ER - TY - JOUR AU - Baxter-King, Ryan AU - Naeim, Arash AU - Huang, Q. Tina AU - Sepucha, Karen AU - Stanton, Annette AU - Rudkin, Aaron AU - Ryu, Rita AU - Sabacan, Leah AU - Vavreck, Lynn AU - Esserman, Laura AU - Stover Fiscalini, Allison AU - Wenger, S. Neil PY - 2024/12/2 TI - Relationship Between Perceived COVID-19 Risk and Change in Perceived Breast Cancer Risk: Prospective Observational Study JO - JMIR Cancer SP - e47856 VL - 10 KW - breast cancer KW - COVID-19 risk perception KW - cancer screening KW - anxiety KW - cancer KW - COVID-19 KW - prevention KW - medical care KW - screening KW - survey N2 - 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. UR - https://cancer.jmir.org/2024/1/e47856 UR - http://dx.doi.org/10.2196/47856 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47856 ER - TY - JOUR AU - Dominguez-Rodriguez, Alejandro AU - Sanz-Gomez, Sergio AU - González Ramírez, Patricia Leivy AU - Herdoiza-Arroyo, Erika Paulina AU - Trevino Garcia, Edith Lorena AU - de la Rosa-Gómez, Anabel AU - González-Cantero, Omar Joel AU - Macias-Aguinaga, Valeria AU - Arenas Landgrave, Paulina AU - Chávez-Valdez, Margarita Sarah PY - 2024/9/30 TI - 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 JO - JMIR Form Res SP - e53767 VL - 8 KW - self-guided web-based intervention KW - chat support KW - depression KW - anxiety KW - COVID-19 KW - opinion KW - usability KW - randomized control trial N2 - 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 UR - https://formative.jmir.org/2024/1/e53767 UR - http://dx.doi.org/10.2196/53767 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53767 ER - TY - JOUR AU - Edler, Johanna-Sophie AU - Terhorst, Yannik AU - Pryss, Rüdiger AU - Baumeister, Harald AU - Cohrdes, Caroline PY - 2024/9/16 TI - 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 JO - J Med Internet Res SP - e45530 VL - 26 KW - passive data KW - depression KW - anxiety KW - predicting mental health KW - mobile phone N2 - 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. UR - https://www.jmir.org/2024/1/e45530 UR - http://dx.doi.org/10.2196/45530 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/45530 ER - TY - JOUR AU - Lyzwinski, Lynnette AU - Zwicker, D. Jennifer AU - Mcdonald, Sheila AU - Tough, Suzanne PY - 2024/9/13 TI - 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 JO - JMIR Pediatr Parent SP - e59171 VL - 7 KW - positive psychology KW - mindfulness KW - resilience KW - mental health KW - flourishing KW - knowledge translation KW - depression KW - anxiety KW - stress N2 - 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). UR - https://pediatrics.jmir.org/2024/1/e59171 UR - http://dx.doi.org/10.2196/59171 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59171 ER - TY - JOUR AU - Guo, Yufang AU - Yue, Fangyan AU - Lu, Xiangyu AU - Sun, Fengye AU - Pan, Meixing AU - Jia, Yannan PY - 2024/9/10 TI - COVID-19?Related Social Isolation, Self-Control, and Internet Gaming Disorder Among Chinese University Students: Cross-Sectional Survey JO - J Med Internet Res SP - e52978 VL - 26 KW - COVID-19 pandemic KW - internet gaming disorder KW - self-control KW - social isolation KW - university students KW - game KW - gaming KW - games KW - addict KW - addictive KW - addiction KW - addictions KW - university KW - universities KW - college KW - colleges KW - postsecondary KW - higher education KW - student KW - students KW - China KW - Chinese KW - isolation KW - isolated KW - self-compassion KW - mental health KW - association KW - associations KW - correlation KW - causal KW - correlated KW - correlations N2 - 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 (?=?.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. UR - https://www.jmir.org/2024/1/e52978 UR - http://dx.doi.org/10.2196/52978 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52978 ER - TY - JOUR AU - Sugaya, Nagisa AU - Yamamoto, Tetsuya AU - Suzuki, Naho AU - Uchiumi, Chigusa PY - 2024/9/9 TI - Loneliness and Social Isolation Factors Under the Prolonged COVID-19 Pandemic in Japan: 2-Year Longitudinal Study JO - JMIR Public Health Surveill SP - e51653 VL - 10 KW - COVID-19 KW - pandemic KW - loneliness KW - social isolation KW - longitudinal survey KW - epidemiology KW - mental health N2 - 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. UR - https://publichealth.jmir.org/2024/1/e51653 UR - http://dx.doi.org/10.2196/51653 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250195 ID - info:doi/10.2196/51653 ER - TY - JOUR AU - Watanabe, Kazuhiro AU - Tran, Thu Thuy Thi AU - Sripo, Narisara AU - Sakuraya, Asuka AU - Imamura, Kotaro AU - Boonyamalik, Plernpit AU - Sasaki, Natsu AU - Tienthong, Thanate AU - Asaoka, Hiroki AU - Iida, Mako AU - Nguyen, Thuy Quynh AU - Nguyen, Thi Nga AU - Vu, Thai Son AU - Ngo, Thi Thuy AU - Luyen, Thi Tham AU - Nguyen, Duc Long AU - Nguyen, Viet Nga Thi AU - Nguyen, Thanh Binh AU - Matsuyama, Yutaka AU - Takemura, Yukie AU - Nishi, Daisuke AU - Tsutsumi, Akizumi AU - Nguyen, Thanh Huong AU - Kaewboonchoo, Orawan AU - Kawakami, Norito PY - 2024/8/30 TI - 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 JO - J Med Internet Res SP - e50071 VL - 26 KW - digital mental health intervention KW - unguided program KW - universal prevention KW - health care workers KW - nurses KW - COVID-19 KW - depression KW - mobile phone N2 - 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 UR - https://www.jmir.org/2024/1/e50071 UR - http://dx.doi.org/10.2196/50071 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50071 ER - TY - JOUR AU - Lanza, T. Stephanie AU - Whetzel, Courtney AU - Bhandari, Sandesh PY - 2024/8/23 TI - Health and Well-Being Among College Students in the United States During the COVID-19 Pandemic: Daily Diary Study JO - Interact J Med Res SP - e45689 VL - 13 KW - daily diary KW - college student KW - young adult KW - mental health KW - substance use KW - stress KW - well-being KW - belonging N2 - 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. UR - https://www.i-jmr.org/2024/1/e45689 UR - http://dx.doi.org/10.2196/45689 UR - http://www.ncbi.nlm.nih.gov/pubmed/39178037 ID - info:doi/10.2196/45689 ER - TY - JOUR AU - Yan, Yifei AU - Li, Jun AU - Liu, Xingyun AU - Li, Qing AU - Yu, Xiaonan Nancy PY - 2024/8/8 TI - Identifying Reddit Users at a High Risk of Suicide and Their Linguistic Features During the COVID-19 Pandemic: Growth-Based Trajectory Model JO - J Med Internet Res SP - e48907 VL - 26 KW - COVID-19 pandemic KW - Reddit KW - suicide risk KW - trajectory N2 - 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. UR - https://www.jmir.org/2024/1/e48907 UR - http://dx.doi.org/10.2196/48907 UR - http://www.ncbi.nlm.nih.gov/pubmed/39115925 ID - info:doi/10.2196/48907 ER - TY - JOUR AU - Yang, Yunjuan AU - Zha, Shun AU - Li, Tunan PY - 2024/7/31 TI - Secular Trends in Depressive Symptoms in Adolescents in Yunnan, Southwest China From Before COVID-19 to During the COVID-19 Pandemic: Longitudinal, Observational Study JO - JMIR Public Health Surveill SP - e52683 VL - 10 KW - COVID-19 exposure KW - depressive symptom KW - adolescent KW - epidemic trend KW - prevalence KW - observational study KW - epidemic KW - COVID-19 KW - depression KW - symptoms KW - teen KW - youth KW - China KW - mental health KW - psychological KW - logistic regression KW - lifestyle intervention N2 - 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. UR - https://publichealth.jmir.org/2024/1/e52683 UR - http://dx.doi.org/10.2196/52683 UR - http://www.ncbi.nlm.nih.gov/pubmed/39083344 ID - info:doi/10.2196/52683 ER - TY - JOUR AU - Wei, Lu AU - Huang, Qing PY - 2024/7/10 TI - Retrospecting Digital Media Use, Negative Emotions, and Trust Gaps During the COVID-19 Pandemic in China: Cross-Sectional Web-Based Survey JO - J Med Internet Res SP - e49422 VL - 26 KW - digital media use KW - negative emotions KW - family members?strangers trust gap KW - family members?acquaintances trust gap KW - mediation effect KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2024/1/e49422 UR - http://dx.doi.org/10.2196/49422 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49422 ER - TY - JOUR AU - Villarreal-Zegarra, David AU - García-Serna, Jackeline AU - Segovia-Bacilio, Piero AU - Mayo-Puchoc, Nikol AU - Navarro-Flores, Alba AU - Huarcaya-Victoria, Jeff PY - 2024/7/8 TI - In-Person and Teleconsultation Services at a National Hospital in Peru: Time Series Analysis of General and Psychiatric Care Amid the COVID-19 Pandemic JO - JMIR Ment Health SP - e53980 VL - 11 KW - health care utilization KW - mental health use KW - COVID-19 KW - mental health KW - health care KW - psychiatric care KW - teleconsultation KW - hospital KW - Peru KW - chronic KW - patient KW - patients KW - telemonitoring N2 - 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. UR - https://mental.jmir.org/2024/1/e53980 UR - http://dx.doi.org/10.2196/53980 UR - http://www.ncbi.nlm.nih.gov/pubmed/38976320 ID - info:doi/10.2196/53980 ER - TY - JOUR AU - Turuba, Roxanne AU - Cormier, Willow AU - Zimmerman, Rae AU - Ow, Nikki AU - Zenone, Marco AU - Quintana, Yuri AU - Jenkins, Emily AU - Ben-David, Shelly AU - Raimundo, Alicia AU - Marcon, R. Alessandro AU - Mathias, Steve AU - Henderson, Jo AU - Barbic, Skye PY - 2024/7/5 TI - Exploring How Youth Use TikTok for Mental Health Information in British Columbia: Semistructured Interview Study With Youth JO - JMIR Infodemiology SP - e53233 VL - 4 KW - youth KW - adolescents KW - young adults KW - mental health KW - TikTok KW - social media KW - qualitative research N2 - 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. UR - https://infodemiology.jmir.org/2024/1/e53233 UR - http://dx.doi.org/10.2196/53233 UR - http://www.ncbi.nlm.nih.gov/pubmed/38967966 ID - info:doi/10.2196/53233 ER - TY - JOUR AU - Ormiston, K. Cameron AU - Villalobos, Kevin AU - Montiel Ishino, Alejandro Francisco AU - Williams, Faustine PY - 2024/6/6 TI - Association Between Discrimination and Depressive Symptoms Among Hispanic or Latino Adults During the COVID-19 Pandemic: Cross-Sectional Study JO - JMIR Form Res SP - e48076 VL - 8 KW - depressive symptoms KW - everyday discrimination KW - COVID-19 pandemic KW - Hispanic and Latino KW - immigrant health N2 - 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. UR - https://formative.jmir.org/2024/1/e48076 UR - http://dx.doi.org/10.2196/48076 UR - http://www.ncbi.nlm.nih.gov/pubmed/38843512 ID - info:doi/10.2196/48076 ER - TY - JOUR AU - Law, Graham AU - Cooper, Rhiannon AU - Pirrie, Melissa AU - Ferron, Richard AU - McLeod, Brent AU - Spaight, Robert AU - Siriwardena, Niroshan A. AU - Agarwal, Gina AU - PY - 2024/5/10 TI - Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study JO - JMIR Public Health Surveill SP - e46029 VL - 10 KW - COVID-19 KW - mental health KW - overdose KW - emergency medical services KW - administrative data KW - Canada KW - the United Kingdom KW - ambulance KW - sex KW - age KW - lockdown KW - pandemic planning KW - emergency service N2 - 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. UR - https://publichealth.jmir.org/2024/1/e46029 UR - http://dx.doi.org/10.2196/46029 UR - http://www.ncbi.nlm.nih.gov/pubmed/38728683 ID - info:doi/10.2196/46029 ER - TY - JOUR AU - Gotra, Milena AU - Lindberg, Katharine AU - Jasinski, Nicholas AU - Scarisbrick, David AU - Reilly, Shannon AU - Perle, Jonathan AU - Miller, Liv AU - Mahoney III, James PY - 2024/4/29 TI - Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study JO - JMIR Form Res SP - e50303 VL - 8 KW - COVID-19 pandemic KW - mental health KW - social worker KW - psychologist KW - neuropsychologist KW - academic medical center KW - community mental health KW - private practice KW - Veteran?s Affairs hospital KW - longitudinal questionnaire study KW - COVID-19 KW - implementation KW - telemental health KW - hybrid model KW - availability N2 - 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. UR - https://formative.jmir.org/2024/1/e50303 UR - http://dx.doi.org/10.2196/50303 UR - http://www.ncbi.nlm.nih.gov/pubmed/38683653 ID - info:doi/10.2196/50303 ER - TY - JOUR AU - Garrett, Camryn AU - Aghaei, Atefeh AU - Aggarwal, Abhishek AU - Qiao, Shan PY - 2024/4/23 TI - The Role of Social Media in the Experiences of COVID-19 Among Long-Hauler Women: Qualitative Study JO - JMIR Hum Factors SP - e50443 VL - 11 KW - COVID-19 KW - long COVID KW - long-haulers KW - women KW - gender KW - social media KW - digital media KW - qualitative study N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e50443 UR - http://dx.doi.org/10.2196/50443 UR - http://www.ncbi.nlm.nih.gov/pubmed/38652515 ID - info:doi/10.2196/50443 ER - TY - JOUR AU - AbdulHussein, Ali AU - Butt, Ahmad Zahid AU - Dimitrov, Stanko AU - Cozzarin, Brian PY - 2024/2/15 TI - Factors Associated With Worsened Mental Health of Health Care Workers in Canada During the COVID-19 Pandemic: Cross-Sectional Survey Study JO - Interact J Med Res SP - e50064 VL - 13 KW - health care workers KW - COVID-19 KW - mental health KW - demographic factors KW - occupational factors KW - access to PPE KW - pandemic KW - health care system KW - psychological trauma KW - psychological KW - trauma KW - respirators KW - eye protection KW - face shields KW - support N2 - 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. UR - https://www.i-jmr.org/2024/1/e50064 UR - http://dx.doi.org/10.2196/50064 UR - http://www.ncbi.nlm.nih.gov/pubmed/38358785 ID - info:doi/10.2196/50064 ER - TY - JOUR AU - Macaluso, Maurizio AU - Rothenberg, E. Marc AU - Ferkol, Thomas AU - Kuhnell, Pierce AU - Kaminski, J. Henry AU - Kimberlin, W. David AU - Benatar, Michael AU - Chehade, Mirna AU - PY - 2024/2/14 TI - Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey JO - JMIR Public Health Surveill SP - e48430 VL - 10 KW - rare diseases KW - rare KW - chronic KW - COVID-19 infection KW - cross-sectional survey KW - access to care KW - changes in symptoms and use of medications KW - psychological impact on self and family KW - access KW - accessibility KW - cross-sectional KW - national KW - nationwide KW - survey KW - surveys KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - comorbid KW - comorbidity KW - vulnerable N2 - 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. UR - https://publichealth.jmir.org/2024/1/e48430 UR - http://dx.doi.org/10.2196/48430 UR - http://www.ncbi.nlm.nih.gov/pubmed/38354030 ID - info:doi/10.2196/48430 ER - TY - JOUR AU - Shen, Chen AU - Smith, B. Rachel AU - Heller, Joel AU - Spiers, V. Alexander D. AU - Thompson, Rhiannon AU - Ward, Helen AU - Roiser, P. Jonathan AU - Nicholls, Dasha AU - Toledano, B. Mireille PY - 2024/2/7 TI - Depression and Anxiety in Adolescents During the COVID-19 Pandemic in Relation to the Use of Digital Technologies: Longitudinal Cohort Study JO - J Med Internet Res SP - e45114 VL - 26 KW - COVID-19 KW - depression KW - anxiety KW - public health KW - adolescence KW - digital technology use KW - sleep KW - mobile phone N2 - 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. UR - https://www.jmir.org/2024/1/e45114 UR - http://dx.doi.org/10.2196/45114 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324379 ID - info:doi/10.2196/45114 ER - TY - JOUR AU - Yu, Chuen Chou AU - Tou, Xiang Nien AU - Low, Alvin James PY - 2024/2/6 TI - 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 JO - JMIR Form Res SP - e46824 VL - 8 KW - COVID-19 KW - digital divide KW - well-being KW - older adults KW - information and communication technology KW - internet of things KW - online KW - mental health KW - lockdown KW - depression KW - stress KW - anxiety KW - digital technology KW - pandemic N2 - 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. UR - https://formative.jmir.org/2024/1/e46824 UR - http://dx.doi.org/10.2196/46824 UR - http://www.ncbi.nlm.nih.gov/pubmed/38319700 ID - info:doi/10.2196/46824 ER - TY - JOUR AU - Mirzayi, Chloe AU - Westmoreland, Drew AU - Stief, Matthew AU - Grov, Christian PY - 2024/1/26 TI - 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 JO - JMIR Public Health Surveill SP - e47048 VL - 10 KW - COVID-19 pandemic KW - lesbian, gay, bisexual, transgender, and queer KW - LGBTQ KW - mental health KW - depression KW - anxiety KW - time series KW - gay and bisexual men KW - cisgender gay KW - pandemic KW - gay N2 - 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. UR - https://publichealth.jmir.org/2024/1/e47048 UR - http://dx.doi.org/10.2196/47048 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277213 ID - info:doi/10.2196/47048 ER - TY - JOUR AU - Moghimi, Elnaz AU - Stephenson, Callum AU - Agarwal, Anika AU - Nikjoo, Niloofar AU - Malakouti, Niloufar AU - Layzell, Gina AU - O'Riordan, Anne AU - Jagayat, Jasleen AU - Shirazi, Amirhossein AU - Gutierrez, Gilmar AU - Khan, Ferwa AU - Patel, Charmy AU - Yang, Megan AU - Omrani, Mohsen AU - Alavi, Nazanin PY - 2023/12/25 TI - 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 JO - JMIR Ment Health SP - e51102 VL - 10 KW - mental health KW - depression KW - anxiety KW - cognitive behavioral therapy KW - online KW - COVID-19 KW - efficacy KW - electronic cognitive behavioral therapy KW - online psychotherapy tool KW - pandemic KW - evidence-based treatment N2 - 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 UR - https://mental.jmir.org/2023/1/e51102 UR - http://dx.doi.org/10.2196/51102 UR - http://www.ncbi.nlm.nih.gov/pubmed/37993984 ID - info:doi/10.2196/51102 ER - TY - JOUR AU - Chen, Hwa Huan AU - Hsu, Tien Hsin AU - Lin, Chao Pei AU - Chen, Chin-Yin AU - Hsieh, Fen Hsiu AU - Ko, Hung Chih PY - 2023/12/14 TI - Efficacy of a Smartphone App in Enhancing Medication Adherence and Accuracy in Individuals With Schizophrenia During the COVID-19 Pandemic: Randomized Controlled Trial JO - JMIR Ment Health SP - e50806 VL - 10 KW - cognitive functions KW - medication adherence KW - psychiatric symptoms KW - schizophrenia KW - smartphone app N2 - 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 UR - https://mental.jmir.org/2023/1/e50806 UR - http://dx.doi.org/10.2196/50806 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096017 ID - info:doi/10.2196/50806 ER - TY - JOUR AU - Sanchez, Travis AU - Hall, Eric AU - Siegler, J. Aaron AU - Prakash-Asrani, Radhika AU - Bradley, Heather AU - Fahimi, Mansour AU - Lopman, Benjamin AU - Luisi, Nicole AU - Nelson, N. Kristin AU - Sailey, Charles AU - Shioda, Kayoko AU - Valentine-Graves, Mariah AU - Sullivan, S. Patrick PY - 2023/12/6 TI - Prevalence of COVID-19 Mitigation Behaviors in US Adults (August-December 2020): Nationwide Household Probability Survey JO - JMIR Public Health Surveill SP - e37102 VL - 9 KW - COVID-19 KW - mask KW - social distancing KW - handwashing KW - hand sanitizer KW - public health KW - pandemic KW - mitigation behavior KW - risk factor KW - disease prevention KW - health policy KW - latent class analysis KW - hygiene N2 - 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. UR - https://publichealth.jmir.org/2023/1/e37102 UR - http://dx.doi.org/10.2196/37102 UR - http://www.ncbi.nlm.nih.gov/pubmed/38055314 ID - info:doi/10.2196/37102 ER - TY - JOUR AU - Nazarov, Anthony AU - Fikretoglu, Deniz AU - Liu, Aihua AU - Born, Jennifer AU - Michaud, Kathy AU - Hendriks, Tonya AU - Bélanger, AH Stéphanie AU - Do, T. Minh AU - Lam, Quan AU - Brooks, Brenda AU - King, Kristen AU - Sudom, Kerry AU - Jetly, Rakesh AU - Garber, Bryan AU - Thompson, Megan PY - 2023/11/6 TI - 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 JO - JMIR Res Protoc SP - e44299 VL - 12 KW - mental health KW - military KW - Canadian Armed Forces KW - operational organization KW - logistics support KW - health care KW - moral distress KW - moral injury KW - deployment KW - risk factors KW - COVID-19 KW - quarantine KW - readiness KW - well-being KW - resilience KW - long-term care facility KW - centre de soins de longue durée KW - survey KW - older adult KW - qualitative interviews KW - quantitative N2 - 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 UR - https://www.researchprotocols.org/2023/1/e44299 UR - http://dx.doi.org/10.2196/44299 UR - http://www.ncbi.nlm.nih.gov/pubmed/37676877 ID - info:doi/10.2196/44299 ER - TY - JOUR AU - Bögemann, A. Sophie AU - Puhlmann, C. Lara M. AU - Wackerhagen, Carolin AU - Zerban, Matthias AU - Riepenhausen, Antje AU - Köber, Göran AU - Yuen, L. Kenneth S. AU - Pooseh, Shakoor AU - Marciniak, A. Marta AU - Reppmann, Zala AU - U?ci?ko, Aleksandra AU - Weermeijer, Jeroen AU - Lenferink, B. Dionne AU - Mituniewicz, Julian AU - Robak, Natalia AU - Donner, C. Nina AU - Mestdagh, Merijn AU - Verdonck, Stijn AU - van Dick, Rolf AU - Kleim, Birgit AU - Lieb, Klaus AU - van Leeuwen, C. Judith M. AU - Kobyli?ska, Dorota AU - Myin-Germeys, Inez AU - Walter, Henrik AU - Tüscher, Oliver AU - Hermans, J. Erno AU - Veer, M. Ilya AU - Kalisch, Raffael PY - 2023/10/17 TI - Psychological Resilience Factors and Their Association With Weekly Stressor Reactivity During the COVID-19 Outbreak in Europe: Prospective Longitudinal Study JO - JMIR Ment Health SP - e46518 VL - 10 KW - resilience KW - stressor reactivity KW - positive appraisal KW - pandemic KW - mental health KW - COVID-19 N2 - 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. UR - https://mental.jmir.org/2023/1/e46518 UR - http://dx.doi.org/10.2196/46518 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847551 ID - info:doi/10.2196/46518 ER - TY - JOUR AU - Prado, Silva Aneliana da AU - Kohls, Elisabeth AU - Baldofski, Sabrina AU - Rummel-Kluge, Christine AU - Freitas, Lucas Joanneliese de PY - 2023/10/13 TI - Acceptability and Feasibility of Online Support Groups for Mental Health Promotion in Brazilian Graduate Students During the COVID-19 Pandemic: Longitudinal Observational Study JO - JMIR Form Res SP - e44887 VL - 7 KW - support group KW - online group KW - COVID-19 pandemic KW - higher education KW - graduate students KW - university students KW - mental health KW - online intervention KW - internet intervention KW - e?mental health KW - mental health promotion KW - feasibility KW - students KW - acceptability N2 - 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. UR - https://formative.jmir.org/2023/1/e44887 UR - http://dx.doi.org/10.2196/44887 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831483 ID - info:doi/10.2196/44887 ER - TY - JOUR AU - Tran, Xuan Bach AU - Dam, Trong Vu Anh AU - Auquier, Pascal AU - Boyer, Laurent AU - Fond, Guillaume AU - Nguyen, Manh Hung AU - Nguyen, Tuan Hung AU - Le, Thi Huong AU - Tran, Thi Ha Nhi AU - Vu, Thu Giang AU - Nguyen, Duc Manh AU - Nguyen, Thi Duong Anh AU - Ly, Viet Bang AU - Latkin, A. Carl AU - Zhang, WB Melvyn AU - Ho, CM Roger AU - Ho, SH Cyrus PY - 2023/10/11 TI - Structural Equation Model for Social Support and Quality of Life Among Individuals With Mental Health Disorders During the COVID-19 Pandemic JO - JMIR Public Health Surveill SP - e47239 VL - 9 KW - contextual KW - social support KW - quality of life KW - mental health disorders KW - Vietnam KW - mental health KW - mental illness KW - cross-sectional KW - association N2 - 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. UR - https://publichealth.jmir.org/2023/1/e47239 UR - http://dx.doi.org/10.2196/47239 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819706 ID - info:doi/10.2196/47239 ER - TY - JOUR AU - Werkmeister, Benjamin AU - Haase, M. Anne AU - Fleming, Theresa AU - Officer, N. Tara PY - 2023/9/22 TI - Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Form Res SP - e50486 VL - 7 KW - telehealth KW - mental health services KW - Aotearoa New Zealand KW - mixed methods research KW - clinician KW - COVID-19 N2 - 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. UR - https://formative.jmir.org/2023/1/e50486 UR - http://dx.doi.org/10.2196/50486 UR - http://www.ncbi.nlm.nih.gov/pubmed/37738075 ID - info:doi/10.2196/50486 ER - TY - JOUR AU - Ward, M. Marcia AU - Ullrich, Fred AU - Bhagianadh, Divya AU - Nelson, Eve-Lynn AU - Marcin, P. James AU - Carter, D. Knute AU - Law, Beth Kari AU - McCord, Carly AU - Neufeld, Jonathan AU - Merchant, S. Kimberly A. PY - 2023/9/18 TI - Telehealth and In-Person Behavioral Health Services in Rural Communities Before and During the COVID-19 Pandemic: Multisite Prospective Cohort Study JO - JMIR Ment Health SP - e47047 VL - 10 KW - anxiety KW - behavior KW - behavioral health KW - COVID-19 KW - depression KW - digital health KW - eHealth KW - mental health KW - mHealth KW - pandemic KW - rural health services KW - rural KW - telehealth KW - telemedicine N2 - 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. UR - https://mental.jmir.org/2023/1/e47047 UR - http://dx.doi.org/10.2196/47047 UR - http://www.ncbi.nlm.nih.gov/pubmed/37721793 ID - info:doi/10.2196/47047 ER - TY - JOUR AU - Vicente, Asunción María AU - Gil Hernández, Eva AU - Carrillo, Irene AU - Fernández, César AU - López-Pineda, Adriana AU - Guilabert, Mercedes AU - Martín-Delgado, Jimmy AU - Solis, Carlos AU - Camba, Karla AU - Cañizares Fuentes, Ricardo Wilson AU - Mira, Joaquín José PY - 2023/9/6 TI - Coping Strategies Used by Health Care Workers in Ecuador During the COVID-19 Pandemic: Observational Study to Enhance Resilience and Develop Training Tools JO - JMIR Hum Factors SP - e47702 VL - 10 KW - COVID-19 KW - coping KW - mental health KW - social support KW - health professionals KW - psychological well-being KW - resilience KW - coping strategy KW - used KW - health care worker KW - pandemic KW - well-being KW - professional KW - intervention N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e47702 UR - http://dx.doi.org/10.2196/47702 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672317 ID - info:doi/10.2196/47702 ER - TY - JOUR AU - Yang, Jia-ming AU - Ye, Hua AU - Long, Yi AU - Zhu, Qiang AU - Huang, Hui AU - Zhong, Yan-biao AU - Luo, Yun AU - Yang, Lei AU - Wang, Mao-yuan PY - 2023/8/29 TI - 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 JO - J Med Internet Res SP - e44000 VL - 25 KW - web-based KW - mindfulness-based intervention KW - COVID-19 KW - health care worker KW - mental disorder N2 - 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 UR - https://www.jmir.org/2023/1/e44000 UR - http://dx.doi.org/10.2196/44000 UR - http://www.ncbi.nlm.nih.gov/pubmed/37527546 ID - info:doi/10.2196/44000 ER - TY - JOUR AU - Neumann, Ariana AU - König, Hans-Helmut AU - Bokermann, Josephine AU - Hajek, André PY - 2023/8/18 TI - Determinants of Patient Use and Satisfaction With Synchronous Telemental Health Services During the COVID-19 Pandemic: Systematic Review JO - JMIR Ment Health SP - e46148 VL - 10 KW - telemedicine KW - digital health KW - teletherapy KW - mental health KW - use KW - satisfaction N2 - 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 UR - https://mental.jmir.org/2023/1/e46148 UR - http://dx.doi.org/10.2196/46148 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594785 ID - info:doi/10.2196/46148 ER - TY - JOUR AU - Vera San Juan, Norha AU - Martin, Sam AU - Badley, Anna AU - Maio, Laura AU - Gronholm, C. Petra AU - Buck, Caroline AU - Flores, C. Elaine AU - Vanderslott, Samantha AU - Syversen, Aron AU - Symmons, Mulcahy Sophie AU - Uddin, Inayah AU - Karia, Amelia AU - Iqbal, Syka AU - Vindrola-Padros, Cecilia PY - 2023/8/14 TI - 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 JO - J Med Internet Res SP - e43000 VL - 25 KW - mental health KW - frontline KW - health care workers KW - COVID-19 KW - health services research KW - Collaborative and Digital Analysis of Big Qualitative Data in Time Sensitive Contexts KW - LISTEN method N2 - 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. UR - https://www.jmir.org/2023/1/e43000 UR - http://dx.doi.org/10.2196/43000 UR - http://www.ncbi.nlm.nih.gov/pubmed/37402283 ID - info:doi/10.2196/43000 ER - TY - JOUR AU - Beogo, Idrissa AU - Sia, Drissa AU - Collin, Stephanie AU - Phaelle Gedeon, Andi AU - Louismé, Michaël-Christopher AU - Ramdé, Jean AU - Gagnon, Marie-Pierre AU - Tchouaket Nguemeleu, Eric PY - 2023/8/14 TI - 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 JO - JMIR Aging SP - e46753 VL - 6 KW - information and communication technology KW - ICT KW - long-term care facilities KW - COVID-19 KW - social isolation KW - loneliness KW - pandemic KW - implementation sciences KW - protocol KW - nursing home KW - mobile phone N2 - 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 UR - https://aging.jmir.org/2023/1/e46753 UR - http://dx.doi.org/10.2196/46753 UR - http://www.ncbi.nlm.nih.gov/pubmed/37578824 ID - info:doi/10.2196/46753 ER - TY - JOUR AU - Fountaine, R. Alex AU - Iyar, M. Megumi AU - Lutes, D. Lesley PY - 2023/6/20 TI - Examining the Utility of a Telehealth Warm Handoff in Integrated Primary Care for Improving Patient Engagement in Mental Health Treatment: Randomized Video Vignette Study JO - JMIR Form Res SP - e40274 VL - 7 KW - integrated primary care KW - integrated care KW - patient-centered medical home KW - warm handoff KW - treatment engagement KW - collaborative care N2 - 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 (?21=10.9, P=.004) and the likelihood of continued engagement (?21=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. UR - https://formative.jmir.org/2023/1/e40274 UR - http://dx.doi.org/10.2196/40274 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338963 ID - info:doi/10.2196/40274 ER - TY - JOUR AU - Liu, Shuyan AU - Wegner, Luisa AU - Haucke, Matthias AU - Gates, Jennifer AU - Adam, Maya AU - Bärnighausen, Till PY - 2023/6/7 TI - An Entertainment-Education Video and Written Messages to Alleviate Loneliness in Germany: Pilot Randomized Controlled Study JO - JMIR Form Res SP - e43036 VL - 7 KW - entertainment media KW - perceived social isolation KW - health communication KW - digital knowledge N2 - 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 (?=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 UR - https://formative.jmir.org/2023/1/e43036 UR - http://dx.doi.org/10.2196/43036 UR - http://www.ncbi.nlm.nih.gov/pubmed/37285206 ID - info:doi/10.2196/43036 ER - TY - JOUR AU - Braz, Rodrigues Patricia AU - Moreira, Ricardo Tiago AU - Ribeiro, Queiroz Andréia AU - de Faria, Ribeiro Luciane AU - Carbogim, Costa Fabio da AU - Püschel, Araújo Vilanice Alves de AU - Fhon, Silva Jack Roberto AU - Freitas, Rezende Eduarda AU - Pinto, Carvalho Ione AU - Zacharias, Machado Fabiana Costa AU - Cruz, Panitz Gylce Eloisa Cabreira AU - Machado, Miranda Richardson AU - Santana, Ferreira Rosimere AU - de Souza, Alfradique Priscilla AU - Bitencourt, Ribeiro Graziele AU - Bulgarelli, Favero Alexandre AU - Cavalcante, Bezerra Ricardo PY - 2023/5/17 TI - COVID-19 Infodemic and Impacts on the Mental Health of Older People: Cross-sectional Multicenter Survey Study JO - JMIR Aging SP - e42707 VL - 6 KW - information dissemination KW - health communication KW - COVID-19 KW - COVID-19 pandemic KW - public health KW - health of older people KW - mental health N2 - 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. UR - https://aging.jmir.org/2023/1/e42707 UR - http://dx.doi.org/10.2196/42707 UR - http://www.ncbi.nlm.nih.gov/pubmed/37195762 ID - info:doi/10.2196/42707 ER - TY - JOUR AU - Alaqra, Sarah Ala AU - Khumalo, C. Akhona PY - 2023/5/12 TI - Handling Public Well-being During the COVID-19 Crisis: Empirical Study With Representatives From Municipalities in Sweden JO - JMIR Form Res SP - e40669 VL - 7 KW - COVID-19 KW - Sweden KW - government KW - well-being KW - public health KW - information and communications technology KW - recreational activities N2 - 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. UR - https://formative.jmir.org/2023/1/e40669 UR - http://dx.doi.org/10.2196/40669 UR - http://www.ncbi.nlm.nih.gov/pubmed/37053098 ID - info:doi/10.2196/40669 ER - TY - JOUR AU - Ruiz, Sienna AU - Okere, Charles Uzoma AU - Eggers, Michelle AU - O'Leary, Catina AU - Politi, Mary AU - Wan, Fei AU - Housten, J. Ashley PY - 2023/4/27 TI - Eliciting Opinions on Health Messaging During the COVID-19 Pandemic: Qualitative Survey Study JO - JMIR Hum Factors SP - e39697 VL - 10 KW - COVID-19 KW - health messaging KW - rural populations KW - urban populations KW - communication KW - health information KW - messaging KW - dissemination KW - health equity KW - prevention KW - implementation N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e39697 UR - http://dx.doi.org/10.2196/39697 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848256 ID - info:doi/10.2196/39697 ER - TY - JOUR AU - Keeble, Matthew AU - Adams, Jean AU - Burgoine, Thomas PY - 2023/4/17 TI - Changes in Online Food Access During the COVID-19 Pandemic and Associations With Deprivation: Longitudinal Analysis JO - JMIR Public Health Surveill SP - e41822 VL - 9 KW - COVID-19 KW - digital food environment KW - fast foods KW - online food delivery services KW - public health N2 - 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. UR - https://publichealth.jmir.org/2023/1/e41822 UR - http://dx.doi.org/10.2196/41822 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848236 ID - info:doi/10.2196/41822 ER - TY - JOUR AU - Li, Ying AU - Ding, XiWen AU - Aierken, Ayizuhere AU - Pan, YiYang AU - Chen, Yuan AU - Hu, DongBin PY - 2023/4/14 TI - The Role of Community Cohesion in Older Adults During the COVID-19 Epidemic: Cross-sectional Study JO - JMIR Public Health Surveill SP - e45110 VL - 9 KW - community cohesion KW - physical and mental health KW - community services KW - environmental resources KW - COVID-19 epidemic KW - older adults N2 - 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. UR - https://publichealth.jmir.org/2023/1/e45110 UR - http://dx.doi.org/10.2196/45110 UR - http://www.ncbi.nlm.nih.gov/pubmed/36921236 ID - info:doi/10.2196/45110 ER - TY - JOUR AU - Ueda, Michiko AU - Watanabe, Kohei AU - Sueki, Hajime PY - 2023/3/16 TI - 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 JO - J Med Internet Res SP - e44965 VL - 25 KW - mental health KW - COVID-19 KW - Twitter KW - social media KW - depression KW - suicidal ideation KW - loneliness KW - public health crisis KW - psychological well-being KW - infodemiology KW - machine learning framework KW - digital surveillance KW - emotional distress KW - online survey N2 - 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. UR - https://www.jmir.org/2023/1/e44965 UR - http://dx.doi.org/10.2196/44965 UR - http://www.ncbi.nlm.nih.gov/pubmed/36809798 ID - info:doi/10.2196/44965 ER - TY - JOUR AU - Wang, Yi AU - Fu, Peipei AU - Li, Jie AU - Gao, Tingting AU - Jing, Zhengyue AU - Wang, Qiong AU - Zhao, Dan AU - Zhou, Chengchao PY - 2023/3/9 TI - 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 JO - JMIR Public Health Surveill SP - e43762 VL - 9 KW - psychological distress KW - frailty KW - multimorbidity KW - community-level social support KW - COVID-19 pandemic KW - psychological KW - rural KW - older adults KW - community KW - support KW - effectiveness N2 - 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 (?=.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 (?=.32, 95% CI 0.22-0.43, P<.001). Further, CSS moderated the aforementioned association (?=?.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 (?=?.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. UR - https://publichealth.jmir.org/2023/1/e43762 UR - http://dx.doi.org/10.2196/43762 UR - http://www.ncbi.nlm.nih.gov/pubmed/36811848 ID - info:doi/10.2196/43762 ER - TY - JOUR AU - Marston, Ramsden Hannah AU - Ko, Pei-Chun AU - Girishan Prabhu, Vishnunarayan AU - Freeman, Shannon AU - Ross, Christopher AU - Sharaievska, Iryna AU - Browning, HEM Matthew AU - Earle, Sarah AU - Ivan, Loredana AU - Kanozia, Rubal AU - Öztürk Çal?ko?lu, Halime AU - Arslan, Hasan AU - Bilir-Koca, Burcu AU - Alexandra Silva, Paula AU - Buttigieg, C. Sandra AU - Großschädl, Franziska AU - Schüttengruber, Gerhilde PY - 2023/3/6 TI - Digital Practices by Citizens During the COVID-19 Pandemic: Findings From an International Multisite Study JO - JMIR Ment Health SP - e41304 VL - 10 KW - COVID-19 KW - communication KW - gerontology KW - community living KW - technology KW - social media N2 - 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 UR - https://mental.jmir.org/2023/1/e41304 UR - http://dx.doi.org/10.2196/41304 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877558 ID - info:doi/10.2196/41304 ER - TY - JOUR AU - Weger, Rachel AU - Lossio-Ventura, Antonio Juan AU - Rose-McCandlish, Margaret AU - Shaw, S. Jacob AU - Sinclair, Stephen AU - Pereira, Francisco AU - Chung, Y. Joyce AU - Atlas, Yvette Lauren PY - 2023/3/1 TI - 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 JO - JMIR Ment Health SP - e40899 VL - 10 KW - COVID-19 KW - mental health KW - natural language processing KW - sentiment analysis KW - free response KW - qualitative KW - text analysis KW - mental illness KW - text KW - mental state KW - language KW - pandemic KW - age KW - education N2 - 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. UR - https://mental.jmir.org/2023/1/e40899 UR - http://dx.doi.org/10.2196/40899 UR - http://www.ncbi.nlm.nih.gov/pubmed/36525362 ID - info:doi/10.2196/40899 ER - TY - JOUR AU - Liang, Elisa AU - Kutok, R. Emily AU - Rosen, K. Rochelle AU - Burke, A. Taylor AU - Ranney, L. Megan PY - 2023/2/23 TI - Effects of Social Media Use on Connectivity and Emotions During Pandemic-Induced School Closures: Qualitative Interview Study Among Adolescents JO - JMIR Ment Health SP - e37711 VL - 10 KW - social media KW - adolescents KW - COVID-19 KW - emotions KW - connectivity N2 - 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. UR - https://mental.jmir.org/2023/1/e37711 UR - http://dx.doi.org/10.2196/37711 UR - http://www.ncbi.nlm.nih.gov/pubmed/36054613 ID - info:doi/10.2196/37711 ER - TY - JOUR AU - Shin, Hyerine AU - Kim, Ji-Su AU - Lee, HyunHae PY - 2023/2/22 TI - Association of Depression With Precautionary Behavior Compliance, COVID-19 Fear, and Health Behaviors in South Korea: National Cross-sectional Study JO - JMIR Public Health Surveill SP - e42677 VL - 9 KW - COVID-19 KW - precautionary behaviors KW - COVID-19 fear KW - health behavior deterioration KW - gender differences N2 - 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. UR - https://publichealth.jmir.org/2023/1/e42677 UR - http://dx.doi.org/10.2196/42677 UR - http://www.ncbi.nlm.nih.gov/pubmed/36716130 ID - info:doi/10.2196/42677 ER - TY - JOUR AU - Montiel Ishino, Alejandro Francisco AU - Villalobos, Kevin AU - Williams, Faustine PY - 2023/2/17 TI - Substance Use From Social Distancing and Isolation by US Nativity During the Time of COVID-19: Cross-sectional Study JO - JMIR Public Health Surveill SP - e38163 VL - 9 KW - substance use KW - COVID-19 KW - US nativity N2 - 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. UR - https://publichealth.jmir.org/2023/1/e38163 UR - http://dx.doi.org/10.2196/38163 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265162 ID - info:doi/10.2196/38163 ER - TY - JOUR AU - Zhong, Shaoling AU - Yang, Xinhu AU - Pan, Zihua AU - Fan, Yu AU - Chen, Yanan AU - Yu, Xin AU - Zhou, Liang PY - 2023/2/13 TI - The Usability, Feasibility, Acceptability, and Efficacy of Digital Mental Health Services in the COVID-19 Pandemic: Scoping Review, Systematic Review, and Meta-analysis JO - JMIR Public Health Surveill SP - e43730 VL - 9 KW - digital medicine KW - COVID-19 KW - mental health services KW - psychological well-being KW - COVID-19 pandemic N2 - 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 UR - https://publichealth.jmir.org/2023/1/e43730 UR - http://dx.doi.org/10.2196/43730 UR - http://www.ncbi.nlm.nih.gov/pubmed/36634261 ID - info:doi/10.2196/43730 ER - TY - JOUR AU - Lemaire, Célia AU - Humbert, Christophe AU - Sueur, Cédric AU - Racin, Céline PY - 2023/2/10 TI - Use of Digital Technologies to Maintain Older Adults? Social Ties During Visitation Restrictions in Long-Term Care Facilities: Scoping Review JO - JMIR Aging SP - e38593 VL - 6 KW - social isolation KW - COVID-19 pandemic KW - remote care KW - nursing homes KW - social ties KW - digital devices KW - older adults N2 - 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 UR - https://aging.jmir.org/2023/1/e38593 UR - http://dx.doi.org/10.2196/38593 UR - http://www.ncbi.nlm.nih.gov/pubmed/36599164 ID - info:doi/10.2196/38593 ER - TY - JOUR AU - Liu, Xu AU - Wu, Jing AU - Yang, Hongyang AU - Zhao, Fangjie AU - Qin, Yuchen AU - Wu, Jiali AU - Yan, Hongli AU - Xu, Yan AU - Zhang, Lulu PY - 2023/2/7 TI - Caregiver Perceptions of Children?s and Adolescents? Psychosocial Functioning During the Stringent COVID-19 Lockdown Restrictions in Shanghai: Cross-sectional Study JO - JMIR Public Health Surveill SP - e43689 VL - 9 KW - COVID-19 exposure KW - psychosocial function KW - parenting KW - children and adolescents KW - China N2 - 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. UR - https://publichealth.jmir.org/2023/1/e43689 UR - http://dx.doi.org/10.2196/43689 UR - http://www.ncbi.nlm.nih.gov/pubmed/36749625 ID - info:doi/10.2196/43689 ER - TY - JOUR AU - Sung, Sumi AU - Kim, Hwan Su AU - Lee, Changwoo AU - Kim, Youlim AU - Bae, Seul Ye AU - Chie, Kyu Eui PY - 2023/1/30 TI - 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 JO - JMIR Public Health Surveill SP - e43003 VL - 9 KW - COVID-19 KW - depression KW - anxiety KW - vital signs KW - symptoms KW - electronic health records N2 - 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. UR - https://publichealth.jmir.org/2023/1/e43003 UR - http://dx.doi.org/10.2196/43003 UR - http://www.ncbi.nlm.nih.gov/pubmed/36645439 ID - info:doi/10.2196/43003 ER - TY - JOUR AU - Albayrak, Bilge AU - Cordier, Jane Larissa AU - Greve, Sandra AU - Teschler, Uta AU - Dathe, Anne-Kathrin AU - Felderhoff-Müser, Ursula AU - Hüning, Maria Britta PY - 2023/1/25 TI - Feasibility of Video Consultation for Preterm Neurodevelopmental Follow-up Care During the COVID-19 Pandemic: Cohort Study JO - JMIR Pediatr Parent SP - e40940 VL - 6 KW - COVID-19 KW - very preterm infant KW - video consultation KW - follow-up care KW - COVID-19 pandemic KW - neurodevelopmental outcome N2 - 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. UR - https://pediatrics.jmir.org/2023/1/e40940 UR - http://dx.doi.org/10.2196/40940 UR - http://www.ncbi.nlm.nih.gov/pubmed/36409307 ID - info:doi/10.2196/40940 ER - TY - JOUR AU - Park, G. Linda AU - Meyer, L. Oanh AU - Dougan, M. Marcelle AU - Golden, Bethany AU - Ta, Kevin AU - Nam, Bora AU - Tsoh, Y. Janice AU - Tzuang, Marian AU - Park, Ta Van M. PY - 2023/1/23 TI - 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 JO - JMIR Public Health Surveill SP - e35748 VL - 9 KW - health disparities KW - mental health KW - depression KW - anxiety KW - social support technology KW - COVID-19 KW - pandemic KW - disparity KW - support KW - technology KW - physical health KW - race KW - survey KW - population KW - discrimination KW - outcome KW - AAPI N2 - 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. UR - https://publichealth.jmir.org/2023/1/e35748 UR - http://dx.doi.org/10.2196/35748 UR - http://www.ncbi.nlm.nih.gov/pubmed/36395324 ID - info:doi/10.2196/35748 ER - TY - JOUR AU - Wang, Zixin AU - Fang, Yuan AU - Chan, Shing-Fong Paul AU - Yu, Yuen Fuk AU - Sun, Fenghua PY - 2023/1/23 TI - 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 JO - JMIR Aging SP - e42223 VL - 6 KW - COVID-19 KW - physical activity KW - older adults KW - barriers KW - changes KW - repeated random telephone survey KW - China KW - aging KW - elderly population KW - community-dwelling older adults KW - health promotion KW - telehealth N2 - 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. UR - https://aging.jmir.org/2023/1/e42223 UR - http://dx.doi.org/10.2196/42223 UR - http://www.ncbi.nlm.nih.gov/pubmed/36599172 ID - info:doi/10.2196/42223 ER - TY - JOUR AU - Konteh, Hassan Frederick AU - Mannion, Russell AU - Jacobs, Rowena PY - 2022/12/29 TI - IT and the Quality and Efficiency of Mental Health Care in a Time of COVID-19: Case Study of Mental Health Providers in England JO - JMIR Form Res SP - e37533 VL - 6 IS - 12 KW - COVID-19 KW - mental health care KW - information technology KW - digital KW - inequalities KW - sociotechnical systems N2 - 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. UR - https://formative.jmir.org/2022/12/e37533 UR - http://dx.doi.org/10.2196/37533 UR - http://www.ncbi.nlm.nih.gov/pubmed/36423321 ID - info:doi/10.2196/37533 ER - TY - JOUR AU - Wells, Kenneth AU - Thames, Denise April AU - Young, S. Alexander AU - Zhang, Lily AU - Heilemann, V. MarySue AU - Romero, Flores Daniela AU - Oliva, Adrian AU - Jones, Felica AU - Tang, Lingqi AU - Brymer, Melissa AU - Elliott, Thomas AU - Arevian, Armen AU - PY - 2022/12/7 TI - Engagement, Use, and Impact of Digital Mental Health Resources for Diverse Populations in COVID-19: Community-Partnered Evaluation JO - JMIR Form Res SP - e42031 VL - 6 IS - 12 KW - digital mental health KW - prevention KW - COVID-19 KW - depression KW - hotline use KW - health disparity KW - community health KW - public health KW - health resource KW - mental well-being KW - ethnic KW - website engagement KW - minority population KW - digital resource N2 - 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 (?=.27, 95% CI .10-.44; P=.002) and number of COVID-19?related behavior changes (?=.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 (?=?.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. UR - https://formative.jmir.org/2022/12/e42031 UR - http://dx.doi.org/10.2196/42031 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346902 ID - info:doi/10.2196/42031 ER - TY - JOUR AU - Fortuna, Karen AU - Hill, Julia AU - Chalker, Samantha AU - Ferron, Joelle PY - 2022/12/7 TI - Certified Peer Support Specialists Training in Technology and Delivery of Digital Peer Support Services: Cross-sectional Study JO - JMIR Form Res SP - e40065 VL - 6 IS - 12 KW - digital peer support KW - mHealth KW - COVID-19 KW - mental health KW - remote service KW - remote mental health KW - telehealth KW - peer support KW - psychological health N2 - 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. UR - https://formative.jmir.org/2022/12/e40065 UR - http://dx.doi.org/10.2196/40065 UR - http://www.ncbi.nlm.nih.gov/pubmed/36476983 ID - info:doi/10.2196/40065 ER - TY - JOUR AU - Garey, Lorra AU - Zvolensky, J. Michael AU - Gallagher, W. Matthew AU - Vujanovic, Anka AU - Kendzor, E. Darla AU - Stephens, Lancer AU - Cheney, K. Marshall AU - Cole, B. Ashley AU - Kezbers, Krista AU - Matoska, T. Cameron AU - Robison, Jillian AU - Montgomery, Audrey AU - Zappi, V. Christopher AU - Businelle, S. Michael PY - 2022/12/5 TI - A Smartphone-Based Intervention for Anxiety and Depression in Racially and Ethnically Diverse Adults (EASE): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e40713 VL - 11 IS - 12 KW - COVID-19 KW - just-in-time adaptive intervention KW - anxiety KW - depression KW - mHealth KW - minority populations KW - death KW - behavioral KW - care KW - mobile application KW - app KW - public health KW - symptoms KW - risk N2 - 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 UR - https://www.researchprotocols.org/2022/12/e40713 UR - http://dx.doi.org/10.2196/40713 UR - http://www.ncbi.nlm.nih.gov/pubmed/36409958 ID - info:doi/10.2196/40713 ER - TY - JOUR AU - Tan, Jin Rayner Kay AU - Lim, Mingjie Jane AU - Neo, Min Pearlyn Hui AU - Ong, Ee Suan PY - 2022/11/22 TI - Reinterpretation of Health Information in the Context of an Emerging Infectious Disease: A Digital Focus Group Study JO - JMIR Hum Factors SP - e39312 VL - 9 IS - 4 KW - health communication KW - infodemic KW - SARS-CoV-2 KW - coronavirus KW - Singapore KW - WhatsApp KW - COVID-19 KW - health information KW - misinformation KW - mobile health KW - smartphone KW - information quality KW - online health information N2 - 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. UR - https://humanfactors.jmir.org/2022/4/e39312 UR - http://dx.doi.org/10.2196/39312 UR - http://www.ncbi.nlm.nih.gov/pubmed/36099011 ID - info:doi/10.2196/39312 ER - TY - JOUR AU - Nicol, Ginger AU - Wang, Ruoyun AU - Graham, Sharon AU - Dodd, Sherry AU - Garbutt, Jane PY - 2022/11/22 TI - Chatbot-Delivered Cognitive Behavioral Therapy in Adolescents With Depression and Anxiety During the COVID-19 Pandemic: Feasibility and Acceptability Study JO - JMIR Form Res SP - e40242 VL - 6 IS - 11 KW - COVID-19 KW - adolescent depression KW - mobile health KW - cognitive behavioral therapy KW - chatbot KW - relational conversational agent KW - depression KW - anxiety KW - suicide KW - self-harm KW - pandemic KW - pediatric KW - youth KW - adolescent KW - adolescence KW - psychiatry KW - conversational agent KW - CBT KW - clinic KW - data KW - acceptability KW - feasibility KW - usability KW - primary care KW - intervention KW - mental health KW - digital health KW - technology mediated KW - computer mediated N2 - 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 UR - https://formative.jmir.org/2022/11/e40242 UR - http://dx.doi.org/10.2196/40242 UR - http://www.ncbi.nlm.nih.gov/pubmed/36413390 ID - info:doi/10.2196/40242 ER - TY - JOUR AU - Yu, Ellie AU - Xu, Bowen AU - Sequeira, Lydia PY - 2022/11/16 TI - Determinants of e-Mental Health Use During COVID-19: Cross-sectional Canadian Study JO - J Med Internet Res SP - e39662 VL - 24 IS - 11 KW - digital health KW - mental health KW - e-Mental health KW - user profile KW - determinants KW - health service KW - use KW - utilization KW - COVID-19 KW - pandemic KW - Canada KW - users KW - factors N2 - 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 ?2 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. UR - https://www.jmir.org/2022/11/e39662 UR - http://dx.doi.org/10.2196/39662 UR - http://www.ncbi.nlm.nih.gov/pubmed/36191173 ID - info:doi/10.2196/39662 ER - TY - JOUR AU - Wilczewski, Hattie AU - Paige, R. Samantha AU - Ong, Triton AU - Soni, Hiral AU - Barrera, F. Janelle AU - Welch, M. Brandon AU - Bunnell, E. Brian PY - 2022/11/11 TI - Providers? Perspectives on Telemental Health Usage After the COVID-19 Pandemic: Retrospective Analysis JO - JMIR Form Res SP - e39634 VL - 6 IS - 11 KW - telemedicine KW - telehealth KW - COVID-19 KW - telemental health KW - mental health KW - pandemic KW - perception KW - use KW - usefulness KW - usage KW - workflow N2 - 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 (?=.10; P=.005), perceived usefulness in general (?=.10; P=.008), ease of use (?=.08; P=.04), social influence (?=.68; P<.001), and facilitating conditions (?=.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. UR - https://formative.jmir.org/2022/11/e39634 UR - http://dx.doi.org/10.2196/39634 UR - http://www.ncbi.nlm.nih.gov/pubmed/36322787 ID - info:doi/10.2196/39634 ER - TY - JOUR AU - Comtois, Anne Katherine AU - Mata-Greve, Felicia AU - Johnson, Morgan AU - Pullmann, D. Michael AU - Mosser, Brittany AU - Arean, Patricia PY - 2022/11/7 TI - Effectiveness of Mental Health Apps for Distress During COVID-19 in US Unemployed and Essential Workers: Remote Pragmatic Randomized Clinical Trial JO - JMIR Mhealth Uhealth SP - e41689 VL - 10 IS - 11 KW - COVID-19 KW - COVID KW - coronavirus KW - pandemic KW - SARS-CoV-2 KW - essential worker KW - suicide KW - suicidal KW - commercial app KW - mental health apps KW - health app KW - mental health KW - mHealth KW - mobile health KW - occupational health KW - employee KW - employment KW - unemployed KW - worker KW - job KW - depression KW - anxiety KW - stress KW - distress KW - mobile app KW - RCT KW - pragmatic trial KW - randomized KW - health care worker KW - health care provider KW - frontline staff N2 - 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 UR - https://mhealth.jmir.org/2022/11/e41689 UR - http://dx.doi.org/10.2196/41689 UR - http://www.ncbi.nlm.nih.gov/pubmed/36191176 ID - info:doi/10.2196/41689 ER - TY - JOUR AU - Lee, Katherine AU - Bolton, Shay-Lee AU - Shterenberg, Ravit AU - Bolton, M. James AU - Hensel, M. Jennifer PY - 2022/11/4 TI - Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study JO - JMIR Form Res SP - e39861 VL - 6 IS - 11 KW - virtual ward KW - mental health KW - COVID-19 KW - implementation KW - driver diagram KW - virtual care KW - virtual health care KW - acceptance KW - psychiatric support KW - crisis support KW - provider perspectives N2 - 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. UR - https://formative.jmir.org/2022/11/e39861 UR - http://dx.doi.org/10.2196/39861 UR - http://www.ncbi.nlm.nih.gov/pubmed/36252139 ID - info:doi/10.2196/39861 ER - TY - JOUR AU - Sourander, Saana AU - Sourander, Andre AU - Hinkka-Yli-Salomäki, Susanna AU - Ristkari, Terja AU - Kurki, Marjo PY - 2022/11/2 TI - 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 JO - JMIR Pediatr Parent SP - e40614 VL - 5 IS - 4 KW - parent training KW - disruptive behavior KW - child psychopathology KW - child functioning KW - internet-based KW - COVID-19 pandemic KW - COVID-19 KW - mental health KW - psychological well-being KW - digital health KW - parenting KW - telehealth KW - behavioral problem KW - psychopathology N2 - 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. UR - https://pediatrics.jmir.org/2022/4/e40614 UR - http://dx.doi.org/10.2196/40614 UR - http://www.ncbi.nlm.nih.gov/pubmed/36194895 ID - info:doi/10.2196/40614 ER - TY - JOUR AU - Fuster-Casanovas, Aïna AU - Das, Ronnie AU - Vidal-Alaball, Josep AU - Lopez Segui, Francesc AU - Ahmed, Wasim PY - 2022/10/28 TI - The #VaccinesWork Hashtag on Twitter in the Context of the COVID-19 Pandemic: Network Analysis JO - JMIR Public Health Surveill SP - e38153 VL - 8 IS - 10 KW - Twitter KW - social media KW - COVID-19 KW - misinformation KW - vaccination KW - public health KW - vaccine hesitancy KW - infodemiology KW - health campaign KW - content analysis KW - social network KW - layout algorithm N2 - 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. UR - https://publichealth.jmir.org/2022/10/e38153 UR - http://dx.doi.org/10.2196/38153 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219832 ID - info:doi/10.2196/38153 ER - TY - JOUR AU - Liu, MingXin AU - Zhou, SiYu AU - Jin, Qun AU - Nishimura, Shoji AU - Ogihara, Atsushi PY - 2022/10/27 TI - Effectiveness, Policy, and User Acceptance of COVID-19 Contact-Tracing Apps in the Post?COVID-19 Pandemic Era: Experience and Comparative Study JO - JMIR Public Health Surveill SP - e40233 VL - 8 IS - 10 KW - COVID-19 KW - contact-tracing app KW - digital contact tracing KW - mobile phone N2 - 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. UR - https://publichealth.jmir.org/2022/10/e40233 UR - http://dx.doi.org/10.2196/40233 UR - http://www.ncbi.nlm.nih.gov/pubmed/36190741 ID - info:doi/10.2196/40233 ER - TY - JOUR AU - Pallavicini, Federica AU - Pepe, Alessandro AU - Clerici, Massimo AU - Mantovani, Fabrizia PY - 2022/10/25 TI - Virtual Reality Applications in Medicine During the COVID-19 Pandemic: Systematic Review JO - JMIR Serious Games SP - e35000 VL - 10 IS - 4 KW - virtual reality KW - medicine KW - mental health KW - physical health KW - education KW - training KW - COVID-19 N2 - 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/ UR - https://games.jmir.org/2022/4/e35000 UR - http://dx.doi.org/10.2196/35000 UR - http://www.ncbi.nlm.nih.gov/pubmed/36282554 ID - info:doi/10.2196/35000 ER - TY - JOUR AU - Woodward, F. Sean AU - Bari, Sumra AU - Vike, Nicole AU - Lalvani, Shamal AU - Stetsiv, Khrystyna AU - Kim, Woo Byoung AU - Stefanopoulos, Leandros AU - Maglaveras, Nicos AU - Breiter, Hans AU - Katsaggelos, K. Aggelos PY - 2022/10/25 TI - Anxiety, Post?COVID-19 Syndrome-Related Depression, and Suicidal Thoughts and Behaviors in COVID-19 Survivors: Cross-sectional Study JO - JMIR Form Res SP - e36656 VL - 6 IS - 10 KW - COVID-19 KW - post?COVID-19 syndrome KW - suicidality KW - depression KW - Patient Health Questionnaire-9 KW - PHQ-9 KW - State Trait Anxiety Index KW - STAI N2 - 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. UR - https://formative.jmir.org/2022/10/e36656 UR - http://dx.doi.org/10.2196/36656 UR - http://www.ncbi.nlm.nih.gov/pubmed/35763757 ID - info:doi/10.2196/36656 ER - TY - JOUR AU - Smith, Katharine AU - Torous, John AU - Cipriani, Andrea PY - 2022/10/14 TI - Teaching Telepsychiatry Skills: Building on the Lessons of the COVID-19 Pandemic to Enhance Mental Health Care in the Future JO - JMIR Ment Health SP - e37939 VL - 9 IS - 10 KW - mHealth KW - mental health KW - smartphones KW - telehealth KW - telepsychiatry KW - COVID-19 UR - https://mental.jmir.org/2022/10/e37939 UR - http://dx.doi.org/10.2196/37939 UR - http://www.ncbi.nlm.nih.gov/pubmed/35358948 ID - info:doi/10.2196/37939 ER - TY - JOUR AU - Mittone, F. Diletta AU - Bailey, P. Caitlin AU - Eddy, L. Ebony AU - Napolitano, A. Melissa AU - Vyas, Amita PY - 2022/10/14 TI - Women?s Satisfaction With Telehealth Services During The COVID-19 Pandemic: Cross-sectional Survey Study JO - JMIR Pediatr Parent SP - e41356 VL - 5 IS - 4 KW - telehealth KW - COVID-19 KW - maternal-child health KW - Perinatal KW - pediatrics KW - telemedicine KW - pregnancy KW - women's health KW - patient outcome N2 - 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. UR - https://pediatrics.jmir.org/2022/4/e41356 UR - http://dx.doi.org/10.2196/41356 UR - http://www.ncbi.nlm.nih.gov/pubmed/36125862 ID - info:doi/10.2196/41356 ER - TY - JOUR AU - Dambi, Jermaine AU - Norman, Clara AU - Doukani, Asmae AU - Potgieter, Stephan AU - Turner, Jean AU - Musesengwa, Rosemary AU - Verhey, Ruth AU - Chibanda, Dixon PY - 2022/10/7 TI - 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 JO - JMIR Ment Health SP - e37968 VL - 9 IS - 10 KW - acceptability KW - COVID-19 KW - feasibility KW - Friendship Bench KW - Inuka KW - pilot KW - task-shifting KW - Zimbabwe N2 - 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. UR - https://mental.jmir.org/2022/10/e37968 UR - http://dx.doi.org/10.2196/37968 UR - http://www.ncbi.nlm.nih.gov/pubmed/35960595 ID - info:doi/10.2196/37968 ER - TY - JOUR AU - Layug, Alyan AU - Krishnamurthy, Samiksha AU - McKenzie, Rachel AU - Feng, Bo PY - 2022/9/19 TI - 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 JO - JMIR Form Res SP - e38589 VL - 6 IS - 9 KW - Asian Americans KW - mental health KW - COVID-19 pandemic KW - racial discrimination KW - social media KW - anxiety KW - depression KW - secondary traumatic stress KW - negative affect KW - racial/ethnic identification N2 - 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. UR - https://formative.jmir.org/2022/9/e38589 UR - http://dx.doi.org/10.2196/38589 UR - http://www.ncbi.nlm.nih.gov/pubmed/36121698 ID - info:doi/10.2196/38589 ER - TY - JOUR AU - Rodriguez-Blazquez, Carmen AU - Romay-Barja, Maria AU - Falcon, Maria AU - Ayala, Alba AU - Forjaz, João Maria PY - 2022/9/8 TI - Psychometric Properties of the COVID-19 Pandemic Fatigue Scale: Cross-sectional Online Survey Study JO - JMIR Public Health Surveill SP - e34675 VL - 8 IS - 9 KW - COVID-19 KW - pandemic fatigue KW - psychometric properties KW - Rasch analysis KW - validation KW - online survey KW - pandemic KW - fatigue KW - mental health KW - information seeking KW - health information N2 - 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; ?25=8.06, P=.15). The CPFS showed good fit to the Rasch model (? 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. UR - https://publichealth.jmir.org/2022/9/e34675 UR - http://dx.doi.org/10.2196/34675 UR - http://www.ncbi.nlm.nih.gov/pubmed/35785547 ID - info:doi/10.2196/34675 ER - TY - JOUR AU - Minian, Nadia AU - Gayapersad, Allison AU - Saiva, Anika AU - Dragonetti, Rosa AU - Kidd, A. Sean AU - Strudwick, Gillian AU - Selby, Peter PY - 2022/8/26 TI - An e?Mental Health Resource for COVID-19?Associated Stress Reduction: Mixed Methods Study of Reach, Usability, and User Perceptions JO - JMIR Ment Health SP - e39885 VL - 9 IS - 8 KW - COVID-19 KW - website KW - stress KW - mental health KW - eHealth KW - internet-based intervention KW - mixed methods evaluation KW - usability KW - digital health KW - health informatics N2 - 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. UR - https://mental.jmir.org/2022/8/e39885 UR - http://dx.doi.org/10.2196/39885 UR - http://www.ncbi.nlm.nih.gov/pubmed/35960596 ID - info:doi/10.2196/39885 ER - TY - JOUR AU - Chikersal, Prerna AU - Venkatesh, Shruthi AU - Masown, Karman AU - Walker, Elizabeth AU - Quraishi, Danyal AU - Dey, Anind AU - Goel, Mayank AU - Xia, Zongqi PY - 2022/8/24 TI - Predicting Multiple Sclerosis Outcomes During the COVID-19 Stay-at-home Period: Observational Study Using Passively Sensed Behaviors and Digital Phenotyping JO - JMIR Ment Health SP - e38495 VL - 9 IS - 8 KW - mobile sensing KW - sensor KW - sensing KW - mobile health KW - mHealth KW - algorithm KW - multiple sclerosis KW - disability KW - mental health KW - depression KW - sleep KW - fatigue KW - tiredness KW - predict KW - machine learning KW - feature selection KW - neurological disorder KW - COVID-19 KW - isolation KW - behavior change KW - health outcome KW - fitness KW - movement KW - physical activity KW - exercise KW - tracker KW - digital phenotyping N2 - 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. UR - https://mental.jmir.org/2022/8/e38495 UR - http://dx.doi.org/10.2196/38495 UR - http://www.ncbi.nlm.nih.gov/pubmed/35849686 ID - info:doi/10.2196/38495 ER - TY - JOUR AU - Wiciak, Teresa Michelle AU - Shazley, Omar AU - Santhosh, Daphne PY - 2022/8/24 TI - 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 JO - JMIR Form Res SP - e38370 VL - 6 IS - 8 KW - coronavirus KW - COVID-19 KW - pandemic KW - mental health KW - depression KW - anxiety KW - screen-time usage KW - young adults KW - students KW - international study KW - observational study KW - cross-sectional study KW - smoking N2 - 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. UR - https://formative.jmir.org/2022/8/e38370 UR - http://dx.doi.org/10.2196/38370 UR - http://www.ncbi.nlm.nih.gov/pubmed/35878157 ID - info:doi/10.2196/38370 ER - TY - JOUR AU - Zangani, Caroline AU - Ostinelli, G. Edoardo AU - Smith, A. Katharine AU - Hong, W. James S. AU - Macdonald, Orla AU - Reen, Gurpreet AU - Reid, Katherine AU - Vincent, Charles AU - Syed Sheriff, Rebecca AU - Harrison, J. Paul AU - Hawton, Keith AU - Pitman, Alexandra AU - Bale, Rob AU - Fazel, Seena AU - Geddes, R. John AU - Cipriani, Andrea PY - 2022/8/22 TI - Impact of the COVID-19 Pandemic on the Global Delivery of Mental Health Services and Telemental Health: Systematic Review JO - JMIR Ment Health SP - e38600 VL - 9 IS - 8 KW - COVID-19 KW - coronavirus KW - mental health services KW - telemental health KW - telepsychiatry KW - face-to-face N2 - 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. UR - https://mental.jmir.org/2022/8/e38600 UR - http://dx.doi.org/10.2196/38600 UR - http://www.ncbi.nlm.nih.gov/pubmed/35994310 ID - info:doi/10.2196/38600 ER - TY - JOUR AU - Choudhury, Renoa AU - Park, Joon-Hyuk AU - Thiamwong, Ladda AU - Xie, Rui AU - Stout, R. Jeffrey PY - 2022/8/22 TI - Objectively Measured Physical Activity Levels and Associated Factors in Older US Women During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Aging SP - e38172 VL - 5 IS - 3 KW - physical activity KW - older women KW - COVID-19 KW - sedentary behavior KW - wrist-worn accelerometers KW - ActiGraph KW - aging KW - elderly population KW - women's health KW - digital health KW - frail KW - healthy lifestyle N2 - 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 UR - https://aging.jmir.org/2022/3/e38172 UR - http://dx.doi.org/10.2196/38172 UR - http://www.ncbi.nlm.nih.gov/pubmed/35994346 ID - info:doi/10.2196/38172 ER - TY - JOUR AU - Bari, Sumra AU - Vike, L. Nicole AU - Stetsiv, Khrystyna AU - Woodward, Sean AU - Lalvani, Shamal AU - Stefanopoulos, Leandros AU - Kim, Woo Byoung AU - Maglaveras, Nicos AU - Breiter, C. Hans AU - Katsaggelos, K. Aggelos PY - 2022/8/16 TI - The Prevalence of Psychotic Symptoms, Violent Ideation, and Disruptive Behavior in a Population With SARS-CoV-2 Infection: Preliminary Study JO - JMIR Form Res SP - e36444 VL - 6 IS - 8 KW - COVID-19 KW - paranoia KW - delusions KW - disruptive behavior KW - violent ideation KW - psychotic symptoms KW - pandemic KW - mental health KW - distress KW - stress KW - psychological health KW - psychosis KW - risk KW - machine learning N2 - 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. UR - https://formative.jmir.org/2022/8/e36444 UR - http://dx.doi.org/10.2196/36444 UR - http://www.ncbi.nlm.nih.gov/pubmed/35763758 ID - info:doi/10.2196/36444 ER - TY - JOUR AU - Mayor, Nikhil AU - Meza-Torres, Bernardo AU - Okusi, Cecilia AU - Delanerolle, Gayathri AU - Chapman, Martin AU - Wang, Wenjuan AU - Anand, Sneha AU - Feher, Michael AU - Macartney, Jack AU - Byford, Rachel AU - Joy, Mark AU - Gatenby, Piers AU - Curcin, Vasa AU - Greenhalgh, Trisha AU - Delaney, Brendan AU - de Lusignan, Simon PY - 2022/8/11 TI - Developing a Long COVID Phenotype for Postacute COVID-19 in a National Primary Care Sentinel Cohort: Observational Retrospective Database Analysis JO - JMIR Public Health Surveill SP - e36989 VL - 8 IS - 8 KW - medical record systems KW - computerized KW - Systematized Nomenclature of Medicine KW - postacute COVID-19 syndrome KW - phenotype KW - COVID-19 KW - long COVID KW - ethnicity KW - social class KW - general practitioners KW - data accuracy KW - data extracts KW - biomedical ontologies KW - SARS-CoV-2 KW - hospitalization KW - epidemiology KW - surveillance KW - public health KW - BioPortal KW - electronic health record KW - disease management KW - digital tool N2 - 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. UR - https://publichealth.jmir.org/2022/8/e36989 UR - http://dx.doi.org/10.2196/36989 UR - http://www.ncbi.nlm.nih.gov/pubmed/35861678 ID - info:doi/10.2196/36989 ER - TY - JOUR AU - Smith, E. Gillian AU - Harcourt, E. Sally AU - Hoang, Uy AU - Lemanska, Agnieszka AU - Elliot, J. Alex AU - Morbey, A. Roger AU - Hughes, E. Helen AU - Lake, Iain AU - Edeghere, Obaghe AU - Oliver, Isabel AU - Sherlock, Julian AU - Amlôt, Richard AU - de Lusignan, Simon PY - 2022/8/3 TI - Mental Health Presentations Across Health Care Settings During the First 9 Months of the COVID-19 Pandemic in England: Retrospective Observational Study JO - JMIR Public Health Surveill SP - e32347 VL - 8 IS - 8 KW - pandemic KW - public health KW - syndromic surveillance KW - mental health KW - anxiety KW - sleep problems KW - COVID-19 KW - health care KW - health surveillance KW - health care service N2 - 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. UR - https://publichealth.jmir.org/2022/8/e32347 UR - http://dx.doi.org/10.2196/32347 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486809 ID - info:doi/10.2196/32347 ER - TY - JOUR AU - Bastien, Laurianne AU - Boke, Naz Bilun AU - Mettler, Jessica AU - Zito, Stephanie AU - Di Genova, Lina AU - Romano, Vera AU - Lewis, P. Stephen AU - Whitley, Rob AU - Iyer, N. Srividya AU - Heath, L. Nancy PY - 2022/7/22 TI - Peer-Presented Versus Mental Health Service Provider?Presented Mental Health Outreach Programs for University Students: Randomized Controlled Trial JO - JMIR Ment Health SP - e34168 VL - 9 IS - 7 KW - web-based mental health outreach KW - resilience building KW - university student KW - peer-presented KW - mental health service provider?presented KW - mental health KW - outreach KW - resilience KW - student KW - service provider KW - randomized controlled trial N2 - 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 UR - https://mental.jmir.org/2022/7/e34168 UR - http://dx.doi.org/10.2196/34168 UR - http://www.ncbi.nlm.nih.gov/pubmed/35762935 ID - info:doi/10.2196/34168 ER - TY - JOUR AU - Spain, Debbie AU - Stewart, R. Gavin AU - Mason, David AU - Milner, Victoria AU - Fairhurst, Bryony AU - Robinson, Janine AU - Gillan, Nicola AU - Ensum, Ian AU - Stark, Eloise AU - Happe, Francesca PY - 2022/7/20 TI - Telehealth Autism Diagnostic Assessments With Children, Young People, and Adults: Qualitative Interview Study With England-Wide Multidisciplinary Health Professionals JO - JMIR Ment Health SP - e37901 VL - 9 IS - 7 KW - autism KW - COVID-19 pandemic KW - autism diagnostic assessment KW - telehealth KW - health professionals KW - clinical supervision KW - training KW - COVID-19 N2 - 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. UR - https://mental.jmir.org/2022/7/e37901 UR - http://dx.doi.org/10.2196/37901 UR - http://www.ncbi.nlm.nih.gov/pubmed/35857358 ID - info:doi/10.2196/37901 ER - TY - JOUR AU - Hanson, L. Bridget AU - Finley, Kari AU - Otto, Jay AU - Ward, J. Nicholas PY - 2022/7/13 TI - Role of Trusted Sources and Behavioral Beliefs in Promoting Mitigation Behaviors During the COVID-19 Pandemic: Survey Study JO - JMIR Hum Factors SP - e37454 VL - 9 IS - 3 KW - behavioral beliefs KW - health literacy KW - vaccination KW - trusted sources KW - social media KW - vaccine hesitancy KW - health information KW - masking KW - healthcare KW - public health KW - health beliefs N2 - 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. UR - https://humanfactors.jmir.org/2022/3/e37454 UR - http://dx.doi.org/10.2196/37454 UR - http://www.ncbi.nlm.nih.gov/pubmed/35830238 ID - info:doi/10.2196/37454 ER - TY - JOUR AU - Xi, JuZhe AU - Gao, YuHan AU - Lyu, Na AU - She, Zhuang AU - Wang, XinYue AU - Zhang, Xin-An AU - Yu, XiaoYu AU - Ji, WeiDong AU - Wei, MengSheng AU - Dai, WeiHui AU - Qian, Xuesheng PY - 2022/7/8 TI - Effect of the ?Art Coloring? Online Coloring Game on Subjective Well-Being Increase and Anxiety Reduction During the COVID-19 Pandemic: Development and Evaluation JO - JMIR Serious Games SP - e37026 VL - 10 IS - 3 KW - coloring game KW - online intervention KW - mental health KW - COVID-19 pandemic KW - gamification KW - game-based intervention KW - commercially released game N2 - 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 ?2=0.053, P=.06) and a significant decrease in anxiety (N=171, F4,170=3.39, partial ?2=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. UR - https://games.jmir.org/2022/3/e37026 UR - http://dx.doi.org/10.2196/37026 UR - http://www.ncbi.nlm.nih.gov/pubmed/35575761 ID - info:doi/10.2196/37026 ER - TY - JOUR AU - Catuara-Solarz, Silvina AU - Skorulski, Bartlomiej AU - Estella-Aguerri, Iñaki AU - Avella-Garcia, Bibiana Claudia AU - Shepherd, Sarah AU - Stott, Emily AU - Hemmings, R. Nicola AU - Ruiz de Villa, Aleix AU - Schulze, Laura AU - Dix, Sophie PY - 2022/7/1 TI - The Efficacy of ?Foundations,? a Digital Mental Health App to Improve Mental Well-being During COVID-19: Proof-of-Principle Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e30976 VL - 10 IS - 7 KW - mental well-being KW - digital health KW - cognitive behavioral therapy KW - positive psychology KW - insomnia KW - COVID-19 KW - mental health KW - mobile app KW - anxiety KW - health app N2 - 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 UR - https://mhealth.jmir.org/2022/7/e30976 UR - http://dx.doi.org/10.2196/30976 UR - http://www.ncbi.nlm.nih.gov/pubmed/34978535 ID - info:doi/10.2196/30976 ER - TY - JOUR AU - Grygarová, Dominika AU - Adámek, Petr AU - Jurí?ková, Veronika AU - Horá?ek, Ji?í AU - Bak?tein, Eduard AU - Fajnerová, Iveta AU - Kesner, Ladislav PY - 2022/6/28 TI - Impact of a Long Lockdown on Mental Health and the Role of Media Use: Web-Based Survey Study JO - JMIR Ment Health SP - e36050 VL - 9 IS - 6 KW - mental health KW - COVID-19 KW - lockdown KW - media use KW - anxiety KW - depression KW - nationally representative data KW - survey KW - longitudinal study KW - pandemic KW - social isolation KW - social media KW - psychological trauma KW - mental stress KW - media news N2 - 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. UR - https://mental.jmir.org/2022/6/e36050 UR - http://dx.doi.org/10.2196/36050 UR - http://www.ncbi.nlm.nih.gov/pubmed/35605112 ID - info:doi/10.2196/36050 ER - TY - JOUR AU - Laur, Celia AU - Agarwal, Payal AU - Thai, Kelly AU - Kishimoto, Vanessa AU - Kelly, Shawna AU - Liang, Kyle AU - Bhatia, Sacha R. AU - Bhattacharyya, Onil AU - Martin, Danielle AU - Mukerji, Geetha PY - 2022/6/28 TI - Implementation and Evaluation of COVIDCare@Home, a Family Medicine?Led Remote Monitoring Program for Patients With COVID-19: Multimethod Cross-sectional Study JO - JMIR Hum Factors SP - e35091 VL - 9 IS - 2 KW - virtual care KW - COVID-19 pandemic KW - remote monitoring programs KW - social determinants of health KW - digital health KW - COVID-19 KW - pandemic KW - health care KW - remote monitoring KW - clinical outcome KW - patient KW - health care cost KW - patient experience N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e35091 UR - http://dx.doi.org/10.2196/35091 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499974 ID - info:doi/10.2196/35091 ER - TY - JOUR AU - Sakur, Fareeya AU - Ward, Kanesha AU - Khatri, Nafees Neha AU - Lau, S. Annie Y. PY - 2022/6/21 TI - Self-care Behaviors and Technology Used During COVID-19: Systematic Review JO - JMIR Hum Factors SP - e35173 VL - 9 IS - 2 KW - self-care KW - self-management KW - chronic conditions KW - COVID-19 KW - pandemic KW - technology KW - digital health KW - telehealth KW - health technology N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e35173 UR - http://dx.doi.org/10.2196/35173 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442904 ID - info:doi/10.2196/35173 ER - TY - JOUR AU - McCrady, Emma AU - Strychowsky, E. Julie AU - Woolfson, P. Jessica PY - 2022/6/15 TI - Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study JO - JMIR Pediatr Parent SP - e34115 VL - 5 IS - 2 KW - virtual care KW - web-based care KW - COVID-19 KW - pediatrics KW - pandemic KW - physicians KW - digital health KW - pediatricians KW - telehealth N2 - 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. UR - https://pediatrics.jmir.org/2022/2/e34115 UR - http://dx.doi.org/10.2196/34115 UR - http://www.ncbi.nlm.nih.gov/pubmed/35666938 ID - info:doi/10.2196/34115 ER - TY - JOUR AU - Nordtug, Maja AU - Assing Hvidt, Elisabeth AU - Lüchau, Christine Elle AU - Grønning, Anette PY - 2022/6/14 TI - General Practitioners? Experiences of Professional Uncertainties Emerging from the Introduction of Video Consultations in General Practice: Qualitative Study JO - JMIR Form Res SP - e36289 VL - 6 IS - 6 KW - video consultation technology KW - general practice, COVID-19, doctor-patient communication KW - uncertainties KW - general practitioners KW - video consultation KW - virtual health KW - physician KW - digital health KW - pandemic N2 - 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. UR - https://formative.jmir.org/2022/6/e36289 UR - http://dx.doi.org/10.2196/36289 UR - http://www.ncbi.nlm.nih.gov/pubmed/35653607 ID - info:doi/10.2196/36289 ER - TY - JOUR AU - Johnson, K. Randi AU - Marker, M. Katie AU - Mayer, David AU - Shortt, Jonathan AU - Kao, David AU - Barnes, C. Kathleen AU - Lowery, T. Jan AU - Gignoux, R. Christopher PY - 2022/6/13 TI - COVID-19 Surveillance in the Biobank at the Colorado Center for Personalized Medicine: Observational Study JO - JMIR Public Health Surveill SP - e37327 VL - 8 IS - 6 KW - COVID-19 KW - surveillance KW - pandemic KW - biobank KW - EHR KW - public health KW - integrated data KW - population health KW - health monitoring KW - electronic health record KW - eHealth KW - health record KW - emergency response KW - vaccination status KW - vaccination KW - testing KW - symptom KW - disease impact N2 - 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. UR - https://publichealth.jmir.org/2022/6/e37327 UR - http://dx.doi.org/10.2196/37327 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486493 ID - info:doi/10.2196/37327 ER - TY - JOUR AU - Yu, Hanzhi AU - Du, Runming AU - Wang, Minmin AU - Yu, Fengyun AU - Yang, Juntao AU - Jiao, Lirui AU - Wang, Zhuoran AU - Liu, Haitao AU - Wu, Peixin AU - Bärnighausen, Till AU - Xue, Lan AU - Wang, Chen AU - McMahon, Shannon AU - Geldsetzer, Pascal AU - Chen, Simiao PY - 2022/6/7 TI - Attitudes Toward the Global Allocation of Chinese COVID-19 Vaccines: Cross-sectional Online Survey of Adults Living in China JO - JMIR Public Health Surveill SP - e33484 VL - 8 IS - 6 KW - COVID-19 vaccines KW - China KW - global allocation KW - public attitudes KW - cross-sectional KW - survey KW - vaccines KW - COVID-19 KW - pandemic KW - public health KW - health policy KW - epidemiology N2 - 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. UR - https://publichealth.jmir.org/2022/6/e33484 UR - http://dx.doi.org/10.2196/33484 UR - http://www.ncbi.nlm.nih.gov/pubmed/35483084 ID - info:doi/10.2196/33484 ER - TY - JOUR AU - Rivest-Beauregard, Marjolaine AU - Fortin, Justine AU - Guo, Connie AU - Cipolletta, Sabrina AU - Sapkota, P. Ram AU - Lonergan, Michelle AU - Brunet, Alain PY - 2022/6/7 TI - Media Use During the COVID-19 Pandemic: Cross-sectional Study JO - J Med Internet Res SP - e33011 VL - 24 IS - 6 KW - media use KW - support KW - information-seeking behaviors KW - trauma- and stressor-related symptoms KW - COVID-19 KW - media KW - information-seeking KW - behavior KW - trauma KW - stress KW - symptom KW - frequency KW - risk KW - distress N2 - 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 (?=.25; P<.001) and extent of information-seeking through media (?=.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 (?COVID-19 stressors: Peritraumatic Distress Inventory=.49, P<.001; ?seeking information: Peritraumatic Distress Inventory=.70, P<.001; ?seeking 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. UR - https://www.jmir.org/2022/6/e33011 UR - http://dx.doi.org/10.2196/33011 UR - http://www.ncbi.nlm.nih.gov/pubmed/3553703 ID - info:doi/10.2196/33011 ER - TY - JOUR AU - Savage, D. Rachel AU - Di Nicolo, Sophia AU - Wu, Wei AU - Li, Joyce AU - Lawson, Andrea AU - Grieve, Jim AU - Goel, Vivek AU - Rochon, A. Paula PY - 2022/6/6 TI - 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 JO - JMIR Aging SP - e34793 VL - 5 IS - 2 KW - digital technology KW - loneliness KW - older adults KW - COVID-19 KW - elderly KW - lonely KW - mental health KW - factor KW - usage KW - social media KW - video KW - communication KW - connection KW - connect KW - family KW - friend KW - age KW - support N2 - 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. UR - https://aging.jmir.org/2022/2/e34793 UR - http://dx.doi.org/10.2196/34793 UR - http://www.ncbi.nlm.nih.gov/pubmed/35344502 ID - info:doi/10.2196/34793 ER - TY - JOUR AU - Gangamma, Rashmi AU - Walia, Bhavneet AU - Luke, Melissa AU - Lucena, Claudine PY - 2022/6/1 TI - Continuation of Teletherapy After the COVID-19 Pandemic: Survey Study of Licensed Mental Health Professionals JO - JMIR Form Res SP - e32419 VL - 6 IS - 6 KW - teletherapy KW - relational teletherapy KW - teletherapy predictors KW - postpandemic teletherapy KW - mental health KW - telemedicine KW - COVID-19 KW - telehealth N2 - 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. UR - https://formative.jmir.org/2022/6/e32419 UR - http://dx.doi.org/10.2196/32419 UR - http://www.ncbi.nlm.nih.gov/pubmed/35584317 ID - info:doi/10.2196/32419 ER - TY - JOUR AU - Clark, D. Kristen AU - Lunn, R. Mitchell AU - Sherman, F. Athena D. AU - Bosley, G. Hannah AU - Lubensky, E. Micah AU - Obedin-Maliver, Juno AU - Dastur, Zubin AU - Flentje, Annesa PY - 2022/5/30 TI - COVID-19 News and Its Association With the Mental Health of Sexual and Gender Minority Adults: Cross-sectional Study JO - JMIR Public Health Surveill SP - e34710 VL - 8 IS - 5 KW - PTSD KW - posttraumatic stress disorder KW - anxiety KW - minority populations KW - vicarious trauma KW - tertiary trauma KW - COVID-19 KW - pandemic KW - public health KW - sexual orientation KW - gender identity KW - mental health N2 - 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. UR - https://publichealth.jmir.org/2022/5/e34710 UR - http://dx.doi.org/10.2196/34710 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486805 ID - info:doi/10.2196/34710 ER - TY - JOUR AU - Zhu, Patricia AU - Tatar, Ovidiu AU - Griffin-Mathieu, Gabrielle AU - Perez, Samara AU - Haward, Ben AU - Zimet, Gregory AU - Tunis, Matthew AU - Dubé, Ève AU - Rosberger, Zeev PY - 2022/5/30 TI - 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 JO - JMIR Public Health Surveill SP - e37328 VL - 8 IS - 5 KW - COVID-19 KW - vaccination KW - altruism KW - prosocial motives KW - video intervention KW - randomized controlled trial KW - younger adults KW - vaccine hesitancy KW - public health KW - youth KW - digital intervention KW - health intervention KW - health promotion KW - web survey KW - digital health KW - online health KW - health information N2 - 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 (?21=20.55, P<.001). The between-group difference in postintervention intentions (?23=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 UR - https://publichealth.jmir.org/2022/5/e37328 UR - http://dx.doi.org/10.2196/37328 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544437 ID - info:doi/10.2196/37328 ER - TY - JOUR AU - Xu, Yue AU - Wu, Qingqing AU - Xu, Shuiyang AU - Zhao, Yusui AU - Zhang, Xuehai PY - 2022/5/26 TI - Factors Associated With Protective Mask-Wearing Behavior to Avoid COVID-19 Infection in China: Internet-Based Cross-sectional Study JO - JMIR Public Health Surveill SP - e32278 VL - 8 IS - 5 KW - COVID-19 KW - internet-based KW - disease prevention KW - mask KW - knowledge KW - behavior N2 - 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. UR - https://publichealth.jmir.org/2022/5/e32278 UR - http://dx.doi.org/10.2196/32278 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486491 ID - info:doi/10.2196/32278 ER - TY - JOUR AU - Kellerman, K. John AU - Hamilton, L. Jessica AU - Selby, A. Edward AU - Kleiman, M. Evan PY - 2022/5/25 TI - The Mental Health Impact of Daily News Exposure During the COVID-19 Pandemic: Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e36966 VL - 9 IS - 5 KW - news consumption KW - worry KW - hopelessness KW - ecological momentary assessment KW - news media KW - COVID-19 KW - pandemic KW - mental health KW - depression KW - stress KW - psychological distress KW - mediation model KW - digital health N2 - 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. UR - https://mental.jmir.org/2022/5/e36966 UR - http://dx.doi.org/10.2196/36966 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377320 ID - info:doi/10.2196/36966 ER - TY - JOUR AU - Zentner, Kristen AU - Gaine, Graham AU - Ethridge, Paige AU - Surood, Shireen AU - Abba-Aji, Adam PY - 2022/5/13 TI - Clinicians? Attitudes Toward Telepsychology in Addiction and Mental Health Services, and Prediction of Postpandemic Telepsychology Uptake: Cross-sectional Study JO - JMIR Form Res SP - e35535 VL - 6 IS - 5 KW - mental health KW - telepsychology KW - clinician attitude KW - unified theory of acceptance and use of technology KW - therapeutic alliance N2 - 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 (?=0.46; P<.001) and telephone services (?=0.35; P<.001) after the pandemic. Social influence (?=0.24; P=.004) and facilitating conditions (?=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. UR - https://formative.jmir.org/2022/5/e35535 UR - http://dx.doi.org/10.2196/35535 UR - http://www.ncbi.nlm.nih.gov/pubmed/35559793 ID - info:doi/10.2196/35535 ER - TY - JOUR AU - Philippe, J. Tristan AU - Sikder, Naureen AU - Jackson, Anna AU - Koblanski, E. Maya AU - Liow, Eric AU - Pilarinos, Andreas AU - Vasarhelyi, Krisztina PY - 2022/5/12 TI - Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review JO - JMIR Ment Health SP - e35159 VL - 9 IS - 5 KW - digital health KW - telepsychology KW - computer-assisted therapy KW - online therapy KW - mobile applications KW - mobile apps KW - telemedicine KW - telepsychiatry KW - virtual reality exposure therapy KW - mental health KW - COVID-19 N2 - 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. UR - https://mental.jmir.org/2022/5/e35159 UR - http://dx.doi.org/10.2196/35159 UR - http://www.ncbi.nlm.nih.gov/pubmed/35551058 ID - info:doi/10.2196/35159 ER - TY - JOUR AU - Al-Jabr, Hiyam AU - Windle, Karen AU - Thompson, R. David AU - Jenkins, M. Zoe AU - Castle, J. David AU - Ski, F. Chantal PY - 2022/5/12 TI - Long COVID Optimal Health Program (LC-OHP) to Enhance Psychological and Physical Health: Protocol for a Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e36673 VL - 11 IS - 5 KW - long COVID KW - COVID-19 KW - optimal health program KW - telemedicine KW - integrated care KW - telehealth KW - patient care KW - health intervention KW - mental health KW - physical health KW - psychological health KW - pandemic KW - patient support N2 - 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 UR - https://www.researchprotocols.org/2022/5/e36673 UR - http://dx.doi.org/10.2196/36673 UR - http://www.ncbi.nlm.nih.gov/pubmed/35468586 ID - info:doi/10.2196/36673 ER - TY - JOUR AU - Xu, Zhimin AU - Ghisi, Melo Gabriela Lima de AU - Cui, Lixian AU - Zeng, Fang AU - Zhou, Xiaohai AU - Yue, Zhongtang AU - Chen, Hanbei PY - 2022/5/6 TI - The Effects of the COVID-19 Pandemic on Mental Health Among Older Adults From Different Communities in Chengmai County, China: Cross-sectional Study JO - JMIR Form Res SP - e37046 VL - 6 IS - 5 KW - mental health KW - COVID-19 KW - depression KW - anxiety KW - aged KW - aging KW - older adults N2 - 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. UR - https://formative.jmir.org/2022/5/e37046 UR - http://dx.doi.org/10.2196/37046 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404834 ID - info:doi/10.2196/37046 ER - TY - JOUR AU - Fassnacht, B. Daniel AU - Ali, Kathina AU - van Agteren, Joep AU - Iasiello, Matthew AU - Mavrangelos, Teri AU - Furber, Gareth AU - Kyrios, Michael PY - 2022/5/5 TI - 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 JO - JMIR Ment Health SP - e37292 VL - 9 IS - 5 KW - COVID-19 KW - mental health KW - well-being KW - depression KW - anxiety KW - online KW - digital KW - intervention KW - Be Well Plan KW - health outcome KW - online health KW - digital health KW - health intervention KW - primary outcome KW - cognition KW - randomized control trial KW - resilience KW - participant satisfaction KW - student N2 - 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 UR - https://mental.jmir.org/2022/5/e37292 UR - http://dx.doi.org/10.2196/37292 UR - http://www.ncbi.nlm.nih.gov/pubmed/35471196 ID - info:doi/10.2196/37292 ER - TY - JOUR AU - Korpilahti-Leino, Tarja AU - Luntamo, Terhi AU - Ristkari, Terja AU - Hinkka-Yli-Salomäki, Susanna AU - Pulkki-Råback, Laura AU - Waris, Otto AU - Matinolli, Hanna-Maria AU - Sinokki, Atte AU - Mori, Yuko AU - Fukaya, Mami AU - Yamada, Yuko AU - Sourander, Andre PY - 2022/4/13 TI - Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study JO - J Med Internet Res SP - e26438 VL - 24 IS - 4 KW - adolescent KW - anxiety KW - child KW - cognitive behavioral therapy KW - coping KW - COVID-19 KW - Internet KW - mental health KW - parents KW - web-based N2 - 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. UR - https://www.jmir.org/2022/4/e26438 UR - http://dx.doi.org/10.2196/26438 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138265 ID - info:doi/10.2196/26438 ER - TY - JOUR AU - Mullarkey, Michael AU - Dobias, Mallory AU - Sung, Jenna AU - Ahuvia, Isaac AU - Shumake, Jason AU - Beevers, Christopher AU - Schleider, Jessica PY - 2022/4/12 TI - Web-Based Single Session Intervention for Perceived Control Over Anxiety During COVID-19: Randomized Controlled Trial JO - JMIR Ment Health SP - e33473 VL - 9 IS - 4 KW - anxiety KW - COVID-19 KW - single-session intervention KW - SSI KW - perceived control KW - intervention KW - mental health KW - control KW - online intervention KW - telemedicine KW - telehealth KW - scalable N2 - 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 UR - https://mental.jmir.org/2022/4/e33473 UR - http://dx.doi.org/10.2196/33473 UR - http://www.ncbi.nlm.nih.gov/pubmed/35230962 ID - info:doi/10.2196/33473 ER - TY - JOUR AU - Jaworski, K. Beth AU - Taylor, Katherine AU - Ramsey, M. Kelly AU - Heinz, J. Adrienne AU - Steinmetz, Sarah AU - Owen, E. Jason AU - Tsai, Jack AU - Pietrzak, H. Robert PY - 2022/4/5 TI - Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel JO - JMIR Ment Health SP - e36217 VL - 9 IS - 4 KW - COVID-19 KW - coronavirus KW - mobile app KW - mHealth KW - digital health KW - mental health KW - public mental health KW - stress KW - coping KW - older adults KW - veterans N2 - 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. UR - https://mental.jmir.org/2022/4/e36217 UR - http://dx.doi.org/10.2196/36217 UR - http://www.ncbi.nlm.nih.gov/pubmed/35245204 ID - info:doi/10.2196/36217 ER - TY - JOUR AU - De Kock, H. Johannes AU - Latham, Ann Helen AU - Cowden, G. Richard AU - Cullen, Breda AU - Narzisi, Katia AU - Jerdan, Shaun AU - Munoz, Sarah-Anne AU - Leslie, J. Stephen AU - Stamatis, Andreas AU - Eze, Jude PY - 2022/4/4 TI - Brief Digital Interventions to Support the Psychological Well-being of NHS Staff During the COVID-19 Pandemic: 3-Arm Pilot Randomized Controlled Trial JO - JMIR Ment Health SP - e34002 VL - 9 IS - 4 KW - eHealth KW - public health KW - depression KW - anxiety KW - well-being KW - mobile health KW - intervention studies KW - staff KW - occupational health KW - NHS KW - intervention KW - support KW - COVID-19 KW - randomized controlled trial N2 - 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 UR - https://mental.jmir.org/2022/4/e34002 UR - http://dx.doi.org/10.2196/34002 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044927 ID - info:doi/10.2196/34002 ER - TY - JOUR AU - Nowicka, Anna AU - Jaszczak, Jakub AU - Szymanek Pasternak, Anna AU - Simon, Krzysztof PY - 2022/4/4 TI - Application of a Web-based Self-assessment Triage Tool During the COVID-19 Pandemic: Descriptive Study JO - JMIR Hum Factors SP - e34134 VL - 9 IS - 2 KW - COVID-19 KW - symptom checker KW - preclinical triage KW - self-assessment tool KW - online applications KW - COVID-19 remote triage KW - COVID-19 self-assessment N2 - 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 Wroc?aw. 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. UR - https://humanfactors.jmir.org/2022/2/e34134 UR - http://dx.doi.org/10.2196/34134 UR - http://www.ncbi.nlm.nih.gov/pubmed/35168192 ID - info:doi/10.2196/34134 ER - TY - JOUR AU - Zhang, Wei AU - Velez, Dominick PY - 2022/4/4 TI - 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 JO - JMIR Form Res SP - e32387 VL - 6 IS - 4 KW - physical activity KW - COVID-19 KW - mental health KW - depression KW - anxiety KW - United States KW - survey KW - cross-sectional KW - distress KW - risk N2 - 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. UR - https://formative.jmir.org/2022/4/e32387 UR - http://dx.doi.org/10.2196/32387 UR - http://www.ncbi.nlm.nih.gov/pubmed/35302509 ID - info:doi/10.2196/32387 ER - TY - JOUR AU - Marshall, Christopher AU - Lanyi, Kate AU - Green, Rhiannon AU - Wilkins, C. Georgina AU - Pearson, Fiona AU - Craig, Dawn PY - 2022/3/31 TI - Using Natural Language Processing to Explore Mental Health Insights From UK Tweets During the COVID-19 Pandemic: Infodemiology Study JO - JMIR Infodemiology SP - e32449 VL - 2 IS - 1 KW - Twitter KW - mental health KW - COVID-19 KW - sentiment KW - lockdown KW - soft intelligence KW - artificial intelligence KW - machine learning KW - natural language processing N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e32449 UR - http://dx.doi.org/10.2196/32449 UR - http://www.ncbi.nlm.nih.gov/pubmed/36406146 ID - info:doi/10.2196/32449 ER - TY - JOUR AU - Bacsu, Juanita-Dawne AU - Fraser, Sarah AU - Chasteen, L. Alison AU - Cammer, Allison AU - Grewal, S. Karl AU - Bechard, E. Lauren AU - Bethell, Jennifer AU - Green, Shoshana AU - McGilton, S. Katherine AU - Morgan, Debra AU - O?Rourke, M. Hannah AU - Poole, Lisa AU - Spiteri, J. Raymond AU - O'Connell, E. Megan PY - 2022/3/31 TI - Using Twitter to Examine Stigma Against People With Dementia During COVID-19: Infodemiology Study JO - JMIR Aging SP - e35677 VL - 5 IS - 1 KW - coronavirus 2019 KW - social media KW - stigma KW - dementia KW - ageism KW - COVID-19 KW - Twitter KW - bias KW - infodemiology KW - attention KW - risk KW - impact KW - misinformation KW - belief KW - cognition KW - cognitive impairment N2 - 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. UR - https://aging.jmir.org/2022/1/e35677 UR - http://dx.doi.org/10.2196/35677 UR - http://www.ncbi.nlm.nih.gov/pubmed/35290197 ID - info:doi/10.2196/35677 ER - TY - JOUR AU - Chen, Xi AU - Lin, Fen AU - Cheng, W. Edmund PY - 2022/3/22 TI - Stratified Impacts of the Infodemic During the COVID-19 Pandemic: Cross-sectional Survey in 6 Asian Jurisdictions JO - J Med Internet Res SP - e31088 VL - 24 IS - 3 KW - infodemic KW - information overload KW - psychological distress KW - protective behavior KW - cross-national survey KW - Asia KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2022/3/e31088 UR - http://dx.doi.org/10.2196/31088 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103601 ID - info:doi/10.2196/31088 ER - TY - JOUR AU - Yu, Ellie AU - Hagens, Simon PY - 2022/3/22 TI - Socioeconomic Disparities in the Demand for and Use of Virtual Visits Among Senior Adults During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Aging SP - e35221 VL - 5 IS - 1 KW - virtual care KW - virtual visit KW - COVID-19 KW - survey KW - virtual care demand KW - virtual care use KW - older adults KW - elderly care KW - aging KW - digital health KW - pandemic N2 - 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 ?2 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. UR - https://aging.jmir.org/2022/1/e35221 UR - http://dx.doi.org/10.2196/35221 UR - http://www.ncbi.nlm.nih.gov/pubmed/35134746 ID - info:doi/10.2196/35221 ER - TY - JOUR AU - Sato, Christa AU - Adumattah, Anita AU - Abulencia, Krisel Maria AU - Garcellano, Dennis Peter AU - Li, Tai-Wai Alan AU - Fung, Kenneth AU - Poon, Kwong-Lai Maurice AU - Vahabi, Mandana AU - Wong, Pui-Hing Josephine PY - 2022/3/22 TI - COVID-19 Mental Health Stressors of Health Care Providers in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Intervention: Qualitative Study JO - JMIR Form Res SP - e35280 VL - 6 IS - 3 KW - COVID-19 KW - COVID-19 in Canada KW - health care providers KW - pandemic stressors KW - health impact KW - caregiving roles KW - situational identities KW - emotional labor KW - hero discourse KW - social ecological framework N2 - 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. UR - https://formative.jmir.org/2022/3/e35280 UR - http://dx.doi.org/10.2196/35280 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138256 ID - info:doi/10.2196/35280 ER - TY - JOUR AU - Haucke, Matthias AU - Heinz, Andreas AU - Liu, Shuyan AU - Heinzel, Stephan PY - 2022/3/17 TI - The Impact of COVID-19 Lockdown on Daily Activities, Cognitions, and Stress in a Lonely and Distressed Population: Temporal Dynamic Network Analysis JO - J Med Internet Res SP - e32598 VL - 24 IS - 3 KW - COVID-19 KW - mental health KW - outbreak KW - epidemic KW - pandemic KW - psychological response KW - emotional well-being KW - ecological momentary assessment KW - risk KW - protective factors KW - lockdown measures KW - loneliness KW - mood inertia KW - stressors KW - mobile apps KW - mHealth KW - digital health KW - EMA KW - smartphone apps KW - network model KW - cognition KW - stress KW - temporal dynamic network KW - permutation testing KW - network comparison KW - network characteristics KW - multilevel vector autoregressive model KW - mlVAR N2 - 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. UR - https://www.jmir.org/2022/3/e32598 UR - http://dx.doi.org/10.2196/32598 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191843 ID - info:doi/10.2196/32598 ER - TY - JOUR AU - Albers, A. Elizabeth AU - Mikal, Jude AU - Millenbah, Ashley AU - Finlay, Jessica AU - Jutkowitz, Eric AU - Mitchell, Lauren AU - Horn, Brenna AU - Gaugler, E. Joseph PY - 2022/3/17 TI - The Use of Technology Among Persons With Memory Concerns and Their Caregivers in the United States During the COVID-19 Pandemic: Qualitative Study JO - JMIR Aging SP - e31552 VL - 5 IS - 1 KW - social isolation KW - dementia KW - caregiving - informal KW - aging in place KW - caregivers KW - aging KW - elderly KW - pandemic KW - COVID-19 KW - mental health KW - technology use KW - health technology N2 - 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. UR - https://aging.jmir.org/2022/1/e31552 UR - http://dx.doi.org/10.2196/31552 UR - http://www.ncbi.nlm.nih.gov/pubmed/35134748 ID - info:doi/10.2196/31552 ER - TY - JOUR AU - ?orgo, Andrej AU - Crnkovi?, Nu?a AU - Gabrovec, Branko AU - Cesar, Katarina AU - Selak, ?pela PY - 2022/3/15 TI - Influence of Forced Online Distance Education During the COVID-19 Pandemic on the Perceived Stress of Postsecondary Students: Cross-sectional Study JO - J Med Internet Res SP - e30778 VL - 24 IS - 3 KW - online study KW - stress KW - COVID-19 KW - postsecondary students KW - pandemic KW - epidemiology KW - educational institutions KW - online education KW - pedagogy KW - mental health N2 - 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. UR - https://www.jmir.org/2022/3/e30778 UR - http://dx.doi.org/10.2196/30778 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171098 ID - info:doi/10.2196/30778 ER - TY - JOUR AU - Gliske, Kate AU - Welsh, W. Justine AU - Braughton, E. Jacqueline AU - Waller, A. Lance AU - Ngo, M. Quyen PY - 2022/3/14 TI - Telehealth Services for Substance Use Disorders During the COVID-19 Pandemic: Longitudinal Assessment of Intensive Outpatient Programming and Data Collection Practices JO - JMIR Ment Health SP - e36263 VL - 9 IS - 3 KW - telehealth KW - substance use disorder KW - COVID-19 KW - substance use treatment KW - feasibility study KW - routine outcome monitoring data KW - mental health KW - addiction KW - digital health KW - telemedicine KW - outpatient program KW - virtual health KW - addiction treatment KW - virtual care KW - patient outcomes N2 - 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 (?22=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. UR - https://mental.jmir.org/2022/3/e36263 UR - http://dx.doi.org/10.2196/36263 UR - http://www.ncbi.nlm.nih.gov/pubmed/35285807 ID - info:doi/10.2196/36263 ER - TY - JOUR AU - Imamura, Kotaro AU - Sasaki, Natsu AU - Sekiya, Yuki AU - Watanabe, Kazuhiro AU - Sakuraya, Asuka AU - Matsuyama, Yutaka AU - Nishi, Daisuke AU - Kawakami, Norito PY - 2022/3/10 TI - The Effect of the Imacoco Care Psychoeducation Website on Improving Psychological Distress Among Workers During the COVID-19 Pandemic: Randomized Controlled Trial JO - JMIR Form Res SP - e33883 VL - 6 IS - 3 KW - COVID-19 KW - education KW - internet-based intervention KW - occupational groups KW - psychological distress KW - mental health KW - digital health KW - health intervention KW - psychoeducation N2 - 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 UR - https://formative.jmir.org/2022/3/e33883 UR - http://dx.doi.org/10.2196/33883 UR - http://www.ncbi.nlm.nih.gov/pubmed/35133972 ID - info:doi/10.2196/33883 ER - TY - JOUR AU - Haraldsson, Patrik AU - Ros, Axel AU - Jonker, Dirk AU - Areskoug Josefsson, Kristina PY - 2022/3/10 TI - Evaluating the Effect of Supported Systematic Work Environment Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e34152 VL - 11 IS - 3 KW - occupational health interventions KW - implementation KW - mixed methods KW - COVID-19 pandemic KW - COVID-19 KW - pandemic KW - occupational health KW - health interventions KW - health care KW - support services KW - employee health N2 - 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 UR - https://www.researchprotocols.org/2022/3/e34152 UR - http://dx.doi.org/10.2196/34152 UR - http://www.ncbi.nlm.nih.gov/pubmed/35234649 ID - info:doi/10.2196/34152 ER - TY - JOUR AU - El Gindi, Hany AU - Shalaby, Reham AU - Gusnowski, April AU - Vuong, Wesley AU - Surood, Shireen AU - Hrabok, Marianne AU - Greenshaw, J. Andrew AU - Agyapong, Vincent PY - 2022/3/9 TI - The Mental Health Impact of the COVID-19 Pandemic Among Physicians, Nurses, and Other Health Care Providers in Alberta: Cross-sectional Survey JO - JMIR Form Res SP - e27469 VL - 6 IS - 3 KW - COVID-19 KW - health care worker KW - mobile technology KW - Text4Hope KW - anxiety KW - depression KW - stress KW - pandemic KW - e-mental health KW - mental health KW - impact KW - physician KW - nurse KW - Canada N2 - 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. UR - https://formative.jmir.org/2022/3/e27469 UR - http://dx.doi.org/10.2196/27469 UR - http://www.ncbi.nlm.nih.gov/pubmed/34995203 ID - info:doi/10.2196/27469 ER - TY - JOUR AU - Coleshill, James Matthew AU - Baldwin, Peter AU - Black, Melissa AU - Newby, Jill AU - Shrestha, Tanya AU - Haffar, Sam AU - Mills, Llewellyn AU - Stensel, Andrew AU - Cockayne, Nicole AU - Tennant, Jon AU - Harvey, Samuel AU - Christensen, Helen PY - 2022/3/9 TI - The Essential Network (TEN): Protocol for an Implementation Study of a Digital-First Mental Health Solution for Australian Health Care Workers During COVID-19 JO - JMIR Res Protoc SP - e34601 VL - 11 IS - 3 KW - blended care KW - mental health KW - burnout KW - health care workers KW - COVID-19 KW - health care service KW - health service N2 - 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 UR - https://www.researchprotocols.org/2022/3/e34601 UR - http://dx.doi.org/10.2196/34601 UR - http://www.ncbi.nlm.nih.gov/pubmed/35148269 ID - info:doi/10.2196/34601 ER - TY - JOUR AU - Håkansson, Anders AU - Sundvall, Andreas AU - Lyckberg, Axel PY - 2022/3/9 TI - Effects of a National Preventive Intervention Against Potential COVID-19?Related Gambling Problems in Online Gamblers: Self-Report Survey Study JO - JMIR Form Res SP - e33066 VL - 6 IS - 3 KW - gambling disorder KW - problem gambling KW - COVID-19 KW - harm reduction KW - behavioral addiction N2 - 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. UR - https://formative.jmir.org/2022/3/e33066 UR - http://dx.doi.org/10.2196/33066 UR - http://www.ncbi.nlm.nih.gov/pubmed/34678751 ID - info:doi/10.2196/33066 ER - TY - JOUR AU - Sugaya, Nagisa AU - Yamamoto, Tetsuya AU - Suzuki, Naho AU - Uchiumi, Chigusa PY - 2022/3/8 TI - The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study JO - JMIR Public Health Surveill SP - e32694 VL - 8 IS - 3 KW - coronavirus disease 2019 KW - mild lockdown KW - social isolation KW - longitudinal survey KW - public health KW - surveillance KW - epidemiology KW - COVID-19 KW - pandemic KW - lockdown KW - psychological behavior KW - social factors KW - mental health N2 - 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. UR - https://publichealth.jmir.org/2022/3/e32694 UR - http://dx.doi.org/10.2196/32694 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107428 ID - info:doi/10.2196/32694 ER - TY - JOUR AU - Geneviève, Darryl Lester AU - Martani, Andrea AU - Wangmo, Tenzin AU - Elger, Simone Bernice PY - 2022/3/4 TI - Precision Public Health and Structural Racism in the United States: Promoting Health Equity in the COVID-19 Pandemic Response JO - JMIR Public Health Surveill SP - e33277 VL - 8 IS - 3 KW - precision public health KW - structural racism KW - COVID-19 KW - pandemic KW - social justice KW - health equity KW - SARS-CoV-2 KW - stigma KW - discrimination KW - disparity KW - inequality KW - precision health KW - public health KW - racism KW - equity KW - mortality KW - morbidity UR - https://publichealth.jmir.org/2022/3/e33277 UR - http://dx.doi.org/10.2196/33277 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089868 ID - info:doi/10.2196/33277 ER - TY - JOUR AU - Schriger, H. Simone AU - Klein, R. Melanie AU - Last, S. Briana AU - Fernandez-Marcote, Sara AU - Dallard, Natalie AU - Jones, Bryanna AU - Beidas, S. Rinad PY - 2022/3/3 TI - Community Mental Health Clinicians? Perspectives on Telehealth During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Pediatr Parent SP - e29250 VL - 5 IS - 1 KW - telehealth KW - COVID-19 KW - evidence-based practice KW - community mental health KW - trauma-focused cognitive behavioral therapy KW - implementation science KW - youth mental health N2 - 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. UR - https://pediatrics.jmir.org/2022/1/e29250 UR - http://dx.doi.org/10.2196/29250 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023839 ID - info:doi/10.2196/29250 ER - TY - JOUR AU - Choi, H. Edmond P. AU - Duan, Wenjie AU - Fong, T. Daniel Y. AU - Lok, W. Kris Y. AU - Ho, Mandy AU - Wong, H. Janet Y. AU - Lin, Chia-Chin PY - 2022/3/2 TI - Psychometric Evaluation of a Fear of COVID-19 Scale in China: Cross-sectional Study JO - JMIR Form Res SP - e31992 VL - 6 IS - 3 KW - Chinese KW - COVID-19 KW - fear KW - psychometric KW - validation KW - scale KW - mental health KW - information KW - cross-sectional KW - validity KW - reliability KW - support N2 - 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 ? 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. UR - https://formative.jmir.org/2022/3/e31992 UR - http://dx.doi.org/10.2196/31992 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072632 ID - info:doi/10.2196/31992 ER - TY - JOUR AU - Houben-Wilke, Sarah AU - Goërtz, MJ Yvonne AU - Delbressine, M. Jeannet AU - Vaes, W. Anouk AU - Meys, Roy AU - Machado, VC Felipe AU - van Herck, Maarten AU - Burtin, Chris AU - Posthuma, Rein AU - Franssen, ME Frits AU - Vijlbrief, Herman AU - Spies, Yvonne AU - van 't Hul, J. Alex AU - Spruit, A. Martijn AU - Janssen, JA Daisy PY - 2022/2/24 TI - The Impact of Long COVID-19 on Mental Health: Observational 6-Month Follow-Up Study JO - JMIR Ment Health SP - e33704 VL - 9 IS - 2 KW - SARS-CoV-2 KW - corona KW - COVID-19 KW - post-traumatic stress disorder KW - anxiety KW - depression KW - PASC N2 - 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. UR - https://mental.jmir.org/2022/2/e33704 UR - http://dx.doi.org/10.2196/33704 UR - http://www.ncbi.nlm.nih.gov/pubmed/35200155 ID - info:doi/10.2196/33704 ER - TY - JOUR AU - Agarwal, K. Anish AU - Southwick, Lauren AU - Schneider, Rachelle AU - Pelullo, Arthur AU - Ortiz, Robin AU - Klinger, V. Elissa AU - Gonzales, E. Rachel AU - Rosin, Roy AU - Merchant, M. Raina PY - 2022/2/23 TI - Crowdsourced Community Support Resources Among Patients Discharged From the Emergency Department During the COVID-19 Pandemic: Pilot Feasibility Study JO - JMIR Ment Health SP - e31909 VL - 9 IS - 2 KW - COVID-19 KW - mHealth KW - CHW KW - digital health KW - platform KW - crowdsource KW - support KW - community KW - health system KW - monitoring KW - virtual care KW - text message KW - model KW - community health worker KW - pilot study KW - feasibility N2 - 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. UR - https://mental.jmir.org/2022/2/e31909 UR - http://dx.doi.org/10.2196/31909 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037886 ID - info:doi/10.2196/31909 ER - TY - JOUR AU - Joseph, Gili AU - Schori, Hadas PY - 2022/2/23 TI - The Beneficial Effect of the First COVID-19 Lockdown on Undergraduate Students of Education: Prospective Cohort Study JO - JMIR Form Res SP - e27286 VL - 6 IS - 2 KW - sleep quality KW - exercise KW - well-being KW - undergraduate students KW - COVID-19 lockdown KW - COVID-19 N2 - 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. UR - https://formative.jmir.org/2022/2/e27286 UR - http://dx.doi.org/10.2196/27286 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072635 ID - info:doi/10.2196/27286 ER - TY - JOUR AU - Dura-Perez, Elena AU - Goodman-Casanova, Marian Jessica AU - Vega-Nuñez, Amanda AU - Guerrero-Pertiñez, Gloria AU - Varela-Moreno, Esperanza AU - Garolera, Maite AU - Quintana, Maria AU - Cuesta-Vargas, I. Antonio AU - Barnestein-Fonseca, Pilar AU - Gómez Sánchez-Lafuente, Carlos AU - Mayoral-Cleries, Fermin AU - Guzman-Parra, Jose PY - 2022/2/22 TI - The Impact of COVID-19 Confinement on Cognition and Mental Health and Technology Use Among Socially Vulnerable Older People: Retrospective Cohort Study JO - J Med Internet Res SP - e30598 VL - 24 IS - 2 KW - COVID-19 KW - cognition KW - quality of life KW - social isolation KW - mental health KW - social support KW - technology KW - physical distancing KW - leisure activities KW - nursing N2 - 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 UR - https://www.jmir.org/2022/2/e30598 UR - http://dx.doi.org/10.2196/30598 UR - http://www.ncbi.nlm.nih.gov/pubmed/35049505 ID - info:doi/10.2196/30598 ER - TY - JOUR AU - Gilley, N. Kristen AU - Baroudi, Loubna AU - Yu, Miao AU - Gainsburg, Izzy AU - Reddy, Niyanth AU - Bradley, Christina AU - Cislo, Christine AU - Rozwadowski, Lois Michelle AU - Clingan, Ashley Caroline AU - DeMoss, Stephen Matthew AU - Churay, Tracey AU - Birditt, Kira AU - Colabianchi, Natalie AU - Chowdhury, Mosharaf AU - Forger, Daniel AU - Gagnier, Joel AU - Zernicke, F. Ronald AU - Cunningham, Lee Julia AU - Cain, M. Stephen AU - Tewari, Muneesh AU - Choi, Won Sung PY - 2022/2/10 TI - 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 JO - JMIR Ment Health SP - e34645 VL - 9 IS - 2 KW - mHealth KW - mobile health KW - college student KW - mental health KW - wearable devices KW - wearable KW - student KW - risk factor KW - risk KW - COVID-19 KW - physical health KW - observational KW - crisis KW - self-report KW - outcome KW - physical activity KW - wellbeing KW - well-being N2 - 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 UR - https://mental.jmir.org/2022/2/e34645 UR - http://dx.doi.org/10.2196/34645 UR - http://www.ncbi.nlm.nih.gov/pubmed/34992051 ID - info:doi/10.2196/34645 ER - TY - JOUR AU - MacDonald, J. James AU - Baxter-King, Ryan AU - Vavreck, Lynn AU - Naeim, Arash AU - Wenger, Neil AU - Sepucha, Karen AU - Stanton, L. Annette PY - 2022/2/10 TI - Depressive Symptoms and Anxiety During the COVID-19 Pandemic: Large, Longitudinal, Cross-sectional Survey JO - JMIR Ment Health SP - e33585 VL - 9 IS - 2 KW - COVID-19 KW - depression KW - anxiety KW - pandemic KW - mental health KW - public health KW - psychological variables KW - younger adults KW - symptom monitoring KW - health intervention N2 - 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. UR - https://mental.jmir.org/2022/2/e33585 UR - http://dx.doi.org/10.2196/33585 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142619 ID - info:doi/10.2196/33585 ER - TY - JOUR AU - Kane, Hélène AU - Gourret Baumgart, Jade AU - El-Hage, Wissam AU - Deloyer, Jocelyn AU - Maes, Christine AU - Lebas, Marie-Clotilde AU - Marazziti, Donatella AU - Thome, Johannes AU - Fond-Harmant, Laurence AU - Denis, Frédéric PY - 2022/2/4 TI - Opportunities and Challenges for Professionals in Psychiatry and Mental Health Care Using Digital Technologies During the COVID-19 Pandemic: Systematic Review JO - JMIR Hum Factors SP - e30359 VL - 9 IS - 1 KW - COVID-19 KW - e?mental health KW - professional practices KW - quality of care KW - telepsychiatry KW - videoconferencing N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e30359 UR - http://dx.doi.org/10.2196/30359 UR - http://www.ncbi.nlm.nih.gov/pubmed/34736224 ID - info:doi/10.2196/30359 ER - TY - JOUR AU - Vlake, H. Johan AU - van Bommel, Jasper AU - Wils, Evert-Jan AU - Bienvenu, Joe AU - Hellemons, E. Merel AU - Korevaar, IM Tim AU - Schut, FC Anna AU - Labout, AM Joost AU - Schreuder, LH Lois AU - van Bavel, P. Marten AU - Gommers, Diederik AU - van Genderen, E. Michel PY - 2022/1/31 TI - Intensive Care Unit?Specific Virtual Reality for Critically Ill Patients With COVID-19: Multicenter Randomized Controlled Trial JO - J Med Internet Res SP - e32368 VL - 24 IS - 1 KW - SARS-CoV-2 KW - intensive care KW - post-intensive care syndrome KW - virtual reality KW - quality of life KW - satisfaction KW - COVID-19 N2 - 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 UR - https://www.jmir.org/2022/1/e32368 UR - http://dx.doi.org/10.2196/32368 UR - http://www.ncbi.nlm.nih.gov/pubmed/34978530 ID - info:doi/10.2196/32368 ER - TY - JOUR AU - Gansner, Meredith AU - Nisenson, Melanie AU - Lin, Vanessa AU - Pong, Sovannarath AU - Torous, John AU - Carson, Nicholas PY - 2022/1/28 TI - Problematic Internet Use Before and During the COVID-19 Pandemic in Youth in Outpatient Mental Health Treatment: App-Based Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e33114 VL - 9 IS - 1 KW - COVID-19 KW - problematic internet use KW - ecological momentary assessment KW - internet KW - app KW - youth KW - young adult KW - teenager KW - outpatient KW - mental health KW - treatment KW - pilot KW - cohort KW - change N2 - 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. UR - https://mental.jmir.org/2022/1/e33114 UR - http://dx.doi.org/10.2196/33114 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089157 ID - info:doi/10.2196/33114 ER - TY - JOUR AU - Skime, K. Michelle AU - Puspitasari, J. Ajeng AU - Gentry, T. Melanie AU - Heredia Jr, Dagoberto AU - Sawchuk, N. Craig AU - Moore, R. Wendy AU - Taylor-Desir, J. Monica AU - Schak, M. Kathryn PY - 2022/1/28 TI - Patient Satisfaction and Recommendations for Delivering a Group-Based Intensive Outpatient Program via Telemental Health During the COVID-19 Pandemic: Cross-sectional Cohort Study JO - JMIR Ment Health SP - e30204 VL - 9 IS - 1 KW - COVID-19 KW - telemental health KW - teletherapy KW - telepsychiatry KW - telemedicine KW - intensive outpatient KW - patient satisfaction N2 - 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. UR - https://mental.jmir.org/2022/1/e30204 UR - http://dx.doi.org/10.2196/30204 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878999 ID - info:doi/10.2196/30204 ER - TY - JOUR AU - Lekkas, Damien AU - Gyorda, A. Joseph AU - Price, D. George AU - Wortzman, Zoe AU - Jacobson, C. Nicholas PY - 2022/1/27 TI - 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 JO - J Med Internet Res SP - e32731 VL - 24 IS - 1 KW - affect KW - sentiment KW - circumplex KW - news KW - mental health KW - online search behavior KW - generalized mixed models KW - natural language processing KW - anxiety KW - depression KW - coronavirus KW - internet KW - information seeking KW - behavior KW - online health information KW - COVID-19 N2 - 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 ?=?.207; P<.001) as predictive of increased depression-related search term activity, with emotional language patterns indicative of affective uncontrollability (FluxA ?=.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. UR - https://www.jmir.org/2022/1/e32731 UR - http://dx.doi.org/10.2196/32731 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932494 ID - info:doi/10.2196/32731 ER - TY - JOUR AU - Claesdotter-Knutsson, Emma AU - André, Frida AU - Håkansson, Anders PY - 2022/1/25 TI - Gaming Activity and Possible Changes in Gaming Behavior Among Young People During the COVID-19 Pandemic: Cross-sectional Online Survey Study JO - JMIR Serious Games SP - e33059 VL - 10 IS - 1 KW - COVID-19 pandemic KW - gaming KW - screen time KW - psychological distress N2 - 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. UR - https://games.jmir.org/2022/1/e33059 UR - http://dx.doi.org/10.2196/33059 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817386 ID - info:doi/10.2196/33059 ER - TY - JOUR AU - Schluter, J. Philip AU - Généreux, Mélissa AU - Hung, KC Kevin AU - Landaverde, Elsa AU - Law, P. Ronald AU - Mok, Yin Catherine Pui AU - Murray, Virginia AU - O'Sullivan, Tracey AU - Qadar, Zeeshan AU - Roy, Mathieu PY - 2022/1/17 TI - Patterns of Suicide Ideation Across Eight Countries in Four Continents During the COVID-19 Pandemic Era: Repeated Cross-sectional Study JO - JMIR Public Health Surveill SP - e32140 VL - 8 IS - 1 KW - pandemic KW - infodemic KW - psychosocial impacts KW - sense of coherence KW - suicide ideation KW - epidemiology KW - suicide KW - pattern KW - COVID-19 KW - cross-sectional KW - mental health KW - misinformation KW - risk KW - prevalence KW - gender KW - age KW - sociodemographic N2 - 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. UR - https://publichealth.jmir.org/2022/1/e32140 UR - http://dx.doi.org/10.2196/32140 UR - http://www.ncbi.nlm.nih.gov/pubmed/34727524 ID - info:doi/10.2196/32140 ER - TY - JOUR AU - Forchuk, A. Callista AU - Nazarov, Anthony AU - Plouffe, A. Rachel AU - Liu, W. Jenny J. AU - Deda, Erisa AU - Le, Tri AU - Gargala, Dominic AU - Soares, Vanessa AU - Bourret-Gheysen, Jesse AU - St Cyr, Kate AU - Nouri, S. Maede AU - Hosseiny, Fardous AU - Smith, Patrick AU - Dupuis, Gabrielle AU - Roth, Maya AU - Marlborough, Michelle AU - Jetly, Rakesh AU - Heber, Alexandra AU - Lanius, Ruth AU - Richardson, Don J. PY - 2022/1/11 TI - Well-being of Canadian Armed Forces Veterans and Spouses of Veterans During the COVID-19 Pandemic: Protocol for a Prospective Longitudinal Survey JO - JMIR Res Protoc SP - e34984 VL - 11 IS - 1 KW - well-being KW - mental health KW - veterans KW - military KW - survey KW - COVID-19 KW - protocol KW - veteran KW - physical health KW - pandemic KW - longitudinal survey KW - healthcare KW - treatment KW - family support KW - peer support N2 - 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 UR - https://www.researchprotocols.org/2022/1/e34984 UR - http://dx.doi.org/10.2196/34984 UR - http://www.ncbi.nlm.nih.gov/pubmed/34935624 ID - info:doi/10.2196/34984 ER - TY - JOUR AU - Beliga, Slobodan AU - Martin?i?-Ip?i?, Sanda AU - Mate?i?, Mihaela AU - Petrijev?anin Vuksanovi?, Irena AU - Me?trovi?, Ana PY - 2021/12/24 TI - Infoveillance of the Croatian Online Media During the COVID-19 Pandemic: One-Year Longitudinal Study Using Natural Language Processing JO - JMIR Public Health Surveill SP - e31540 VL - 7 IS - 12 KW - COVID-19 KW - pandemic KW - online media KW - news coverage KW - infoveillance KW - infodemic KW - infodemiology KW - natural language processing KW - name entity recognition KW - longitudinal study N2 - 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. UR - https://publichealth.jmir.org/2021/12/e31540 UR - http://dx.doi.org/10.2196/31540 UR - http://www.ncbi.nlm.nih.gov/pubmed/34739388 ID - info:doi/10.2196/31540 ER - TY - JOUR AU - Collins-Pisano, Caroline AU - Velez Court, Juan AU - Johnson, Michael AU - Mois, George AU - Brooks, Jessica AU - Myers, Amanda AU - Muralidharan, Anjana AU - Storm, Marianne AU - Wright, Maggie AU - Berger, Nancy AU - Kasper, Ann AU - Fox, Anthony AU - MacDonald, Sandi AU - Schultze, Sarah AU - Fortuna, Karen PY - 2021/12/16 TI - Core Competencies to Promote Consistency and Standardization of Best Practices for Digital Peer Support: Focus Group Study JO - JMIR Ment Health SP - e30221 VL - 8 IS - 12 KW - COVID-19 KW - peer support KW - competencies KW - training KW - digital N2 - 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). UR - https://mental.jmir.org/2021/12/e30221 UR - http://dx.doi.org/10.2196/30221 UR - http://www.ncbi.nlm.nih.gov/pubmed/34736223 ID - info:doi/10.2196/30221 ER - TY - JOUR AU - Koren, Ainat AU - Alam, Ul Mohammad Arif AU - Koneru, Sravani AU - DeVito, Alexa AU - Abdallah, Lisa AU - Liu, Benyuan PY - 2021/12/10 TI - Nursing Perspectives on the Impacts of COVID-19: Social Media Content Analysis JO - JMIR Form Res SP - e31358 VL - 5 IS - 12 KW - mental health KW - information retrieval KW - coronavirus KW - COVID-19 KW - nursing KW - nurses KW - health care workers KW - pandemic KW - impact KW - social media analytics N2 - 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. UR - https://formative.jmir.org/2021/12/e31358 UR - http://dx.doi.org/10.2196/31358 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623957 ID - info:doi/10.2196/31358 ER - TY - JOUR AU - Newman, A. Peter AU - Chakrapani, Venkatesan AU - Williams, Charmaine AU - Massaquoi, Notisha AU - Tepjan, Suchon AU - Roungprakhon, Surachet AU - Akkakanjanasupar, Pakorn AU - Logie, Carmen AU - Rawat, Shruta PY - 2021/12/10 TI - 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) JO - JMIR Res Protoc SP - e34381 VL - 10 IS - 12 KW - COVID-19 KW - eHealth KW - RCT KW - protective behaviors KW - psychological distress KW - LGBT+ KW - India KW - Thailand N2 - 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 UR - https://www.researchprotocols.org/2021/12/e34381 UR - http://dx.doi.org/10.2196/34381 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726610 ID - info:doi/10.2196/34381 ER - TY - JOUR AU - Appleton, Rebecca AU - Williams, Julie AU - Vera San Juan, Norha AU - Needle, J. Justin AU - Schlief, Merle AU - Jordan, Harriet AU - Sheridan Rains, Luke AU - Goulding, Lucy AU - Badhan, Monika AU - Roxburgh, Emily AU - Barnett, Phoebe AU - Spyridonidis, Spyros AU - Tomaskova, Magdalena AU - Mo, Jiping AU - Harju-Seppänen, Jasmine AU - Haime, Zoë AU - Casetta, Cecilia AU - Papamichail, Alexandra AU - Lloyd-Evans, Brynmor AU - Simpson, Alan AU - Sevdalis, Nick AU - Gaughran, Fiona AU - Johnson, Sonia PY - 2021/12/9 TI - Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review JO - J Med Internet Res SP - e31746 VL - 23 IS - 12 KW - telemental health KW - COVID-19 KW - remote care KW - telemedicine KW - mental health KW - systematic review, implementation science N2 - 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 UR - https://www.jmir.org/2021/12/e31746 UR - http://dx.doi.org/10.2196/31746 UR - http://www.ncbi.nlm.nih.gov/pubmed/34709179 ID - info:doi/10.2196/31746 ER - TY - JOUR AU - Ng, Reuben PY - 2021/12/8 TI - Anti-Asian Sentiments During the COVID-19 Pandemic Across 20 Countries: Analysis of a 12-Billion-Word News Media Database JO - J Med Internet Res SP - e28305 VL - 23 IS - 12 KW - racism KW - COVID-19 KW - anti-Asian sentiments KW - psychomics KW - quantitative social science KW - culture KW - text as data KW - xenophobia KW - digital humanities N2 - 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. UR - https://www.jmir.org/2021/12/e28305 UR - http://dx.doi.org/10.2196/28305 UR - http://www.ncbi.nlm.nih.gov/pubmed/34678754 ID - info:doi/10.2196/28305 ER - TY - JOUR AU - Syed Abdul, Shabbir AU - Ramaswamy, Meghna AU - Fernandez-Luque, Luis AU - John, Oommen AU - Pitti, Thejkiran AU - Parashar, Babita PY - 2021/12/8 TI - The Pandemic, Infodemic, and People?s Resilience in India: Viewpoint JO - JMIR Public Health Surveill SP - e31645 VL - 7 IS - 12 KW - pandemic KW - COVID-19 KW - India KW - digital health KW - infodemics KW - Sustainable Development Goals KW - SDGs UR - https://publichealth.jmir.org/2021/12/e31645 UR - http://dx.doi.org/10.2196/31645 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787574 ID - info:doi/10.2196/31645 ER - TY - JOUR AU - Stewart, Callum AU - Ranjan, Yatharth AU - Conde, Pauline AU - Rashid, Zulqarnain AU - Sankesara, Heet AU - Bai, Xi AU - Dobson, B. Richard J. AU - Folarin, A. Amos PY - 2021/12/8 TI - Investigating the Use of Digital Health Technology to Monitor COVID-19 and Its Effects: Protocol for an Observational Study (Covid Collab Study) JO - JMIR Res Protoc SP - e32587 VL - 10 IS - 12 KW - mobile health KW - COVID-19 KW - digital health KW - smartphone KW - wearable devices KW - mental health KW - wearable KW - data KW - crowdsourced KW - monitoring KW - surveillance KW - observational KW - feasibility KW - infectious disease KW - recovery KW - mobile phone N2 - 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 UR - https://www.researchprotocols.org/2021/12/e32587 UR - http://dx.doi.org/10.2196/32587 UR - http://www.ncbi.nlm.nih.gov/pubmed/34784292 ID - info:doi/10.2196/32587 ER - TY - JOUR AU - Ellis, A. Louise AU - Meulenbroeks, Isabelle AU - Churruca, Kate AU - Pomare, Chiara AU - Hatem, Sarah AU - Harrison, Reema AU - Zurynski, Yvonne AU - Braithwaite, Jeffrey PY - 2021/12/6 TI - The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis JO - JMIR Ment Health SP - e32948 VL - 8 IS - 12 KW - e-mental health KW - mental health KW - COVID-19 KW - bibliometrics KW - health systems N2 - 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. UR - https://mental.jmir.org/2021/12/e32948 UR - http://dx.doi.org/10.2196/32948 UR - http://www.ncbi.nlm.nih.gov/pubmed/34666306 ID - info:doi/10.2196/32948 ER - TY - JOUR AU - Fung, Kenneth AU - Liu, JW Jenny AU - Vahabi, Mandana AU - Li, Tai-Wai Alan AU - Zurowski, Mateusz AU - Wong, Pui-Hing Josephine PY - 2021/12/6 TI - Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training: Protocol for the Development and Rapid-Response Deployment JO - JMIR Res Protoc SP - e33495 VL - 10 IS - 12 KW - COVID KW - COVID-19 KW - coronavirus KW - pandemic KW - resilience KW - acceptance commitment therapy KW - group empowerment N2 - 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 UR - https://www.researchprotocols.org/2021/12/e33495 UR - http://dx.doi.org/10.2196/33495 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726602 ID - info:doi/10.2196/33495 ER - TY - JOUR AU - Goldin, Shoshanna AU - Kong, Joyce So Yeon AU - Tokar, Anna AU - Utunen, Heini AU - Ndiaye, Ngouille AU - Bahl, Jhilmil AU - Appuhamy, Ranil AU - Moen, Ann PY - 2021/12/3 TI - Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study JO - JMIR Public Health Surveill SP - e33455 VL - 7 IS - 12 KW - COVID-19 KW - vaccination KW - training KW - massive open online course KW - pandemic KW - vaccine KW - education KW - online education KW - preparation KW - evaluation KW - user experience KW - challenge KW - impact KW - knowledge KW - interest N2 - 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. UR - https://publichealth.jmir.org/2021/12/e33455 UR - http://dx.doi.org/10.2196/33455 UR - http://www.ncbi.nlm.nih.gov/pubmed/34794116 ID - info:doi/10.2196/33455 ER - TY - JOUR AU - Taira, Kazuya AU - Hosokawa, Rikuya AU - Itatani, Tomoya AU - Fujita, Sumio PY - 2021/12/3 TI - Predicting the Number of Suicides in Japan Using Internet Search Queries: Vector Autoregression Time Series Model JO - JMIR Public Health Surveill SP - e34016 VL - 7 IS - 12 KW - suicide KW - internet search engine KW - infoveillance KW - query KW - time series analysis KW - vector autoregression model KW - COVID-19 KW - suicide-related terms KW - internet KW - information seeking KW - time series KW - model KW - loneliness KW - mental health KW - prediction KW - Japan KW - behavior KW - trend N2 - 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. UR - https://publichealth.jmir.org/2021/12/e34016 UR - http://dx.doi.org/10.2196/34016 UR - http://www.ncbi.nlm.nih.gov/pubmed/34823225 ID - info:doi/10.2196/34016 ER - TY - JOUR AU - Amundsen, Myklebust Ole AU - Hoffart, Asle AU - Johnson, Urnes Sverre AU - Ebrahimi, V. Omid PY - 2021/12/3 TI - Pandemic Information Dissemination and Its Associations With the Symptoms of Mental Distress During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Form Res SP - e28239 VL - 5 IS - 12 KW - information sources KW - COVID-19 KW - avoidance KW - psychopathology N2 - 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 UR - https://formative.jmir.org/2021/12/e28239 UR - http://dx.doi.org/10.2196/28239 UR - http://www.ncbi.nlm.nih.gov/pubmed/34678750 ID - info:doi/10.2196/28239 ER - TY - JOUR AU - Oksanen, Atte AU - Oksa, Reetta AU - Savela, Nina AU - Celuch, Magdalena AU - Savolainen, Iina PY - 2021/12/2 TI - Drinking and Social Media Use Among Workers During COVID-19 Pandemic Restrictions: Five-Wave Longitudinal Study JO - J Med Internet Res SP - e33125 VL - 23 IS - 12 KW - excessive drinking KW - alcohol KW - COVID-19 KW - social media KW - remote work KW - psychological distress KW - distress KW - pattern KW - trend KW - prediction KW - survey KW - app KW - risk N2 - 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. UR - https://www.jmir.org/2021/12/e33125 UR - http://dx.doi.org/10.2196/33125 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662290 ID - info:doi/10.2196/33125 ER - TY - JOUR AU - Jolliff, Anna AU - Zhao, Qianqian AU - Eickhoff, Jens AU - Moreno, Megan PY - 2021/12/2 TI - Depression, Anxiety, and Daily Activity Among Adolescents Before and During the COVID-19 Pandemic: Cross-sectional Survey Study JO - JMIR Form Res SP - e30702 VL - 5 IS - 12 KW - COVID-19 KW - pandemic KW - adolescent KW - depression KW - anxiety KW - socioeconomic status KW - survey KW - mental health N2 - 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. UR - https://formative.jmir.org/2021/12/e30702 UR - http://dx.doi.org/10.2196/30702 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609316 ID - info:doi/10.2196/30702 ER - TY - JOUR AU - Fisher, B. Lauren AU - Tuchman, Sylvie AU - Curreri, J. Andrew AU - Markgraf, Maggie AU - Nyer, B. Maren AU - Cassano, Paolo AU - Iverson, L. Grant AU - Fava, Maurizio AU - Zafonte, D. Ross AU - Pedrelli, Paola PY - 2021/12/1 TI - 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 JO - JMIR Form Res SP - e28734 VL - 5 IS - 12 KW - COVID-19 KW - telemental health KW - clinical trial KW - traumatic brain injury KW - depression KW - cognitive behavioral therapy N2 - 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 UR - https://formative.jmir.org/2021/12/e28734 UR - http://dx.doi.org/10.2196/28734 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662285 ID - info:doi/10.2196/28734 ER - TY - JOUR AU - Schulz, Johannes Peter AU - Andersson, M. Elin AU - Bizzotto, Nicole AU - Norberg, Margareta PY - 2021/11/29 TI - Using Ecological Momentary Assessment to Study the Development of COVID-19 Worries in Sweden: Longitudinal Study JO - J Med Internet Res SP - e26743 VL - 23 IS - 11 KW - COVID-19 KW - coronavirus KW - longitudinal studies KW - EMA KW - worry KW - fear KW - pandemics N2 - 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. UR - https://www.jmir.org/2021/11/e26743 UR - http://dx.doi.org/10.2196/26743 UR - http://www.ncbi.nlm.nih.gov/pubmed/34847065 ID - info:doi/10.2196/26743 ER - TY - JOUR AU - Kang, EunKyo AU - Lee, Hyejin AU - Sohn, Hoon Jee AU - Yun, Jieun AU - Lee, Yong Jin AU - Hong, Yun-Chul PY - 2021/11/26 TI - Impact of the COVID-19 Pandemic on the Health Status and Behaviors of Adults in Korea: National Cross-sectional Web-Based Self-report Survey JO - JMIR Public Health Surveill SP - e31635 VL - 7 IS - 11 KW - COVID-19 KW - health status KW - health behavior KW - self-reported online survey KW - pandemic KW - epidemiology KW - public health KW - sociodemographic factors KW - health interventions KW - lockdown N2 - 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. UR - https://publichealth.jmir.org/2021/11/e31635 UR - http://dx.doi.org/10.2196/31635 UR - http://www.ncbi.nlm.nih.gov/pubmed/34653017 ID - info:doi/10.2196/31635 ER - TY - JOUR AU - Midorikawa, Haruhiko AU - Tachikawa, Hirokazu AU - Taguchi, Takaya AU - Shiratori, Yuki AU - Takahashi, Asumi AU - Takahashi, Sho AU - Nemoto, Kiyotaka AU - Arai, Tetsuaki PY - 2021/11/22 TI - Demographics Associated With Stress, Severe Mental Distress, and Anxiety Symptoms During the COVID-19 Pandemic in Japan: Nationwide Cross-sectional Web-Based Survey JO - JMIR Public Health Surveill SP - e29970 VL - 7 IS - 11 KW - COVID-19 KW - mental health KW - stress KW - depression KW - anxiety KW - occupation KW - public health KW - demographic factors KW - epidemiology KW - occupational health N2 - 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. UR - https://publichealth.jmir.org/2021/11/e29970 UR - http://dx.doi.org/10.2196/29970 UR - http://www.ncbi.nlm.nih.gov/pubmed/34653018 ID - info:doi/10.2196/29970 ER - TY - JOUR AU - Ahlers-Schmidt, R. Carolyn AU - Schunn, Christy AU - Hervey, M. Ashley AU - Torres, Maria AU - Nelson, V. Jill Elizabeth PY - 2021/11/22 TI - Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study JO - JMIR Pediatr Parent SP - e31908 VL - 4 IS - 4 KW - COVID-19 KW - SIDS KW - sudden infant death syndrome KW - safe sleep KW - tobacco cessation KW - breastfeeding KW - virtual education N2 - 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. UR - https://pediatrics.jmir.org/2021/4/e31908 UR - http://dx.doi.org/10.2196/31908 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550075 ID - info:doi/10.2196/31908 ER - TY - JOUR AU - Hueniken, Katrina AU - Somé, Habib Nibene AU - Abdelhack, Mohamed AU - Taylor, Graham AU - Elton Marshall, Tara AU - Wickens, M. Christine AU - Hamilton, A. Hayley AU - Wells, Samantha AU - Felsky, Daniel PY - 2021/11/17 TI - Machine Learning?Based Predictive Modeling of Anxiety and Depressive Symptoms During 8 Months of the COVID-19 Global Pandemic: Repeated Cross-sectional Survey Study JO - JMIR Ment Health SP - e32876 VL - 8 IS - 11 KW - mental health KW - machine learning KW - COVID-19 KW - emotional distress KW - emotion KW - distress KW - prediction KW - model KW - anxiety KW - depression KW - symptom KW - cross-sectional KW - survey N2 - 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. UR - https://mental.jmir.org/2021/11/e32876 UR - http://dx.doi.org/10.2196/32876 UR - http://www.ncbi.nlm.nih.gov/pubmed/34705663 ID - info:doi/10.2196/32876 ER - TY - JOUR AU - Wood, M. Sarah AU - Pickel, Julia AU - Phillips, W. Alexis AU - Baber, Kari AU - Chuo, John AU - Maleki, Pegah AU - Faust, L. Haley AU - Petsis, Danielle AU - Apple, E. Danielle AU - Dowshen, Nadia AU - Schwartz, A. Lisa PY - 2021/11/15 TI - Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences JO - JMIR Pediatr Parent SP - e32708 VL - 4 IS - 4 KW - telehealth KW - telemedicine KW - adolescent KW - COVID-19 KW - acceptability KW - feasibility KW - young adult KW - teenager KW - cross-sectional KW - patient experience KW - experience KW - efficiency KW - equity KW - survey N2 - 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. UR - https://pediatrics.jmir.org/2021/4/e32708 UR - http://dx.doi.org/10.2196/32708 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779782 ID - info:doi/10.2196/32708 ER - TY - JOUR AU - Widmann, N. Catherine AU - Wieberneit, Michelle AU - Bieler, Luzie AU - Bernsen, Sarah AU - Gräfenkämper, Robin AU - Brosseron, Frederic AU - Schmeel, Carsten AU - Tacik, Pawel AU - Skowasch, Dirk AU - Radbruch, Alexander AU - Heneka, T. Michael PY - 2021/11/11 TI - Longitudinal Neurocognitive and Pulmonological Profile of Long COVID-19: Protocol for the COVIMMUNE-Clin Study JO - JMIR Res Protoc SP - e30259 VL - 10 IS - 11 KW - SARS-CoV-2 KW - COVID-19 KW - postacute COVID-19 syndrome KW - cognition KW - neuropsychology KW - lung KW - magnetic resonance imaging N2 - 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 UR - https://www.researchprotocols.org/2021/11/e30259 UR - http://dx.doi.org/10.2196/30259 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559059 ID - info:doi/10.2196/30259 ER - TY - JOUR AU - Monnig, A. Mollie AU - Treloar Padovano, Hayley AU - Sokolovsky, W. Alexander AU - DeCost, Grace AU - Aston, R. Elizabeth AU - Haass-Koffler, L. Carolina AU - Szapary, Claire AU - Moyo, Patience AU - Avila, C. Jaqueline AU - Tidey, W. Jennifer AU - Monti, M. Peter AU - Ahluwalia, S. Jasjit PY - 2021/11/9 TI - Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey JO - JMIR Public Health Surveill SP - e29319 VL - 7 IS - 11 KW - SARS-CoV-2 KW - novel coronavirus KW - COVID-19 KW - alcohol use KW - alcohol drinking KW - opioid use KW - stimulant use KW - nicotine KW - smoking KW - survey KW - substance abuse KW - addiction KW - mental health KW - pandemic N2 - 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. UR - https://publichealth.jmir.org/2021/11/e29319 UR - http://dx.doi.org/10.2196/29319 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591780 ID - info:doi/10.2196/29319 ER - TY - JOUR AU - Loveys, Kate AU - Sagar, Mark AU - Pickering, Isabella AU - Broadbent, Elizabeth PY - 2021/11/8 TI - 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 JO - JMIR Ment Health SP - e31586 VL - 8 IS - 11 KW - COVID-19 KW - loneliness KW - stress KW - well-being KW - eHealth KW - digital human KW - conversational agent KW - older adults KW - chronic illness N2 - 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 UR - https://mental.jmir.org/2021/11/e31586 UR - http://dx.doi.org/10.2196/31586 UR - http://www.ncbi.nlm.nih.gov/pubmed/34596572 ID - info:doi/10.2196/31586 ER - TY - JOUR AU - Joshi, Megha AU - Shah, Aangi AU - Trivedi, Bhavi AU - Trivedi, Jaahnavee AU - Patel, Viral AU - Parghi, Devam AU - Thakkar, Manini AU - Barot, Kanan AU - Jadawala, Vivek PY - 2021/11/5 TI - Psychosocial and Behavioral Effects of the COVID-19 Pandemic in the Indian Population: Protocol for a Cross-sectional Study JO - JMIR Res Protoc SP - e29896 VL - 10 IS - 11 KW - COVID-19 KW - mental health KW - India KW - lockdown KW - isolation KW - social isolation KW - behavior KW - psychology KW - psychosocial effects N2 - 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 UR - https://www.researchprotocols.org/2021/11/e29896 UR - http://dx.doi.org/10.2196/29896 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519652 ID - info:doi/10.2196/29896 ER - TY - JOUR AU - Claesdotter-Knutsson, Emma AU - Håkansson, Anders PY - 2021/11/3 TI - Changes in Self-Reported Web-Based Gambling Activity During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Serious Games SP - e30747 VL - 9 IS - 4 KW - COVID-19 KW - pandemic KW - web-based gambling KW - psychological distress KW - gender N2 - 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. UR - https://games.jmir.org/2021/4/e30747 UR - http://dx.doi.org/10.2196/30747 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730540 ID - info:doi/10.2196/30747 ER - TY - JOUR AU - Calvo-Valderrama, Gabriela Maria AU - Marroquín-Rivera, Arturo AU - Burn, Erin AU - Ospina-Pinillos, Laura AU - Bird, Victoria AU - Gómez-Restrepo, Carlos PY - 2021/11/3 TI - Adapting a Mental Health Intervention for Adolescents During the COVID-19 Pandemic: Web-Based Synchronous Focus Group Study JO - JMIR Form Res SP - e30293 VL - 5 IS - 11 KW - pandemic KW - COVID-19 KW - online focus groups KW - qualitative research KW - technology KW - adolescents KW - public health N2 - 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. UR - https://formative.jmir.org/2021/11/e30293 UR - http://dx.doi.org/10.2196/30293 UR - http://www.ncbi.nlm.nih.gov/pubmed/34637395 ID - info:doi/10.2196/30293 ER - TY - JOUR AU - Blanco, Ivan AU - Boemo, Teresa AU - Sanchez-Lopez, Alvaro PY - 2021/11/2 TI - 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 JO - JMIR Ment Health SP - e30961 VL - 8 IS - 11 KW - COVID-19 KW - emotion regulation KW - cognitive biases KW - psychological adjustment KW - resilience N2 - 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; ?29=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. UR - https://mental.jmir.org/2021/11/e30961 UR - http://dx.doi.org/10.2196/30961 UR - http://www.ncbi.nlm.nih.gov/pubmed/34517337 ID - info:doi/10.2196/30961 ER - TY - JOUR AU - Aguilera, Adrian AU - Hernandez-Ramos, Rosa AU - Haro-Ramos, Y. Alein AU - Boone, Elizabeth Claire AU - Luo, Christina Tiffany AU - Xu, Jing AU - Chakraborty, Bibhas AU - Karr, Chris AU - Darrow, Sabrina AU - Figueroa, Astrid Caroline PY - 2021/11/1 TI - A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study JO - JMIR Ment Health SP - e25298 VL - 8 IS - 11 KW - mobile health KW - COVID-19 KW - text messaging KW - cognitive behavioral therapy KW - anxiety KW - depression KW - microrandomized trials KW - mHealth KW - intervention KW - mental health KW - SMS N2 - 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 UR - https://mental.jmir.org/2021/11/e25298 UR - http://dx.doi.org/10.2196/25298 UR - http://www.ncbi.nlm.nih.gov/pubmed/34543230 ID - info:doi/10.2196/25298 ER - TY - JOUR AU - Monzani, Dario AU - Vergani, Laura AU - Pizzoli, Maria Silvia Francesca AU - Marton, Giulia AU - Pravettoni, Gabriella PY - 2021/10/27 TI - Emotional Tone, Analytical Thinking, and Somatosensory Processes of a Sample of Italian Tweets During the First Phases of the COVID-19 Pandemic: Observational Study JO - J Med Internet Res SP - e29820 VL - 23 IS - 10 KW - internet KW - mHealth KW - infodemiology KW - infoveillance KW - pandemic KW - public health KW - COVID-19 KW - Twitter KW - psycholinguistic analysis KW - trauma N2 - 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. UR - https://www.jmir.org/2021/10/e29820 UR - http://dx.doi.org/10.2196/29820 UR - http://www.ncbi.nlm.nih.gov/pubmed/34516386 ID - info:doi/10.2196/29820 ER - TY - JOUR AU - Ahn, Hee Myung AU - Shin, Yong-Wook AU - Suh, Sooyeon AU - Kim, Hye Jeong AU - Kim, Jung Hwa AU - Lee, Kyoung-Uk AU - Chung, Seockhoon PY - 2021/10/22 TI - High Work-Related Stress and Anxiety as a Response to COVID-19 Among Health Care Workers in South Korea: Cross-sectional Online Survey Study JO - JMIR Public Health Surveill SP - e25489 VL - 7 IS - 10 KW - COVID-19 KW - health personnel KW - occupational stress KW - anxiety KW - depression KW - stress KW - mental health KW - South Korea KW - health care worker KW - assessment KW - intervention N2 - 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. UR - https://publichealth.jmir.org/2021/10/e25489 UR - http://dx.doi.org/10.2196/25489 UR - http://www.ncbi.nlm.nih.gov/pubmed/34478401 ID - info:doi/10.2196/25489 ER - TY - JOUR AU - Corrêa, Pires Roberta AU - Castro, Carla Helena AU - Quaresma, Salomão Bruna Maria Castro AU - Stephens, Soares Paulo Roberto AU - Araujo-Jorge, Cremonini Tania AU - Ferreira, Rodrigues Roberto PY - 2021/10/22 TI - Perceptions and Feelings of Brazilian Health Care Professionals Regarding the Effects of COVID-19: Cross-sectional Web-Based Survey JO - JMIR Form Res SP - e28088 VL - 5 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - health professionals KW - Brazil KW - pandemic KW - mental health KW - health planning N2 - 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. UR - https://formative.jmir.org/2021/10/e28088 UR - http://dx.doi.org/10.2196/28088 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519656 ID - info:doi/10.2196/28088 ER - TY - JOUR AU - Kemp, Jessica AU - Chorney, Jill AU - Kassam, Iman AU - MacDonald, Julie AU - MacDonald, Tara AU - Wozney, Lori AU - Strudwick, Gillian PY - 2021/10/19 TI - Learning About the Current State of Digital Mental Health Interventions for Canadian Youth to Inform Future Decision-Making: Mixed Methods Study JO - J Med Internet Res SP - e30491 VL - 23 IS - 10 KW - youth mental health KW - digital mental health KW - COVID-19 KW - digital mental health interventions KW - e-mental health N2 - 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. UR - https://www.jmir.org/2021/10/e30491 UR - http://dx.doi.org/10.2196/30491 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665141 ID - info:doi/10.2196/30491 ER - TY - JOUR AU - Aguiar, A. AU - Pinto, M. AU - Duarte, R. PY - 2021/10/19 TI - Psychological Impact of the COVID-19 Pandemic and Social Determinants on the Portuguese Population: Protocol for a Web-Based Cross-sectional Study JO - JMIR Res Protoc SP - e28071 VL - 10 IS - 10 KW - COVID-19 KW - public health KW - mental health KW - study protocol KW - psychological impact KW - anxiety KW - depression KW - grief KW - behavior change N2 - 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 UR - https://www.researchprotocols.org/2021/10/e28071 UR - http://dx.doi.org/10.2196/28071 UR - http://www.ncbi.nlm.nih.gov/pubmed/34516387 ID - info:doi/10.2196/28071 ER - TY - JOUR AU - Agley, Jon AU - Xiao, Yunyu AU - Thompson, E. Esi AU - Chen, Xiwei AU - Golzarri-Arroyo, Lilian PY - 2021/10/14 TI - Intervening on Trust in Science to Reduce Belief in COVID-19 Misinformation and Increase COVID-19 Preventive Behavioral Intentions: Randomized Controlled Trial JO - J Med Internet Res SP - e32425 VL - 23 IS - 10 KW - infodemic KW - misinformation KW - trust in science KW - COVID-19 KW - RCT KW - randomized controlled trial N2 - 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 UR - https://www.jmir.org/2021/10/e32425 UR - http://dx.doi.org/10.2196/32425 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581678 ID - info:doi/10.2196/32425 ER - TY - JOUR AU - Hood, M. Anna AU - Stotesbury, Hanne AU - Murphy, Jennifer AU - Kölbel, Melanie AU - Slee, April AU - Springall, Charlie AU - Paradis, Matthew AU - Corral-Frías, Saraí Nadia AU - Reyes-Aguilar, Azalea AU - Cuellar Barboza, B. Alfredo AU - Noser, E. Amy AU - Gomes, Stacey AU - Mitchell, Monica AU - Watkins, M. Sharon AU - Butsch Kovacic, Melinda AU - Kirkham, J. Fenella AU - Crosby, E. Lori PY - 2021/10/7 TI - Attitudes About COVID-19 and Health (ATTACH): Online Survey and Mixed Methods Study JO - JMIR Ment Health SP - e29963 VL - 8 IS - 10 KW - COVID-19 KW - mental health KW - international KW - mitigation strategies KW - deprivation N2 - 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. UR - https://mental.jmir.org/2021/10/e29963 UR - http://dx.doi.org/10.2196/29963 UR - http://www.ncbi.nlm.nih.gov/pubmed/34357877 ID - info:doi/10.2196/29963 ER - TY - JOUR AU - Ranjan, Yatharth AU - Althobiani, Malik AU - Jacob, Joseph AU - Orini, Michele AU - Dobson, JB Richard AU - Porter, Joanna AU - Hurst, John AU - Folarin, A. Amos PY - 2021/10/7 TI - Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study JO - JMIR Res Protoc SP - e28873 VL - 10 IS - 10 KW - mHealth KW - COVID-19 KW - mobile health KW - remote monitoring KW - wearables KW - internet of things KW - lung diseases KW - respiratory health KW - mental health KW - cardiopulmonary diseases N2 - 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 UR - https://www.researchprotocols.org/2021/10/e28873 UR - http://dx.doi.org/10.2196/28873 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319235 ID - info:doi/10.2196/28873 ER - TY - JOUR AU - Kaufmann, G. Peter AU - Havens, S. Donna AU - Mensinger, L. Janell AU - Bradley, K. Patricia AU - Brom, M. Heather AU - Copel, C. Linda AU - Costello, Alexander AU - D'Annunzio, Christine AU - Dean Durning, Jennifer AU - Maldonado, Linda AU - Barrow McKenzie, Ann AU - Smeltzer, C. Suzanne AU - Yost, Jennifer AU - PY - 2021/10/7 TI - The COVID-19 Study of Healthcare and Support Personnel (CHAMPS): Protocol for a Longitudinal Observational Study JO - JMIR Res Protoc SP - e30757 VL - 10 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - stress KW - depression KW - anxiety KW - sleep KW - social support KW - resilience KW - mental health KW - physical health N2 - 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 UR - https://www.researchprotocols.org/2021/10/e30757 UR - http://dx.doi.org/10.2196/30757 UR - http://www.ncbi.nlm.nih.gov/pubmed/34582354 ID - info:doi/10.2196/30757 ER - TY - JOUR AU - Summers, Charlotte AU - Wu, Philip AU - Taylor, G. Alisdair J. PY - 2021/10/6 TI - Supporting Mental Health During the COVID-19 Pandemic Using a Digital Behavior Change Intervention: An Open-Label, Single-Arm, Pre-Post Intervention Study JO - JMIR Form Res SP - e31273 VL - 5 IS - 10 KW - stress KW - mental health KW - COVID-19 KW - digital therapy KW - mHealth KW - support KW - behavior KW - intervention KW - online intervention KW - outcome KW - wellbeing KW - sleep KW - activity KW - nutrition N2 - 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. UR - https://formative.jmir.org/2021/10/e31273 UR - http://dx.doi.org/10.2196/31273 UR - http://www.ncbi.nlm.nih.gov/pubmed/34459740 ID - info:doi/10.2196/31273 ER - TY - JOUR AU - Gonsalves, P. Pattie AU - Sharma, Rhea AU - Hodgson, Eleanor AU - Bhat, Bhargav AU - Jambhale, Abhijeet AU - Weiss, A. Helen AU - Fairburn, G. Christopher AU - Cavanagh, Kate AU - Cuijpers, Pim AU - Michelson, Daniel AU - Patel, Vikram PY - 2021/10/6 TI - 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 JO - JMIR Res Protoc SP - e30339 VL - 10 IS - 10 KW - randomized controlled trial KW - internet-based intervention KW - smartphone KW - adolescent KW - schools KW - mental health KW - COVID-19 KW - app KW - protocol KW - problem-solving KW - intervention KW - teenager KW - young adult KW - India KW - feasibility KW - effective N2 - 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 UR - https://www.researchprotocols.org/2021/10/e30339 UR - http://dx.doi.org/10.2196/30339 UR - http://www.ncbi.nlm.nih.gov/pubmed/34586075 ID - info:doi/10.2196/30339 ER - TY - JOUR AU - Luo, Yan PY - 2021/10/5 TI - The Association of Delayed Care With Depression Among US Middle-Aged and Older Adults During the COVID-19 Pandemic: Cross-sectional Analysis JO - JMIR Aging SP - e29953 VL - 4 IS - 4 KW - depression KW - COVID-19 KW - delayed care KW - middle-aged adults KW - older adults N2 - 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. UR - https://aging.jmir.org/2021/4/e29953 UR - http://dx.doi.org/10.2196/29953 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524964 ID - info:doi/10.2196/29953 ER - TY - JOUR AU - Gordon, S. Judith AU - Sbarra, David AU - Armin, Julie AU - Pace, W. Thaddeus W. AU - Gniady, Chris AU - Barraza, Yessenya PY - 2021/10/4 TI - Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19?Related Stress: Pilot Feasibility Study JO - JMIR Form Res SP - e32353 VL - 5 IS - 10 KW - COVID-19 KW - stress KW - anxiety KW - isolation KW - intervention KW - guided imagery KW - mobile app N2 - 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. UR - https://formative.jmir.org/2021/10/e32353 UR - http://dx.doi.org/10.2196/32353 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546941 ID - info:doi/10.2196/32353 ER - TY - JOUR AU - Hentati, Amira AU - Forsell, Erik AU - Ljótsson, Brjánn AU - Kraepelien, Martin PY - 2021/10/4 TI - Practical and Emotional Problems Reported by Users of a Self-guided Digital Problem-solving Intervention During the COVID-19 Pandemic: Content Analysis JO - JMIR Form Res SP - e31722 VL - 5 IS - 10 KW - digital intervention KW - COVID-19 KW - problem-solving KW - self-guided intervention KW - content analysis KW - public health KW - mental health KW - depression KW - anxiety KW - pandemic N2 - 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 UR - https://formative.jmir.org/2021/10/e31722 UR - http://dx.doi.org/10.2196/31722 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559670 ID - info:doi/10.2196/31722 ER - TY - JOUR AU - Usher, Kim AU - Durkin, Joanne AU - Martin, Sam AU - Vanderslott, Samantha AU - Vindrola-Padros, Cecilia AU - Usher, Luke AU - Jackson, Debra PY - 2021/10/1 TI - Public Sentiment and Discourse on Domestic Violence During the COVID-19 Pandemic in Australia: Analysis of Social Media Posts JO - J Med Internet Res SP - e29025 VL - 23 IS - 10 KW - COVID-19 KW - domestic violence KW - social media KW - Twitter KW - sentiment analysis KW - discourse analysis KW - keyword analysis KW - pandemic KW - sentiment KW - public health KW - public expression N2 - 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. UR - https://www.jmir.org/2021/10/e29025 UR - http://dx.doi.org/10.2196/29025 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519659 ID - info:doi/10.2196/29025 ER - TY - JOUR AU - Withiel, Toni AU - Barson, Elizabeth AU - Ng, Irene AU - Segal, Reny AU - Williams, Goulding Daryl Lindsay AU - Krieser, Benjamin Roni AU - Lee, Keat AU - Mezzavia, Mario Paul AU - Sindoni, Teresa AU - Chen, Yinwei AU - Fisher, Anne Caroline PY - 2021/9/29 TI - The Psychological Experience of Frontline Perioperative Health Care Staff in Responding to COVID-19: Qualitative Study JO - JMIR Perioper Med SP - e27166 VL - 4 IS - 2 KW - COVID-19 KW - perioperative KW - mental health KW - qualitative KW - grief KW - psychology KW - health care worker KW - experience KW - hospital KW - trauma KW - thematic analysis KW - interview N2 - 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. UR - https://periop.jmir.org/2021/2/e27166 UR - http://dx.doi.org/10.2196/27166 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346887 ID - info:doi/10.2196/27166 ER - TY - JOUR AU - Geronikolou, Styliani AU - Drosatos, George AU - Chrousos, George PY - 2021/9/29 TI - Emotional Analysis of Twitter Posts During the First Phase of the COVID-19 Pandemic in Greece: Infoveillance Study JO - JMIR Form Res SP - e27741 VL - 5 IS - 9 KW - emotional analysis KW - COVID-19 KW - Twitter KW - Greece KW - infodemics KW - emotional contagion KW - epidemiology KW - pandemic KW - mental health N2 - 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. UR - https://formative.jmir.org/2021/9/e27741 UR - http://dx.doi.org/10.2196/27741 UR - http://www.ncbi.nlm.nih.gov/pubmed/34469328 ID - info:doi/10.2196/27741 ER - TY - JOUR AU - Kawakami, Norito AU - Imamura, Kotaro AU - Watanabe, Kazuhiro AU - Sekiya, Yuki AU - Sasaki, Natsu AU - Sato, Nana AU - PY - 2021/9/29 TI - 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 JO - JMIR Res Protoc SP - e30305 VL - 10 IS - 9 KW - deep learning KW - unguided intervention KW - universal prevention KW - workplace KW - depression KW - machine learning N2 - 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 UR - https://www.researchprotocols.org/2021/9/e30305 UR - http://dx.doi.org/10.2196/30305 UR - http://www.ncbi.nlm.nih.gov/pubmed/34460414 ID - info:doi/10.2196/30305 ER - TY - JOUR AU - Matthes, Jörg AU - Koban, Kevin AU - Neureiter, Ariadne AU - Stevic, Anja PY - 2021/9/27 TI - Longitudinal Relationships Among Fear of COVID-19, Smartphone Online Self-Disclosure, Happiness, and Psychological Well-being: Survey Study JO - J Med Internet Res SP - e28700 VL - 23 IS - 9 KW - COVID-19 pandemic KW - fear KW - self-disclosure KW - happiness, well-being KW - panel study KW - smartphones KW - online platform KW - social media N2 - 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. UR - https://www.jmir.org/2021/9/e28700 UR - http://dx.doi.org/10.2196/28700 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519657 ID - info:doi/10.2196/28700 ER - TY - JOUR AU - Liu, W. Jenny J. AU - Nazarov, Anthony AU - Plouffe, A. Rachel AU - Forchuk, A. Callista AU - Deda, Erisa AU - Gargala, Dominic AU - Le, Tri AU - Bourret-Gheysen, Jesse AU - Soares, Vanessa AU - Nouri, S. Maede AU - Hosseiny, Fardous AU - Smith, Patrick AU - Roth, Maya AU - MacDougall, G. Arlene AU - Marlborough, Michelle AU - Jetly, Rakesh AU - Heber, Alexandra AU - Albuquerque, Joy AU - Lanius, Ruth AU - Balderson, Ken AU - Dupuis, Gabrielle AU - Mehta, Viraj AU - Richardson, Don J. PY - 2021/9/27 TI - Exploring the Well-being of Health Care Workers During the COVID-19 Pandemic: Protocol for a Prospective Longitudinal Study JO - JMIR Res Protoc SP - e32663 VL - 10 IS - 9 KW - COVID-19 KW - health care worker KW - pandemic KW - mental health KW - wellbeing KW - survey KW - design KW - longitudinal KW - prospective KW - protocol KW - challenge KW - impact KW - distress KW - perception N2 - 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 UR - https://www.researchprotocols.org/2021/9/e32663 UR - http://dx.doi.org/10.2196/32663 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477557 ID - info:doi/10.2196/32663 ER - TY - JOUR AU - Cross, J. Troy AU - Isautier, J. Jennifer M. AU - Morris, J. Sarah AU - Johnson, D. Bruce AU - Wheatley-Guy, M. Courtney AU - Taylor, J. Bryan PY - 2021/9/24 TI - The Influence of Social Distancing Behaviors and Psychosocial Factors on Physical Activity During the COVID-19 Pandemic: Cross-sectional Survey Study JO - JMIR Public Health Surveill SP - e31278 VL - 7 IS - 9 KW - physical activity KW - COVID-19 KW - mental health KW - social distancing KW - public health KW - pandemic KW - physical health KW - exercise N2 - 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. UR - https://publichealth.jmir.org/2021/9/e31278 UR - http://dx.doi.org/10.2196/31278 UR - http://www.ncbi.nlm.nih.gov/pubmed/34509976 ID - info:doi/10.2196/31278 ER - TY - JOUR AU - Mote, Jasmine AU - Gill, Kathryn AU - Fulford, Daniel PY - 2021/9/23 TI - ?Skip the Small Talk? Virtual Event Intended to Promote Social Connection During a Global Pandemic: Online Survey Study JO - JMIR Form Res SP - e28002 VL - 5 IS - 9 KW - COVID-19 KW - depression KW - digital group KW - loneliness KW - social connection KW - virtual social interaction KW - community KW - mental health KW - connection KW - virtual health N2 - 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. UR - https://formative.jmir.org/2021/9/e28002 UR - http://dx.doi.org/10.2196/28002 UR - http://www.ncbi.nlm.nih.gov/pubmed/34468326 ID - info:doi/10.2196/28002 ER - TY - JOUR AU - Wati, Laras Risa AU - Ulfa, Sayyidatul Annisa AU - Kevaladandra, Zulfa AU - Shalihat, Shelly AU - Syahadatina, Bella AU - Pratomo, Hadi PY - 2021/9/23 TI - Pretesting a Poster on Recommended Stress Management During the COVID-19 Pandemic in Indonesia: Qualitative Study JO - JMIR Form Res SP - e25615 VL - 5 IS - 9 KW - pretesting KW - media KW - stress KW - COVID-19 N2 - 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. UR - https://formative.jmir.org/2021/9/e25615 UR - http://dx.doi.org/10.2196/25615 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254944 ID - info:doi/10.2196/25615 ER - TY - JOUR AU - Van Herck, Maarten AU - Goërtz, J. Yvonne M. AU - Houben-Wilke, Sarah AU - Machado, C. Felipe V. AU - Meys, Roy AU - Delbressine, M. Jeannet AU - Vaes, W. Anouk AU - Burtin, Chris AU - Posthuma, Rein AU - Franssen, E. Frits M. AU - Hajian, Bita AU - Vijlbrief, Herman AU - Spies, Yvonne AU - van 't Hul, J. Alex AU - Janssen, A. Daisy J. AU - Spruit, A. Martijn PY - 2021/9/21 TI - Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups JO - J Med Internet Res SP - e30274 VL - 23 IS - 9 KW - COVID-19 KW - SARS-CoV-2 KW - long COVID KW - post-COVID-19 syndrome KW - post-acute sequelae of COVID-19 KW - fatigue KW - post-viral fatigue KW - pandemic KW - online health KW - mental health KW - online support N2 - 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. UR - https://www.jmir.org/2021/9/e30274 UR - http://dx.doi.org/10.2196/30274 UR - http://www.ncbi.nlm.nih.gov/pubmed/34494964 ID - info:doi/10.2196/30274 ER - TY - JOUR AU - Siedlikowski, Sophia AU - Noël, Louis-Philippe AU - Moynihan, Anne Stephanie AU - Robin, Marc PY - 2021/9/21 TI - Chloe for COVID-19: Evolution of an Intelligent Conversational Agent to Address Infodemic Management Needs During the COVID-19 Pandemic JO - J Med Internet Res SP - e27283 VL - 23 IS - 9 KW - chatbot KW - COVID-19 KW - conversational agents KW - public health KW - artificial intelligence KW - infodemic KW - infodemiology KW - misinformation KW - digital health KW - virtual care UR - https://www.jmir.org/2021/9/e27283 UR - http://dx.doi.org/10.2196/27283 UR - http://www.ncbi.nlm.nih.gov/pubmed/34375299 ID - info:doi/10.2196/27283 ER - TY - JOUR AU - Budhwani, Suman AU - Fujioka, Keiko Jamie AU - Chu, Cherry AU - Baranek, Hayley AU - Pus, Laura AU - Wasserman, Lori AU - Vigod, Simone AU - Martin, Danielle AU - Agarwal, Payal AU - Mukerji, Geetha PY - 2021/9/21 TI - Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context JO - JMIR Form Res SP - e30280 VL - 5 IS - 9 KW - virtual care KW - mental health KW - quality of care KW - implementation KW - COVID-19 KW - digital health KW - pandemic KW - ambulatory care N2 - 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. UR - https://formative.jmir.org/2021/9/e30280 UR - http://dx.doi.org/10.2196/30280 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406967 ID - info:doi/10.2196/30280 ER - TY - JOUR AU - Omowale, S. Serwaa AU - Casas, Andrea AU - Lai, Yu-Hsuan AU - Sanders, A. Sarah AU - Hill, V. Ashley AU - Wallace, L. Meredith AU - Rathbun, L. Stephen AU - Gary-Webb, L. Tiffany AU - Burke, E. Lora AU - Davis, M. Esa AU - Mendez, D. Dara PY - 2021/9/21 TI - 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 JO - JMIR Ment Health SP - e30422 VL - 8 IS - 9 KW - COVID-19 KW - ecological momentary assessment KW - health status disparities KW - pandemics KW - postpartum KW - pregnancy KW - psychological stress N2 - 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 UR - https://mental.jmir.org/2021/9/e30422 UR - http://dx.doi.org/10.2196/30422 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328420 ID - info:doi/10.2196/30422 ER - TY - JOUR AU - Brogly, Chris AU - Bauer, A. Michael AU - Lizotte, J. Daniel AU - Press, L. MacLean AU - MacDougall, Arlene AU - Speechley, Mark AU - Huner, Erin AU - Mitchell, Marc AU - Anderson, K. Kelly AU - Pila, Eva PY - 2021/9/17 TI - An App-Based Surveillance System for Undergraduate Students? Mental Health During the COVID-19 Pandemic: Protocol for a Prospective Cohort Study JO - JMIR Res Protoc SP - e30504 VL - 10 IS - 9 KW - undergraduate KW - mental health KW - smartphone KW - app KW - COVID-19 KW - postsecondary institutions KW - mobile apps KW - mHealth KW - mobile health N2 - 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 UR - https://www.researchprotocols.org/2021/9/e30504 UR - http://dx.doi.org/10.2196/30504 UR - http://www.ncbi.nlm.nih.gov/pubmed/34516391 ID - info:doi/10.2196/30504 ER - TY - JOUR AU - Han, Lei AU - Zhan, Yanru AU - Li, Weizi AU - Xu, Yuqing AU - Xu, Yan AU - Zhao, Jinzhe PY - 2021/9/16 TI - Associations Between the Perceived Severity of the COVID-19 Pandemic, Cyberchondria, Depression, Anxiety, Stress, and Lockdown Experience: Cross-sectional Survey Study JO - JMIR Public Health Surveill SP - e31052 VL - 7 IS - 9 KW - COVID-19 KW - cyberchondria KW - depression KW - anxiety KW - stress KW - ABC theory of emotions KW - lockdown experience KW - perceived severity KW - cross-sectional KW - online health information N2 - 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 (?=0.36, t=8.51, P<.001), anxiety (?=0.41, t=9.84, P<.001), and stress (?=0.46, t=11.45, P<.001), which were mediated by cyberchondria (?=0.36, t=8.59, P<.001). The direct effects of perceived severity of the COVID-19 pandemic on anxiety (?=0.07, t=2.01, P=.045) and stress (?=0.09, t=2.75, P=.006) and the indirect effects of cyberchondria on depression (?=0.10, t=2.59, P=.009) and anxiety (?=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. UR - https://publichealth.jmir.org/2021/9/e31052 UR - http://dx.doi.org/10.2196/31052 UR - http://www.ncbi.nlm.nih.gov/pubmed/34478402 ID - info:doi/10.2196/31052 ER - TY - JOUR AU - Ryu, Jihan AU - Sükei, Emese AU - Norbury, Agnes AU - H Liu, Shelley AU - Campaña-Montes, José Juan AU - Baca-Garcia, Enrique AU - Artés, Antonio AU - Perez-Rodriguez, Mercedes M. PY - 2021/9/15 TI - Shift in Social Media App Usage During COVID-19 Lockdown and Clinical Anxiety Symptoms: Machine Learning?Based Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e30833 VL - 8 IS - 9 KW - anxiety disorder KW - COVID-19 KW - social media KW - public health KW - digital phenotype KW - ecological momentary assessment KW - smartphone KW - machine learning KW - hidden Markov model N2 - 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. UR - https://mental.jmir.org/2021/9/e30833 UR - http://dx.doi.org/10.2196/30833 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524091 ID - info:doi/10.2196/30833 ER - TY - JOUR AU - Raphaely, Shiri AU - Goldberg, B. Simon AU - Moreno, Megan AU - Stowe, Zachary PY - 2021/9/14 TI - Rates of Assessment of Social Media Use in Psychiatric Interviews Prior to and During COVID-19: Needs Assessment Survey JO - JMIR Med Educ SP - e28495 VL - 7 IS - 3 KW - social media KW - screentime KW - problematic Internet use KW - psychiatric interview KW - psychiatric training KW - COVID-19 KW - residency KW - training KW - survey KW - psychiatry KW - evaluation KW - quarantine N2 - 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 ?21=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. UR - https://mededu.jmir.org/2021/3/e28495 UR - http://dx.doi.org/10.2196/28495 UR - http://www.ncbi.nlm.nih.gov/pubmed/34375297 ID - info:doi/10.2196/28495 ER - TY - JOUR AU - Hirten, P. Robert AU - Danieletto, Matteo AU - Tomalin, Lewis AU - Choi, Hyewon Katie AU - Zweig, Micol AU - Golden, Eddye AU - Kaur, Sparshdeep AU - Helmus, Drew AU - Biello, Anthony AU - Pyzik, Renata AU - Calcagno, Claudia AU - Freeman, Robert AU - Sands, E. Bruce AU - Charney, Dennis AU - Bottinger, P. Erwin AU - Murrough, W. James AU - Keefer, Laurie AU - Suarez-Farinas, Mayte AU - Nadkarni, N. Girish AU - Fayad, A. Zahi PY - 2021/9/13 TI - Factors Associated With Longitudinal Psychological and Physiological Stress in Health Care Workers During the COVID-19 Pandemic: Observational Study Using Apple Watch Data JO - J Med Internet Res SP - e31295 VL - 23 IS - 9 KW - wearable device KW - COVID-19 KW - stress KW - heart rate variability KW - psychological KW - psychology KW - physiology KW - mental health KW - health care worker KW - observational KW - app KW - heart rate KW - nervous system KW - resilience KW - emotion KW - support KW - quality of life N2 - 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. UR - https://www.jmir.org/2021/9/e31295 UR - http://dx.doi.org/10.2196/31295 UR - http://www.ncbi.nlm.nih.gov/pubmed/34379602 ID - info:doi/10.2196/31295 ER - TY - JOUR AU - Rashid Soron, Tanjir AU - Ashiq, Rahman Md Ashiqur AU - Al-Hakeem, Marzia AU - Chowdhury, Farzan Zaid AU - Uddin Ahmed, Helal AU - Afrooz Chowdhury, Chaman PY - 2021/9/13 TI - Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh JO - JMIR Form Res SP - e24624 VL - 5 IS - 9 KW - domestic violence KW - COVID-19 KW - mental health KW - violence KW - Bangladesh KW - lockdown KW - isolation KW - anxiety KW - stress KW - telemental health KW - telepsychiatry KW - web-based survey N2 - 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. UR - https://formative.jmir.org/2021/9/e24624 UR - http://dx.doi.org/10.2196/24624 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346893 ID - info:doi/10.2196/24624 ER - TY - JOUR AU - Tuck, B. Alison AU - Thompson, J. Renee PY - 2021/9/7 TI - Social Networking Site Use During the COVID-19 Pandemic and Its Associations With Social and Emotional Well-being in College Students: Survey Study JO - JMIR Form Res SP - e26513 VL - 5 IS - 9 KW - social media KW - social networking sites KW - COVID-19 KW - loneliness KW - well-being N2 - 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 (r64 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 UR - https://www.researchprotocols.org/2021/9/e28337 UR - http://dx.doi.org/10.2196/28337 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292163 ID - info:doi/10.2196/28337 ER - TY - JOUR AU - Ladapo, A. Joseph AU - Rothwell, T. Jonathan AU - Ramirez, M. Christina PY - 2021/8/30 TI - Association of COVID-19 Risk Misperceptions With Household Isolation in the United States: Survey Study JO - JMIR Form Res SP - e30164 VL - 5 IS - 8 KW - COVID-19 KW - pandemic KW - mental health KW - public health KW - isolation KW - loneliness KW - guideline KW - risk KW - perception KW - United States KW - health risk KW - well-being N2 - 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. UR - https://formative.jmir.org/2021/8/e30164 UR - http://dx.doi.org/10.2196/30164 UR - http://www.ncbi.nlm.nih.gov/pubmed/34253507 ID - info:doi/10.2196/30164 ER - TY - JOUR AU - Keller, Maria Franziska AU - Dahmen, Alina AU - Derksen, Christina AU - Kötting, Lukas AU - Lippke, Sonia PY - 2021/8/26 TI - Psychosomatic Rehabilitation Patients and the General Population During COVID-19: Online Cross-sectional and Longitudinal Study of Digital Trainings and Rehabilitation Effects JO - JMIR Ment Health SP - e30610 VL - 8 IS - 8 KW - mental health KW - COVID-19 KW - medical rehabilitation KW - psychosomatic rehabilitation KW - internet-delivered digital trainings N2 - 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, ?2p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F1,837=31.67, P<.001, ?2p=0.04), had lower financial worries (F1,837=38.96, P<.001, ?2p=0.04), but had higher household-related worries (F1,837=5.34, P=.02, ?2p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F1,712=23.21, P<.001, ?2p=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, ?2p=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 (?=?.14, P<.001), anxiety (?=?.12, P<.001), loneliness (?=?.18, P<.001), and stress postrehabilitation (?=?.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F1,725=4.82, P=.03, ?2p=0.01) and anxiety (F1,725=6.22, P=.01, ?2p=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 UR - https://mental.jmir.org/2021/8/e30610 UR - http://dx.doi.org/10.2196/30610 UR - http://www.ncbi.nlm.nih.gov/pubmed/34270444 ID - info:doi/10.2196/30610 ER - TY - JOUR AU - Haucke, Matthias AU - Liu, Shuyan AU - Heinzel, Stephan PY - 2021/8/26 TI - 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 JO - JMIR Ment Health SP - e29419 VL - 8 IS - 8 KW - COVID-19 KW - outbreaks KW - epidemics KW - pandemics KW - psychological responses and emotional well-being KW - ecological momentary assessment KW - risk and protective factors KW - low incidence and restrictions N2 - 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. UR - https://mental.jmir.org/2021/8/e29419 UR - http://dx.doi.org/10.2196/29419 UR - http://www.ncbi.nlm.nih.gov/pubmed/34347622 ID - info:doi/10.2196/29419 ER - TY - JOUR AU - Plomecka, Martyna AU - Gobbi, Susanna AU - Neckels, Rachael AU - Radzinski, Piotr AU - Skorko, Beata AU - Lazzeri, Samuel AU - Almazidou, Kristina AU - Dedic, Alisa AU - Bakalovic, Asja AU - Hrustic, Lejla AU - Ashraf, Zainab AU - Es Haghi, Sarvin AU - Rodriguez-Pino, Luis AU - Waller, Verena AU - Jabeen, Hafsa AU - Alp, Beyza A. AU - Behnam, Mehdi AU - Shibli, Dana AU - Baranczuk-Turska, Zofia AU - Haq, Zeeshan AU - Qureshi, Salah AU - Strutt, M. Adriana AU - Jawaid, Ali PY - 2021/8/19 TI - Factors Associated With Psychological Disturbances During the COVID-19 Pandemic: Multicountry Online Study JO - JMIR Ment Health SP - e28736 VL - 8 IS - 8 KW - COVID-19 KW - pandemic KW - mental health KW - depression KW - posttraumatic stress disorder KW - general psychological disturbance KW - global N2 - 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. UR - https://mental.jmir.org/2021/8/e28736 UR - http://dx.doi.org/10.2196/28736 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254939 ID - info:doi/10.2196/28736 ER - TY - JOUR AU - Tan, Hao AU - Peng, Sheng-Lan AU - Zhu, Chun-Peng AU - You, Zuo AU - Miao, Ming-Cheng AU - Kuai, Shu-Guang PY - 2021/8/12 TI - Long-term Effects of the COVID-19 Pandemic on Public Sentiments in Mainland China: Sentiment Analysis of Social Media Posts JO - J Med Internet Res SP - e29150 VL - 23 IS - 8 KW - COVID-19 KW - emotional trauma KW - public sentiment on social media KW - long-term effect N2 - 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. UR - https://www.jmir.org/2021/8/e29150 UR - http://dx.doi.org/10.2196/29150 UR - http://www.ncbi.nlm.nih.gov/pubmed/34280118 ID - info:doi/10.2196/29150 ER - TY - JOUR AU - Venville, Annie AU - O'Connor, Sarah AU - Roeschlein, Hannah AU - Ennals, Priscilla AU - McLoughlan, Grace AU - Thomas, Neil PY - 2021/8/12 TI - Mental Health Service User and Worker Experiences of Psychosocial Support Via Telehealth Through the COVID-19 Pandemic: Qualitative Study JO - JMIR Ment Health SP - e29671 VL - 8 IS - 8 KW - telehealth KW - mental health KW - psychosocial support KW - COVID-19 KW - service user KW - workers KW - qualitative KW - e-mental health KW - support KW - telemedicine KW - intervention KW - user experience N2 - 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. UR - https://mental.jmir.org/2021/8/e29671 UR - http://dx.doi.org/10.2196/29671 UR - http://www.ncbi.nlm.nih.gov/pubmed/34182461 ID - info:doi/10.2196/29671 ER - TY - JOUR AU - Mata-Greve, Felicia AU - Johnson, Morgan AU - Pullmann, D. Michael AU - Friedman, C. Emily AU - Griffith Fillipo, Isabell AU - Comtois, A. Katherine AU - Arean, Patricia PY - 2021/8/5 TI - 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 JO - JMIR Ment Health SP - e28360 VL - 8 IS - 8 KW - digital health KW - COVID-19 KW - essential worker KW - unemployed KW - usability KW - user burden KW - mental health KW - e-mental health KW - survey KW - distress N2 - 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. UR - https://mental.jmir.org/2021/8/e28360 UR - http://dx.doi.org/10.2196/28360 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081592 ID - info:doi/10.2196/28360 ER - TY - JOUR AU - Shah, Anish AU - Darling, Michele AU - Arstein-Kerslake, Olivia AU - Morgan, Tiffany AU - Vance Tovrea, Aubreen AU - Young, James AU - Laines, Helen PY - 2021/7/29 TI - Measuring the Impact of COVID-19 on Siyan Mental Health Patients Using the Epidemic-Pandemic Impacts Inventory: Survey Study JO - JMIR Form Res SP - e29952 VL - 5 IS - 7 KW - COVID-19 KW - coronavirus KW - pandemic KW - mental health KW - social isolation KW - wellness N2 - 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 UR - https://formative.jmir.org/2021/7/e29952 UR - http://dx.doi.org/10.2196/29952 UR - http://www.ncbi.nlm.nih.gov/pubmed/34323851 ID - info:doi/10.2196/29952 ER - TY - JOUR AU - Mazziotti, Raffaele AU - Rutigliano, Grazia PY - 2021/7/29 TI - Tele?Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction JO - JMIR Ment Health SP - e26187 VL - 8 IS - 7 KW - telepsychiatry KW - telepsychology KW - e-mental health KW - document clustering KW - survey KW - COVID-19 KW - access to care KW - patient satisfaction KW - mental health KW - tele?mental health KW - review KW - telemedicine KW - satisfaction KW - access N2 - 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. UR - https://mental.jmir.org/2021/7/e26187 UR - http://dx.doi.org/10.2196/26187 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114956 ID - info:doi/10.2196/26187 ER - TY - JOUR AU - Scholl, Julia AU - Kohls, Elisabeth AU - Görges, Frauke AU - Steinbrecher, Marc AU - Baldofski, Sabrina AU - Moessner, Markus AU - Rummel-Kluge, Christine PY - 2021/7/23 TI - 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 JO - JMIR Form Res SP - e27865 VL - 5 IS - 7 KW - online KW - group chats KW - COVID-19 pandemic KW - psychiatric outpatient setting KW - online interventions KW - e-mental health KW - COVID-19 KW - pandemic KW - mental health KW - psychoeducation KW - online chat N2 - 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 UR - https://formative.jmir.org/2021/7/e27865 UR - http://dx.doi.org/10.2196/27865 UR - http://www.ncbi.nlm.nih.gov/pubmed/34161252 ID - info:doi/10.2196/27865 ER - TY - JOUR AU - Mhende, Josephine AU - Bell, A. Sharrill AU - Cottrell-Daniels, Cherell AU - Luong, Jackie AU - Streiff, Micah AU - Dannenfelser, Mark AU - Hayat, J. Matthew AU - Spears, Adams Claire PY - 2021/7/23 TI - Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e25926 VL - 5 IS - 7 KW - acceptability KW - addiction KW - African American KW - cessation KW - COVID-19 KW - feasibility KW - income KW - low socioeconomic status KW - mHealth KW - mindfulness KW - minority KW - smoking KW - SMS KW - text messaging KW - treatment N2 - 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. UR - https://formative.jmir.org/2021/6/e28055 UR - http://dx.doi.org/10.2196/28055 UR - http://www.ncbi.nlm.nih.gov/pubmed/33999835 ID - info:doi/10.2196/28055 ER - TY - JOUR AU - Mack, L. Dante AU - DaSilva, W. Alex AU - Rogers, Courtney AU - Hedlund, Elin AU - Murphy, I. Eilis AU - Vojdanovski, Vlado AU - Plomp, Jane AU - Wang, Weichen AU - Nepal, K. Subigya AU - Holtzheimer, E. Paul AU - Wagner, D. Dylan AU - Jacobson, C. Nicholas AU - Meyer, L. Meghan AU - Campbell, T. Andrew AU - Huckins, F. Jeremy PY - 2021/6/4 TI - Mental Health and Behavior of College Students During the COVID-19 Pandemic: Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study, Part II JO - J Med Internet Res SP - e28892 VL - 23 IS - 6 KW - anxiety KW - college KW - COVID-19 KW - COVID fatigue KW - depression KW - George Floyd KW - mobile sensing KW - phone usage KW - sleep KW - digital phenotyping N2 - 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. UR - https://www.jmir.org/2021/6/e28892 UR - http://dx.doi.org/10.2196/28892 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900935 ID - info:doi/10.2196/28892 ER - TY - JOUR AU - Esmaeilzadeh, Pouyan AU - Mirzaei, Tala PY - 2021/6/3 TI - Using Electronic Health Records to Mitigate Workplace Burnout Among Clinicians During the COVID-19 Pandemic: Field Study in Iran JO - JMIR Med Inform SP - e28497 VL - 9 IS - 6 KW - COVID-19 KW - pandemic KW - clinician burnout KW - electronic health record KW - health information technologies KW - hospital intervention N2 - 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. UR - https://medinform.jmir.org/2021/6/e28497 UR - http://dx.doi.org/10.2196/28497 UR - http://www.ncbi.nlm.nih.gov/pubmed/34033578 ID - info:doi/10.2196/28497 ER - TY - JOUR AU - Yoon, Sungwon AU - Goh, Hendra AU - Nadarajan, Devi Gayathri AU - Sung, Sharon AU - Teo, Irene AU - Lee, Jungup AU - Ong, H. Marcus E. AU - Graves, Nicholas AU - Teo, Lin Tess PY - 2021/5/31 TI - 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 JO - J Med Internet Res SP - e26282 VL - 23 IS - 5 KW - COVID-19 KW - frontline health care workers KW - mHealth KW - well-being KW - psychosocial N2 - 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. UR - https://www.jmir.org/2021/5/e26282 UR - http://dx.doi.org/10.2196/26282 UR - http://www.ncbi.nlm.nih.gov/pubmed/33979296 ID - info:doi/10.2196/26282 ER - TY - JOUR AU - Detweiler Guarino, Isadora AU - Cowan, R. Devin AU - Fellows, M. Abigail AU - Buckey, C. Jay PY - 2021/5/31 TI - Use of a Self-guided Computerized Cognitive Behavioral Tool During COVID-19: Evaluation Study JO - JMIR Form Res SP - e26989 VL - 5 IS - 5 KW - computerized cognitive behavioral therapy KW - interactive media KW - COVID-19 KW - computer-based therapy KW - usability KW - acceptability KW - cognitive behavioral therapy KW - therapy KW - effectiveness KW - digital health KW - depression KW - stress N2 - 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 UR - https://formative.jmir.org/2021/5/e26989 UR - http://dx.doi.org/10.2196/26989 UR - http://www.ncbi.nlm.nih.gov/pubmed/33973856 ID - info:doi/10.2196/26989 ER - TY - JOUR AU - Gabrielli, Silvia AU - Rizzi, Silvia AU - Bassi, Giulia AU - Carbone, Sara AU - Maimone, Rosa AU - Marchesoni, Michele AU - Forti, Stefano PY - 2021/5/28 TI - Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study JO - JMIR Mhealth Uhealth SP - e27965 VL - 9 IS - 5 KW - mobile mental health KW - chatbots KW - anxiety KW - stress KW - university students KW - digital health KW - healthy-coping intervention KW - COVID-19 N2 - 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. UR - https://mhealth.jmir.org/2021/5/e27965 UR - http://dx.doi.org/10.2196/27965 UR - http://www.ncbi.nlm.nih.gov/pubmed/33950849 ID - info:doi/10.2196/27965 ER - TY - JOUR AU - Bhuiyan, Nishat AU - Puzia, Megan AU - Stecher, Chad AU - Huberty, Jennifer PY - 2021/5/26 TI - Associations Between Rural or Urban Status, Health Outcomes and Behaviors, and COVID-19 Perceptions Among Meditation App Users: Longitudinal Survey Study JO - JMIR Mhealth Uhealth SP - e26037 VL - 9 IS - 5 KW - mHealth KW - rural health KW - physical activity KW - mental health KW - COVID-19 N2 - 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. UR - https://mhealth.jmir.org/2021/5/e26037 UR - http://dx.doi.org/10.2196/26037 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900930 ID - info:doi/10.2196/26037 ER - TY - JOUR AU - Singh, Laura AU - Kanstrup, Marie AU - Depa, Katherine AU - Falk, Ann-Charlotte AU - Lindström, Veronica AU - Dahl, Oili AU - Göransson, E. Katarina AU - Rudman, Ann AU - Holmes, A. Emily PY - 2021/5/26 TI - Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma for Health Care Staff Working During COVID-19: Exploratory Pilot Study With Nurses JO - JMIR Form Res SP - e27473 VL - 5 IS - 5 KW - intrusive memories KW - psychological trauma KW - prevention KW - pilot trial KW - COVID-19 KW - digital intervention KW - remote delivery KW - cognitive science KW - person-based approach KW - mixed methods KW - co-design KW - health care staff N2 - 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. UR - https://formative.jmir.org/2021/5/e27473 UR - http://dx.doi.org/10.2196/27473 UR - http://www.ncbi.nlm.nih.gov/pubmed/33886490 ID - info:doi/10.2196/27473 ER - TY - JOUR AU - Yang, Xue AU - Yip, K. Benjamin H. AU - Mak, P. Arthur D. AU - Zhang, Dexing AU - Lee, P. Eric K. AU - Wong, S. Samuel Y. PY - 2021/5/25 TI - 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 JO - JMIR Public Health Surveill SP - e24623 VL - 7 IS - 5 KW - social media KW - depression KW - suicidal ideation KW - social loneliness KW - posttraumatic stress KW - suicide KW - mental health KW - COVID-19 KW - loneliness KW - age KW - mediation N2 - 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 (?262=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 (?234=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 (?=?.07; P=.04) but not among younger people (?=.04; P=.55). The indirect effect via PTSD symptoms was significantly positive among both younger people (?=.09; P=.02) and older people (?=.10; P=.01). The indirect effect via social loneliness was significant among older people (?=?.01; P=.04) but not among younger people (?=.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 (?=.02; P=.04) and older people (?=.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. UR - https://publichealth.jmir.org/2021/5/e24623 UR - http://dx.doi.org/10.2196/24623 UR - http://www.ncbi.nlm.nih.gov/pubmed/33835937 ID - info:doi/10.2196/24623 ER - TY - JOUR AU - Wang, Cuiyan AU - López-Núñez, Inmaculada María AU - Pan, Riyu AU - Wan, Xiaoyang AU - Tan, Yilin AU - Xu, Linkang AU - Choo, Faith AU - Ho, Roger AU - Ho, Cyrus AU - Aparicio García, E. Marta PY - 2021/5/21 TI - The Impact of the COVID-19 Pandemic on Physical and Mental Health in China and Spain: Cross-sectional Study JO - JMIR Form Res SP - e27818 VL - 5 IS - 5 KW - anxiety KW - China KW - coronavirus KW - COVID-19 KW - depression KW - developing countries KW - knowledge KW - masks KW - pandemic KW - physical KW - precaution KW - psychological impact KW - Spain KW - stress N2 - 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. UR - https://formative.jmir.org/2021/5/e27818 UR - http://dx.doi.org/10.2196/27818 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900933 ID - info:doi/10.2196/27818 ER - TY - JOUR AU - Stewart, H. Nancy AU - Koza, Anya AU - Dhaon, Serena AU - Shoushtari, Christiana AU - Martinez, Maylyn AU - Arora, M. Vineet PY - 2021/5/19 TI - Sleep Disturbances in Frontline Health Care Workers During the COVID-19 Pandemic: Social Media Survey Study JO - J Med Internet Res SP - e27331 VL - 23 IS - 5 KW - social media KW - sleep disorders KW - frontline health care workers KW - burnout KW - insomnia KW - sleep KW - health care worker KW - stress KW - survey KW - demographic KW - outcome KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2021/5/e27331 UR - http://dx.doi.org/10.2196/27331 UR - http://www.ncbi.nlm.nih.gov/pubmed/33875414 ID - info:doi/10.2196/27331 ER - TY - JOUR AU - Cui, Shu AU - Zhang, Chao AU - Wang, Shijiang AU - Zhang, Xingong AU - Wang, Lei AU - Zhang, Ling AU - Yuan, Qiuyu AU - Huang, Cui AU - Cheng, Fangshuo AU - Zhang, Kai AU - Zhou, Xiaoqin PY - 2021/5/19 TI - Experiences and Attitudes of Elementary School Students and Their Parents Toward Online Learning in China During the COVID-19 Pandemic: Questionnaire Study JO - J Med Internet Res SP - e24496 VL - 23 IS - 5 KW - attitude KW - elementary school students KW - parents KW - online learning KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2021/5/e24496 UR - http://dx.doi.org/10.2196/24496 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878022 ID - info:doi/10.2196/24496 ER - TY - JOUR AU - Fiol-DeRoque, Antònia Maria AU - Serrano-Ripoll, Jesús Maria AU - Jiménez, Rafael AU - Zamanillo-Campos, Rocío AU - Yáñez-Juan, María Aina AU - Bennasar-Veny, Miquel AU - Leiva, Alfonso AU - Gervilla, Elena AU - García-Buades, Esther M. AU - García-Toro, Mauro AU - Alonso-Coello, Pablo AU - Pastor-Moreno, Guadalupe AU - Ruiz-Pérez, Isabel AU - Sitges, Carolina AU - García-Campayo, Javier AU - Llobera-Cánaves, Joan AU - Ricci-Cabello, Ignacio PY - 2021/5/18 TI - A Mobile Phone?Based Intervention to Reduce Mental Health Problems in Health Care Workers During the COVID-19 Pandemic (PsyCovidApp): Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e27039 VL - 9 IS - 5 KW - COVID-19 KW - randomized controlled trial KW - mental health KW - health care workers KW - mHealth KW - app N2 - 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. UR - https://mhealth.jmir.org/2021/5/e27039 UR - http://dx.doi.org/10.2196/27039 UR - http://www.ncbi.nlm.nih.gov/pubmed/33909587 ID - info:doi/10.2196/27039 ER - TY - JOUR AU - Goodman-Casanova, Marian Jessica AU - Dura-Perez, Elena AU - Guerrero-Pertiñez, Gloria AU - Barnestein-Fonseca, Pilar AU - Guzman-Parra, Jose AU - Vega-Nuñez, Amanda AU - Varela-Moreno, Esperanza AU - Cuesta-Vargas, Antonio AU - Mayoral-Cleries, Fermin PY - 2021/5/18 TI - Cognitive Outcomes During COVID-19 Confinement Among Older People and Their Caregivers Using Technologies for Dementia: Protocol for an Observational Cohort Study JO - JMIR Res Protoc SP - e26431 VL - 10 IS - 5 KW - caregiver KW - cognition KW - cognitive impairment KW - cohort KW - COVID-19 KW - dementia KW - older people KW - informal caregivers KW - information and communications technologies KW - isolation KW - older adults KW - outcome KW - quality of life KW - social isolation KW - stress KW - technologies N2 - 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 UR - https://www.researchprotocols.org/2021/5/e26431 UR - http://dx.doi.org/10.2196/26431 UR - http://www.ncbi.nlm.nih.gov/pubmed/33909588 ID - info:doi/10.2196/26431 ER - TY - JOUR AU - Zou, Changqing AU - Zhang, Weiyu AU - Sznajder, Kristin AU - Yang, Fengzhi AU - Jia, Yajing AU - Ma, Ruqing AU - Cui, Can AU - Yang, Xiaoshi PY - 2021/5/17 TI - Factors Influencing Anxiety Among WeChat Users During the Early Stages of the COVID-19 Pandemic in Mainland China: Cross-sectional Survey Study JO - J Med Internet Res SP - e24412 VL - 23 IS - 5 KW - anxiety KW - COVID-19 KW - information seeking behavior KW - positive psychological response KW - health information KW - public health emergency KW - mental health KW - online survey KW - China KW - cross-sectional study N2 - 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. UR - https://www.jmir.org/2021/5/e24412 UR - http://dx.doi.org/10.2196/24412 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878025 ID - info:doi/10.2196/24412 ER - TY - JOUR AU - Xiao, Yunyu AU - Hinrichs, Rachel AU - Johnson, Nina AU - McKinley, Amanda AU - Carlson, Joan AU - Agley, Jon AU - Yip, Fai Paul Siu PY - 2021/5/17 TI - Suicide Prevention Among College Students Before and During the COVID-19 Pandemic: Protocol for a Systematic Review and Meta-analysis JO - JMIR Res Protoc SP - e26948 VL - 10 IS - 5 KW - suicide KW - suicidal prevention KW - college KW - university KW - health disparities KW - equity KW - suicidal ideation KW - suicide attempt KW - COVID-19 KW - college student KW - young adult KW - disparity KW - review N2 - 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 UR - https://www.researchprotocols.org/2021/5/e26948 UR - http://dx.doi.org/10.2196/26948 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878016 ID - info:doi/10.2196/26948 ER - TY - JOUR AU - Liu, Zhifen AU - Qiao, Dan AU - Xu, Yifan AU - Zhao, Wentao AU - Yang, Yang AU - Wen, Dan AU - Li, Xinrong AU - Nie, Xiaoping AU - Dong, Yongkang AU - Tang, Shiyou AU - Jiang, Yi AU - Wang, Ying AU - Zhao, Juan AU - Xu, Yong PY - 2021/5/14 TI - The Efficacy of Computerized Cognitive Behavioral Therapy for Depressive and Anxiety Symptoms in Patients With COVID-19: Randomized Controlled Trial JO - J Med Internet Res SP - e26883 VL - 23 IS - 5 KW - mental health KW - depression KW - anxiety KW - COVID-19 KW - treatment KW - cCBT KW - computerized cognitive behavioral therapy N2 - 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 UR - https://www.jmir.org/2021/5/e26883 UR - http://dx.doi.org/10.2196/26883 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900931 ID - info:doi/10.2196/26883 ER - TY - JOUR AU - Lai, Jocelyn AU - Rahmani, Amir AU - Yunusova, Asal AU - Rivera, P. Alexander AU - Labbaf, Sina AU - Hu, Sirui AU - Dutt, Nikil AU - Jain, Ramesh AU - Borelli, L. Jessica PY - 2021/5/11 TI - Using Multimodal Assessments to Capture Personalized Contexts of College Student Well-being in 2020: Case Study JO - JMIR Form Res SP - e26186 VL - 5 IS - 5 KW - COVID-19 KW - emerging adulthood KW - multimodal personal chronicles KW - case study KW - wearable internet of things KW - individualized mHealth KW - college students KW - mental health N2 - 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. UR - https://formative.jmir.org/2021/5/e26186 UR - http://dx.doi.org/10.2196/26186 UR - http://www.ncbi.nlm.nih.gov/pubmed/33882022 ID - info:doi/10.2196/26186 ER - TY - JOUR AU - Prioleau, Temiloluwa PY - 2021/5/11 TI - Learning From the Experiences of COVID-19 Survivors: Web-Based Survey Study JO - JMIR Form Res SP - e23009 VL - 5 IS - 5 KW - patient-reported outcomes KW - coronavirus KW - COVID-19 KW - outcome KW - crowdsourcing KW - social media KW - internet KW - survivor KW - experience N2 - 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. UR - https://formative.jmir.org/2021/5/e23009 UR - http://dx.doi.org/10.2196/23009 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878012 ID - info:doi/10.2196/23009 ER - TY - JOUR AU - Zhu, Shimin AU - Zhuang, Yanqiong AU - Lee, Paul AU - Li, Chi-Mei Jessica AU - Wong, C. Paul W. PY - 2021/5/7 TI - Leisure and Problem Gaming Behaviors Among Children and Adolescents During School Closures Caused by COVID-19 in Hong Kong: Quantitative Cross-sectional Survey Study JO - JMIR Serious Games SP - e26808 VL - 9 IS - 2 KW - COVID-19 KW - leisure gaming KW - excessive gaming KW - pathological gaming KW - familial factors KW - loneliness KW - COVID-19 lockdown KW - school closure N2 - 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. UR - https://games.jmir.org/2021/2/e26808 UR - http://dx.doi.org/10.2196/26808 UR - http://www.ncbi.nlm.nih.gov/pubmed/33960954 ID - info:doi/10.2196/26808 ER - TY - JOUR AU - Cosco, D. Theodore AU - Fortuna, Karen AU - Wister, Andrew AU - Riadi, Indira AU - Wagner, Kevin AU - Sixsmith, Andrew PY - 2021/5/6 TI - COVID-19, Social Isolation, and Mental Health Among Older Adults: A Digital Catch-22 JO - J Med Internet Res SP - e21864 VL - 23 IS - 5 KW - social isolation KW - mental health KW - COVID-19 KW - technology KW - older adult KW - psychology KW - digital health UR - https://www.jmir.org/2021/5/e21864 UR - http://dx.doi.org/10.2196/21864 UR - http://www.ncbi.nlm.nih.gov/pubmed/33891557 ID - info:doi/10.2196/21864 ER - TY - JOUR AU - Golden, A. Eddye AU - Zweig, Micol AU - Danieletto, Matteo AU - Landell, Kyle AU - Nadkarni, Girish AU - Bottinger, Erwin AU - Katz, Lindsay AU - Somarriba, Ricardo AU - Sharma, Vansh AU - Katz, L. Craig AU - Marin, B. Deborah AU - DePierro, Jonathan AU - Charney, S. Dennis PY - 2021/5/5 TI - A Resilience-Building App to Support the Mental Health of Health Care Workers in the COVID-19 Era: Design Process, Distribution, and Evaluation JO - JMIR Form Res SP - e26590 VL - 5 IS - 5 KW - mHealth KW - resilience KW - mental health KW - COVID-19 KW - HCWs KW - digital health KW - health app KW - mental health platform KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/5/e26590 UR - http://dx.doi.org/10.2196/26590 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872189 ID - info:doi/10.2196/26590 ER - TY - JOUR AU - Adikari, Achini AU - Nawaratne, Rashmika AU - De Silva, Daswin AU - Ranasinghe, Sajani AU - Alahakoon, Oshadi AU - Alahakoon, Damminda PY - 2021/4/30 TI - Emotions of COVID-19: Content Analysis of Self-Reported Information Using Artificial Intelligence JO - J Med Internet Res SP - e27341 VL - 23 IS - 4 KW - COVID-19 KW - pandemic KW - lockdown KW - human emotions KW - affective computing KW - human-centric artificial intelligence KW - artificial intelligence KW - AI KW - machine learning KW - natural language processing KW - language modeling KW - infodemiology KW - infoveillance N2 - 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. UR - https://www.jmir.org/2021/4/e27341 UR - http://dx.doi.org/10.2196/27341 UR - http://www.ncbi.nlm.nih.gov/pubmed/33819167 ID - info:doi/10.2196/27341 ER - TY - JOUR AU - Albright, Glenn AU - Khalid, Nikita AU - Shockley, Kristen AU - Robinson, Kelsey AU - Hughes, Kevin AU - Pace-Danley, Bethany PY - 2021/4/29 TI - Innovative Virtual Role Play Simulations for Managing Substance Use Conversations: Pilot Study Results and Relevance During and After COVID-19 JO - JMIR Form Res SP - e27164 VL - 5 IS - 4 KW - simulations KW - behavior change KW - motivational interviewing KW - virtual humans KW - role play KW - substance use KW - prevention KW - alcohol KW - public awareness KW - innovation KW - interview KW - COVID-19 KW - pilot study KW - simulation KW - communication KW - problem solving N2 - 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. UR - https://formative.jmir.org/2021/4/e27164 UR - http://dx.doi.org/10.2196/27164 UR - http://www.ncbi.nlm.nih.gov/pubmed/33848972 ID - info:doi/10.2196/27164 ER - TY - JOUR AU - Giesbrecht, F. Gerald AU - Bagshawe, Mercedes AU - van Sloten, Melinda AU - MacKinnon, L. Anna AU - Dhillon, Ashley AU - van de Wouw, Marcel AU - Vaghef-Mehrabany, Elnaz AU - Rojas, Laura AU - Cattani, Danielle AU - Lebel, Catherine AU - Tomfohr-Madsen, Lianne PY - 2021/4/28 TI - 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 JO - JMIR Res Protoc SP - e25407 VL - 10 IS - 4 KW - pregnancy KW - anxiety KW - depression KW - stress KW - social support KW - resilience KW - COVID-19 KW - infant development KW - pandemic N2 - 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 UR - https://www.researchprotocols.org/2021/4/e25407 UR - http://dx.doi.org/10.2196/25407 UR - http://www.ncbi.nlm.nih.gov/pubmed/33848971 ID - info:doi/10.2196/25407 ER - TY - JOUR AU - Zainel, Abdullatif Abduljaleel AU - Qotba, Hamda AU - Al-Maadeed, Alyaa AU - Al-Kohji, Sadriya AU - Al Mujalli, Hanan AU - Ali, Atif AU - Al Mannai, Lolwa AU - Aladab, Aisha AU - AlSaadi, Hamda AU - AlKarbi, Ali Khalid AU - Al-Baghdadi, Tholfakhar PY - 2021/4/27 TI - Psychological and Coping Strategies Related to Home Isolation and Social Distancing in Children and Adolescents During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Form Res SP - e24760 VL - 5 IS - 4 KW - COVID-19 KW - coronavirus KW - pandemic KW - psychological KW - coping strategies KW - children KW - adolescents KW - Qatar N2 - 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. UR - https://formative.jmir.org/2021/4/e24760 UR - http://dx.doi.org/10.2196/24760 UR - http://www.ncbi.nlm.nih.gov/pubmed/33851577 ID - info:doi/10.2196/24760 ER - TY - JOUR AU - Suruliraj, Banuchitra AU - Bessenyei, Kitti AU - Bagnell, Alexa AU - McGrath, Patrick AU - Wozney, Lori AU - Orji, Rita AU - Meier, Sandra PY - 2021/4/26 TI - Mobile Sensing Apps and Self-management of Mental Health During the COVID-19 Pandemic: Web-Based Survey JO - JMIR Form Res SP - e24180 VL - 5 IS - 4 KW - app KW - awareness KW - behavior KW - COVID-19 KW - helpfulness KW - mobile health KW - mobile sensing KW - self-management KW - sensing KW - web-based survey N2 - 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 (?=.24; 95% CI 0.16-0.33; P<.001), had a better understanding of technology (?=.17; 95% CI 0.08-0.25; P<.001), and had a higher education (?=.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. UR - https://formative.jmir.org/2021/4/e24180 UR - http://dx.doi.org/10.2196/24180 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872181 ID - info:doi/10.2196/24180 ER - TY - JOUR AU - Patel, I. Darpan AU - Gamez, Yazmin AU - Shah, Lajja AU - Patel, Jaini PY - 2021/4/22 TI - Decline of Psychological Health Following the Designation of COVID-19 as a Pandemic: Descriptive Study JO - J Med Internet Res SP - e24964 VL - 23 IS - 4 KW - anxiety KW - COVID-19 KW - descriptive study KW - mental health KW - pandemic KW - physical health KW - quality of life KW - stress N2 - 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. UR - https://www.jmir.org/2021/4/e24964 UR - http://dx.doi.org/10.2196/24964 UR - http://www.ncbi.nlm.nih.gov/pubmed/33793408 ID - info:doi/10.2196/24964 ER - TY - JOUR AU - Utunen, Heini AU - Van Kerkhove, D. Maria AU - Tokar, Anna AU - O'Connell, Gillian AU - Gamhewage, M. Gaya AU - Fall, Socé Ibrahima PY - 2021/4/21 TI - One Year of Pandemic Learning Response: Benefits of Massive Online Delivery of the World Health Organization?s Technical Guidance JO - JMIR Public Health Surveill SP - e28945 VL - 7 IS - 4 KW - COVID-19 KW - e-learning KW - massive open web-based courses KW - OpenWHO KW - pandemic KW - public health KW - web-based learning KW - World Health Organization UR - https://publichealth.jmir.org/2021/4/e28945 UR - http://dx.doi.org/10.2196/28945 UR - http://www.ncbi.nlm.nih.gov/pubmed/33881404 ID - info:doi/10.2196/28945 ER - TY - JOUR AU - Wang, Zhicheng AU - Lin, Leesa AU - Guo, Yan AU - Xiong, Huayi AU - Tang, Kun PY - 2021/4/20 TI - The Uncounted Casualties of a Hidden COVID-19 Epidemic in China: Cross-sectional Study on Deaths Related to Overwork JO - J Med Internet Res SP - e23311 VL - 23 IS - 4 KW - nonpharmaceutical interventions KW - on-duty deaths KW - COVID-19 KW - overwork death KW - crowdsourced data KW - intervention KW - mortality KW - casualty KW - cross-sectional KW - overwork KW - stress N2 - 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. UR - https://www.jmir.org/2021/4/e23311 UR - http://dx.doi.org/10.2196/23311 UR - http://www.ncbi.nlm.nih.gov/pubmed/33822735 ID - info:doi/10.2196/23311 ER - TY - JOUR AU - Jha, Prakash Indra AU - Awasthi, Raghav AU - Kumar, Ajit AU - Kumar, Vibhor AU - Sethi, Tavpritesh PY - 2021/4/20 TI - Learning the Mental Health Impact of COVID-19 in the United States With Explainable Artificial Intelligence: Observational Study JO - JMIR Ment Health SP - e25097 VL - 8 IS - 4 KW - COVID-19 KW - mental health KW - Bayesian network KW - machine learning KW - artificial intelligence KW - disorder KW - susceptibility KW - well-being KW - explainable artificial intelligence N2 - 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. UR - https://mental.jmir.org/2021/4/e25097 UR - http://dx.doi.org/10.2196/25097 UR - http://www.ncbi.nlm.nih.gov/pubmed/33877051 ID - info:doi/10.2196/25097 ER - TY - JOUR AU - Sorkin, H. Dara AU - Janio, A. Emily AU - Eikey, V. Elizabeth AU - Schneider, Margaret AU - Davis, Katelyn AU - Schueller, M. Stephen AU - Stadnick, A. Nicole AU - Zheng, Kai AU - Neary, Martha AU - Safani, David AU - Mukamel, B. Dana PY - 2021/4/16 TI - Rise in Use of Digital Mental Health Tools and Technologies in the United States During the COVID-19 Pandemic: Survey Study JO - J Med Internet Res SP - e26994 VL - 23 IS - 4 KW - COVID-19 KW - digital technologies KW - mHealth KW - mental health KW - anxiety KW - depression KW - MTurk KW - e-mental health KW - digital health KW - distress KW - self-management N2 - 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. UR - https://www.jmir.org/2021/4/e26994 UR - http://dx.doi.org/10.2196/26994 UR - http://www.ncbi.nlm.nih.gov/pubmed/33822737 ID - info:doi/10.2196/26994 ER - TY - JOUR AU - Guo, Ziqiu AU - Zhao, Zhi Sheng AU - Guo, Ningyuan AU - Wu, Yongda AU - Weng, Xue AU - Wong, Yuen-Ha Janet AU - Lam, Hing Tai AU - Wang, Ping Man PY - 2021/4/14 TI - Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study JO - J Med Internet Res SP - e24577 VL - 23 IS - 4 KW - COVID-19 KW - eHealth literacy KW - preventive behaviors KW - socioeconomic disparities KW - web-based information seeking N2 - 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. UR - https://www.jmir.org/2021/4/e24577 UR - http://dx.doi.org/10.2196/24577 UR - http://www.ncbi.nlm.nih.gov/pubmed/33784240 ID - info:doi/10.2196/24577 ER - TY - JOUR AU - Green, Jennifer AU - Huberty, Jennifer AU - Puzia, Megan AU - Stecher, Chad PY - 2021/4/13 TI - 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 JO - JMIR Ment Health SP - e28479 VL - 8 IS - 4 KW - coronavirus KW - health behavior KW - mindfulness meditation KW - mHealth KW - COVID-19 KW - mental health N2 - 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. UR - https://mental.jmir.org/2021/4/e28479 UR - http://dx.doi.org/10.2196/28479 UR - http://www.ncbi.nlm.nih.gov/pubmed/33788698 ID - info:doi/10.2196/28479 ER - TY - JOUR AU - Lebrasseur, Audrey AU - Fortin-Bédard, Noémie AU - Lettre, Josiane AU - Raymond, Emilie AU - Bussières, Eve-Line AU - Lapierre, Nolwenn AU - Faieta, Julie AU - Vincent, Claude AU - Duchesne, Louise AU - Ouellet, Marie-Christine AU - Gagnon, Eric AU - Tourigny, André AU - Lamontagne, Marie-Ève AU - Routhier, François PY - 2021/4/12 TI - Impact of the COVID-19 Pandemic on Older Adults: Rapid Review JO - JMIR Aging SP - e26474 VL - 4 IS - 2 KW - COVID-19 KW - impact KW - rapid review KW - older adults KW - aged individuals KW - review N2 - 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. UR - https://aging.jmir.org/2021/2/e26474 UR - http://dx.doi.org/10.2196/26474 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720839 ID - info:doi/10.2196/26474 ER - TY - JOUR AU - Calderaro, Cerqueira Débora AU - Kahlow, Stadler Barbara AU - Munhoz, Araújo Gabriela AU - Dias, Basualto Samuel Elias AU - Lopes, Ziroldo João Vitor AU - Borges, Rizzo Aline AU - Mariz, Ataíde Henrique De AU - Gomes, Poti Kirla Wagner AU - Valadares, Azevedo Lilian David De AU - Araújo, Costa Nafice AU - Ribeiro, Euzébio Sandra Lucia AU - Kakehasi, Maria Adriana AU - Reis, Gomides Ana Paula Monteiro AU - Marques, Cláudia AU - Reis-Neto, Torres Edgard AU - Paiva, Santos Eduardo Dos AU - Pileggi, Salviato Gecilmara AU - Ferreira, Aparecida Gilda AU - Provenza, Roberto José AU - Mota, Henrique Licia Maria AU - Xavier, Machado Ricardo AU - Teodoro, Martins Maycoln Leôni AU - Pinheiro, Medeiros Marcelo De AU - PY - 2021/4/9 TI - 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 JO - JMIR Res Protoc SP - e24617 VL - 10 IS - 4 KW - SARS-CoV-2 KW - COVID-19 KW - medical education KW - observational KW - cross-sectional KW - case-control study KW - voluntary KW - mental health KW - rheumatic disease KW - medical student KW - protocol KW - survey N2 - 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 UR - https://www.researchprotocols.org/2021/4/e24617 UR - http://dx.doi.org/10.2196/24617 UR - http://www.ncbi.nlm.nih.gov/pubmed/33735094 ID - info:doi/10.2196/24617 ER - TY - JOUR AU - Oyebode, Oladapo AU - Ndulue, Chinenye AU - Adib, Ashfaq AU - Mulchandani, Dinesh AU - Suruliraj, Banuchitra AU - Orji, Anulika Fidelia AU - Chambers, T. Christine AU - Meier, Sandra AU - Orji, Rita PY - 2021/4/6 TI - Health, Psychosocial, and Social Issues Emanating From the COVID-19 Pandemic Based on Social Media Comments: Text Mining and Thematic Analysis Approach JO - JMIR Med Inform SP - e22734 VL - 9 IS - 4 KW - social media KW - COVID-19 KW - coronavirus KW - infodemiology KW - infoveillance KW - natural language processing KW - text mining KW - thematic analysis KW - interventions KW - health issues KW - psychosocial issues KW - social issues N2 - 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. UR - https://medinform.jmir.org/2021/4/e22734 UR - http://dx.doi.org/10.2196/22734 UR - http://www.ncbi.nlm.nih.gov/pubmed/33684052 ID - info:doi/10.2196/22734 ER - TY - JOUR AU - Schück, Stéphane AU - Foulquié, Pierre AU - Mebarki, Adel AU - Faviez, Carole AU - Khadhar, Mickaïl AU - Texier, Nathalie AU - Katsahian, Sandrine AU - Burgun, Anita AU - Chen, Xiaoyi PY - 2021/4/5 TI - Concerns Discussed on Chinese and French Social Media During the COVID-19 Lockdown: Comparative Infodemiology Study Based on Topic Modeling JO - JMIR Form Res SP - e23593 VL - 5 IS - 4 KW - comparative analysis KW - content analysis KW - topic model KW - social media KW - COVID-19 KW - lockdown KW - China KW - France KW - impact KW - population N2 - 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. UR - https://formative.jmir.org/2021/4/e23593 UR - http://dx.doi.org/10.2196/23593 UR - http://www.ncbi.nlm.nih.gov/pubmed/33750736 ID - info:doi/10.2196/23593 ER - TY - JOUR AU - Bonner, Carissa AU - Cvejic, Erin AU - Ayre, Julie AU - Isautier, Jennifer AU - Semsarian, Christopher AU - Nickel, Brooke AU - Batcup, Carys AU - Pickles, Kristen AU - Dodd, Rachael AU - Cornell, Samuel AU - Copp, Tessa AU - McCaffery, J. Kirsten PY - 2021/3/30 TI - The Psychological Impact of Hypertension During COVID-19 Restrictions: Retrospective Case-Control Study JO - JMIRx Med SP - e25610 VL - 2 IS - 1 KW - public health KW - global health KW - COVID-19 KW - hypertension KW - risk KW - strategy KW - mental health KW - behavior KW - response KW - anxiety KW - vaccine KW - retrospective KW - perception KW - prevention KW - intention N2 - 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. UR - https://xmed.jmir.org/2021/1/e25610 UR - http://dx.doi.org/10.2196/25610 UR - http://www.ncbi.nlm.nih.gov/pubmed/34076628 ID - info:doi/10.2196/25610 ER - TY - JOUR AU - Balcombe, Luke AU - De Leo, Diego PY - 2021/3/29 TI - Digital Mental Health Challenges and the Horizon Ahead for Solutions JO - JMIR Ment Health SP - e26811 VL - 8 IS - 3 KW - challenges KW - COVID-19 KW - digital mental health implementation KW - explainable artificial intelligence KW - hybrid model of care KW - human-computer interaction KW - resilience KW - technology UR - https://mental.jmir.org/2021/3/e26811 UR - http://dx.doi.org/10.2196/26811 UR - http://www.ncbi.nlm.nih.gov/pubmed/33779570 ID - info:doi/10.2196/26811 ER - TY - JOUR AU - Daly, R. Jessica AU - Depp, Colin AU - Graham, A. Sarah AU - Jeste, V. Dilip AU - Kim, Ho-Cheol AU - Lee, E. Ellen AU - Nebeker, Camille PY - 2021/3/22 TI - Health Impacts of the Stay-at-Home Order on Community-Dwelling Older Adults and How Technologies May Help: Focus Group Study JO - JMIR Aging SP - e25779 VL - 4 IS - 1 KW - aging KW - quarantine KW - mental health KW - physical health KW - social isolation KW - COVID-19 pandemic KW - continued care senior housing community KW - CCSHC KW - qualitative research KW - videoconferencing KW - older adults KW - gerontechnology KW - loneliness KW - housing for the elderly KW - independent living N2 - 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. UR - https://aging.jmir.org/2021/1/e25779 UR - http://dx.doi.org/10.2196/25779 UR - http://www.ncbi.nlm.nih.gov/pubmed/33690146 ID - info:doi/10.2196/25779 ER - TY - JOUR AU - Shao, Ruosi AU - Shi, Zhen AU - Zhang, Di PY - 2021/3/16 TI - Social Media and Emotional Burnout Regulation During the COVID-19 Pandemic: Multilevel Approach JO - J Med Internet Res SP - e27015 VL - 23 IS - 3 KW - COVID-19 KW - pandemic KW - emotion regulation KW - emotional exhaustion KW - multilevel approach KW - well-being KW - emotion KW - mental health KW - social media KW - perspective KW - strategy KW - effective KW - modeling KW - buffer N2 - 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; ?=.24; P<.001) and interpersonal-level (B=0.35; ?=.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; ?=?.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. UR - https://www.jmir.org/2021/3/e27015 UR - http://dx.doi.org/10.2196/27015 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661753 ID - info:doi/10.2196/27015 ER - TY - JOUR AU - Lim, Julian AU - Leow, Zaven AU - Ong, Jason AU - Pang, Ly-Shan AU - Lim, Eric PY - 2021/3/15 TI - Effects of Web-Based Group Mindfulness Training on Stress and Sleep Quality in Singapore During the COVID-19 Pandemic: Retrospective Equivalence Analysis JO - JMIR Ment Health SP - e21757 VL - 8 IS - 3 KW - mindfulness KW - COVID-19 KW - videoconference KW - perceived stress KW - sleep quality KW - intervention KW - telehealth KW - mental health KW - psychology N2 - 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. UR - https://mental.jmir.org/2021/3/e21757 UR - http://dx.doi.org/10.2196/21757 UR - http://www.ncbi.nlm.nih.gov/pubmed/33482627 ID - info:doi/10.2196/21757 ER - TY - JOUR AU - Puspitasari, J. Ajeng AU - Heredia, Dagoberto AU - Coombes, J. Brandon AU - Geske, R. Jennifer AU - Gentry, T. Melanie AU - Moore, R. Wendy AU - Sawchuk, N. Craig AU - Schak, M. Kathryn PY - 2021/3/11 TI - 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 JO - JMIR Ment Health SP - e25542 VL - 8 IS - 3 KW - COVID-19 KW - teletherapy KW - intensive outpatient KW - serious mental illness KW - mental health KW - therapy KW - telemedicine KW - telehealth KW - feasibility KW - outcome KW - behavioral science KW - pilot KW - implementation KW - effective N2 - 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. UR - https://mental.jmir.org/2021/3/e25542 UR - http://dx.doi.org/10.2196/25542 UR - http://www.ncbi.nlm.nih.gov/pubmed/33651706 ID - info:doi/10.2196/25542 ER - TY - JOUR AU - Rauschenberg, Christian AU - Schick, Anita AU - Hirjak, Dusan AU - Seidler, Andreas AU - Paetzold, Isabell AU - Apfelbacher, Christian AU - Riedel-Heller, G. Steffi AU - Reininghaus, Ulrich PY - 2021/3/10 TI - Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review JO - J Med Internet Res SP - e23365 VL - 23 IS - 3 KW - COVID-19 KW - mHealth KW - eHealth KW - telemedicine KW - prevention KW - mental health promotion KW - intervention KW - digital mental health KW - digital intervention KW - public mental health N2 - 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. UR - https://www.jmir.org/2021/3/e23365 UR - http://dx.doi.org/10.2196/23365 UR - http://www.ncbi.nlm.nih.gov/pubmed/33606657 ID - info:doi/10.2196/23365 ER - TY - JOUR AU - Mansbach, E. William AU - Mace, A. Ryan AU - Tanner, A. Melissa PY - 2021/3/10 TI - A New Tool for Detecting COVID-19 Psychological Burden Among Postacute and Long-term Care Residents (Mood-5 Scale): Observational Study JO - JMIR Aging SP - e26340 VL - 4 IS - 1 KW - nursing homes KW - long-term care KW - COVID-19 KW - depression KW - stress KW - coping KW - burden KW - mental health KW - elderly KW - older adults KW - risk KW - telehealth KW - self-assessment KW - scale KW - mood N2 - 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 ?=.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. UR - https://aging.jmir.org/2021/1/e26340 UR - http://dx.doi.org/10.2196/26340 UR - http://www.ncbi.nlm.nih.gov/pubmed/33640866 ID - info:doi/10.2196/26340 ER - TY - JOUR AU - Mira, Joaquin Jose AU - Cobos, Angel AU - Martínez García, Olga AU - Bueno Domínguez, José María AU - Astier-Peña, Pilar María AU - Pérez Pérez, Pastora AU - Carrillo, Irene AU - Guilabert, Mercedes AU - Perez-Jover, Virtudes AU - Fernandez, Cesar AU - Vicente, Asuncion María AU - Lahera-Martin, Matilde AU - Silvestre Busto, Carmen AU - Lorenzo Martínez, Susana AU - Sanchez Martinez, Ascension AU - Martin-Delgado, Jimmy AU - Mula, Aurora AU - Marco-Gomez, Barbara AU - Abad Bouzan, Cristina AU - Aibar-Remon, Carlos AU - Aranaz-Andres, Jesus AU - PY - 2021/3/9 TI - An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study JO - JMIR Form Res SP - e27107 VL - 5 IS - 3 KW - SARS-CoV-2 virus KW - COVID-19 outbreak KW - medical staff KW - acute stress KW - moral injury KW - posttraumatic stress KW - COVID-19 N2 - 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 ? and McDonald ?. 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 ?). 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. UR - https://formative.jmir.org/2021/3/e27107 UR - http://dx.doi.org/10.2196/27107 UR - http://www.ncbi.nlm.nih.gov/pubmed/33687343 ID - info:doi/10.2196/27107 ER - TY - JOUR AU - Lewis, Matthew AU - Palmer, J. Victoria AU - Kotevski, Aneta AU - Densley, Konstancja AU - O'Donnell, L. Meaghan AU - Johnson, Caroline AU - Wohlgezogen, Franz AU - Gray, Kathleen AU - Robins-Browne, Kate AU - Burchill, Luke PY - 2021/3/9 TI - 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 JO - JMIR Res Protoc SP - e26168 VL - 10 IS - 3 KW - mental health KW - mobile applications KW - COVID-19 KW - health personnel KW - experience-based co-design KW - impact KW - evaluation KW - digital interventions KW - app KW - intervention KW - health care worker KW - design KW - delivery KW - support N2 - 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 UR - https://www.researchprotocols.org/2021/3/e26168 UR - http://dx.doi.org/10.2196/26168 UR - http://www.ncbi.nlm.nih.gov/pubmed/33635823 ID - info:doi/10.2196/26168 ER - TY - JOUR AU - Strudwick, Gillian AU - Sockalingam, Sanjeev AU - Kassam, Iman AU - Sequeira, Lydia AU - Bonato, Sarah AU - Youssef, Alaa AU - Mehta, Rohan AU - Green, Nadia AU - Agic, Branka AU - Soklaridis, Sophie AU - Impey, Danielle AU - Wiljer, David AU - Crawford, Allison PY - 2021/3/2 TI - Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review JO - JMIR Ment Health SP - e26550 VL - 8 IS - 3 KW - digital health KW - psychiatry KW - mental health KW - informatics KW - pandemic KW - COVID-19 KW - telemedicine KW - eHealth KW - public health KW - virtual care KW - mobile apps KW - population health N2 - 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. UR - https://mental.jmir.org/2021/3/e26550 UR - http://dx.doi.org/10.2196/26550 UR - http://www.ncbi.nlm.nih.gov/pubmed/33650985 ID - info:doi/10.2196/26550 ER - TY - JOUR AU - Yunusova, Asal AU - Lai, Jocelyn AU - Rivera, P. Alexander AU - Hu, Sirui AU - Labbaf, Sina AU - Rahmani, M. Amir AU - Dutt, Nikil AU - Jain, C. Ramesh AU - Borelli, L. Jessica PY - 2021/3/2 TI - Assessing the Mental Health of Emerging Adults Through a Mental Health App: Protocol for a Prospective Pilot Study JO - JMIR Res Protoc SP - e25775 VL - 10 IS - 3 KW - ecological momentary assessment KW - stress KW - digital mental health KW - college student KW - mental health KW - protocol KW - prospective KW - feasibility KW - individual KW - factors KW - sleepy KW - physiology KW - activity KW - COVID-19 N2 - 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 UR - https://www.researchprotocols.org/2021/3/e25775 UR - http://dx.doi.org/10.2196/25775 UR - http://www.ncbi.nlm.nih.gov/pubmed/33513124 ID - info:doi/10.2196/25775 ER - TY - JOUR AU - Jaworski, K. Beth AU - Taylor, Katherine AU - Ramsey, M. Kelly AU - Heinz, Adrienne AU - Steinmetz, Sarah AU - Pagano, Ian AU - Moraja, Giovanni AU - Owen, E. Jason PY - 2021/3/1 TI - Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data JO - J Med Internet Res SP - e26559 VL - 23 IS - 3 KW - COVID-19 KW - coronavirus KW - mobile app KW - mHealth KW - digital health KW - mental health KW - public mental health KW - stress KW - coping KW - public health KW - app N2 - 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. UR - https://www.jmir.org/2021/3/e26559 UR - http://dx.doi.org/10.2196/26559 UR - http://www.ncbi.nlm.nih.gov/pubmed/33606656 ID - info:doi/10.2196/26559 ER - TY - JOUR AU - Ortiz, Robin AU - Southwick, Lauren AU - Schneider, Rachelle AU - Klinger, V. Elissa AU - Pelullo, Arthur AU - Guntuku, Chandra Sharath AU - Merchant, M. Raina AU - Agarwal, K. Anish PY - 2021/2/26 TI - Improving Mood Through Community Connection and Resources Using an Interactive Digital Platform: Development and Usability Study JO - JMIR Ment Health SP - e25834 VL - 8 IS - 2 KW - community KW - COVID-19 KW - digital health KW - digital tool KW - mental health KW - mood KW - prospective KW - thematic analysis KW - virtual support KW - well-being N2 - 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. UR - https://mental.jmir.org/2021/2/e25834 UR - http://dx.doi.org/10.2196/25834 UR - http://www.ncbi.nlm.nih.gov/pubmed/33635280 ID - info:doi/10.2196/25834 ER - TY - JOUR AU - Yu, Yanqiu AU - She, Rui AU - Luo, Sitong AU - Xin, Meiqi AU - Li, Lijuan AU - Wang, Suhua AU - Ma, Le AU - Tao, Fangbiao AU - Zhang, Jianxin AU - Zhao, Junfeng AU - Li, Liping AU - Hu, Dongsheng AU - Zhang, Guohua AU - Gu, Jing AU - Lin, Danhua AU - Wang, Hongmei AU - Cai, Yong AU - Wang, Zhaofen AU - You, Hua AU - Hu, Guoqing AU - Lau, Tak-Fai Joseph PY - 2021/2/22 TI - Factors Influencing Depression and Mental Distress Related to COVID-19 Among University Students in China: Online Cross-sectional Mediation Study JO - JMIR Ment Health SP - e22705 VL - 8 IS - 2 KW - COVID-19 KW - depression KW - mental distress KW - psychological responses KW - mediation KW - China KW - online survey N2 - 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. UR - https://mental.jmir.org/2021/2/e22705 UR - http://dx.doi.org/10.2196/22705 UR - http://www.ncbi.nlm.nih.gov/pubmed/33616541 ID - info:doi/10.2196/22705 ER - TY - JOUR AU - Nishimura, Yoshito AU - Ochi, Kanako AU - Tokumasu, Kazuki AU - Obika, Mikako AU - Hagiya, Hideharu AU - Kataoka, Hitomi AU - Otsuka, Fumio PY - 2021/2/18 TI - Impact of the COVID-19 Pandemic on the Psychological Distress of Medical Students in Japan: Cross-sectional Survey Study JO - J Med Internet Res SP - e25232 VL - 23 IS - 2 KW - COVID-19 KW - online education KW - depression KW - pandemic KW - anxiety KW - medical student N2 - 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. UR - http://www.jmir.org/2021/2/e25232/ UR - http://dx.doi.org/10.2196/25232 UR - http://www.ncbi.nlm.nih.gov/pubmed/33556033 ID - info:doi/10.2196/25232 ER - TY - JOUR AU - Kaveladze, Benjamin AU - Chang, Katherine AU - Siev, Jedidiah AU - Schueller, M. Stephen PY - 2021/2/17 TI - Impact of the COVID-19 Pandemic on Online Obsessive-Compulsive Disorder Support Community Members: Survey Study JO - JMIR Ment Health SP - e26715 VL - 8 IS - 2 KW - obsessive-compulsive disorder KW - COVID-19 pandemic KW - online support communities KW - mental health N2 - 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. UR - http://mental.jmir.org/2021/2/e26715/ UR - http://dx.doi.org/10.2196/26715 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595449 ID - info:doi/10.2196/26715 ER - TY - JOUR AU - Mongkhon, Pajaree AU - Ruengorn, Chidchanok AU - Awiphan, Ratanaporn AU - Thavorn, Kednapa AU - Hutton, Brian AU - Wongpakaran, Nahathai AU - Wongpakaran, Tinakon AU - Nochaiwong, Surapon PY - 2021/2/12 TI - Exposure to COVID-19-Related Information and its Association With Mental Health Problems in Thailand: Nationwide, Cross-sectional Survey Study JO - J Med Internet Res SP - e25363 VL - 23 IS - 2 KW - coronavirus KW - COVID-19 KW - insomnia KW - mental health KW - social media KW - depression KW - anxiety KW - stress KW - psychosocial problem N2 - 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. UR - http://www.jmir.org/2021/2/e25363/ UR - http://dx.doi.org/10.2196/25363 UR - http://www.ncbi.nlm.nih.gov/pubmed/33523828 ID - info:doi/10.2196/25363 ER - TY - JOUR AU - Al-Alawi, Mohammed AU - McCall, K. Roopa AU - Sultan, Alya AU - Al Balushi, Naser AU - Al-Mahrouqi, Tamadhir AU - Al Ghailani, Abdullah AU - Al Sabti, Hilal AU - Al-Maniri, Abdullah AU - Panchatcharam, M. Sathiya AU - Al Sinawi, Hamed PY - 2021/2/12 TI - 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 JO - JMIR Ment Health SP - e26683 VL - 8 IS - 2 KW - COVID-19 KW - depression KW - anxiety KW - Oman KW - online therapy KW - randomized controlled trial KW - telehealth KW - therapy KW - mental health KW - e-mental health KW - self-help KW - distress N2 - 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 (?=?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 (?=?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 UR - http://mental.jmir.org/2021/2/e26683/ UR - http://dx.doi.org/10.2196/26683 UR - http://www.ncbi.nlm.nih.gov/pubmed/33512323 ID - info:doi/10.2196/26683 ER - TY - JOUR AU - Wang, Qian AU - Song, Bo AU - Di, Jiangli AU - Yang, Xue AU - Wu, Anise AU - Lau, Joseph AU - Xin, Meiqi AU - Wang, Linhong AU - Mo, Kit-Han Phoenix PY - 2021/2/11 TI - 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 JO - JMIR Ment Health SP - e24162 VL - 8 IS - 2 KW - pregnant women KW - COVID-19 KW - depression KW - anxiety KW - help-seeking KW - mental health services KW - social support KW - trust KW - intention KW - mental health KW - pregnancy KW - survey N2 - 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. UR - http://mental.jmir.org/2021/2/e24162/ UR - http://dx.doi.org/10.2196/24162 UR - http://www.ncbi.nlm.nih.gov/pubmed/33570500 ID - info:doi/10.2196/24162 ER - TY - JOUR AU - Liu, Guihua AU - Wang, Shuo AU - Liao, Jinhua AU - Ou, Ping AU - Huang, Longsheng AU - Xie, Namei AU - He, Yingshuang AU - Lin, Jinling AU - He, Hong-Gu AU - Hu, Rongfang PY - 2021/2/10 TI - 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 JO - JMIR Ment Health SP - e23917 VL - 8 IS - 2 KW - coronavirus disease 2019 KW - autism spectrum disorder KW - parenting training KW - psychological well-being KW - social media KW - WeChat KW - COVID-19 KW - autism KW - parenting KW - mental health KW - well-being KW - anxiety KW - depression KW - stress N2 - 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 UR - https://mental.jmir.org/2021/2/e23917 UR - http://dx.doi.org/10.2196/23917 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481751 ID - info:doi/10.2196/23917 ER - TY - JOUR AU - Lin, Yu-Hsuan AU - Chen, Chung-Yen AU - Wu, Shiow-Ing PY - 2021/2/10 TI - Efficiency and Quality of Data Collection Among Public Mental Health Surveys Conducted During the COVID-19 Pandemic: Systematic Review JO - J Med Internet Res SP - e25118 VL - 23 IS - 2 KW - COVID-19 KW - mental health KW - Newcastle-Ottawa Scale KW - review KW - data collection KW - survey KW - surveillance KW - literature KW - research N2 - 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. UR - http://www.jmir.org/2021/2/e25118/ UR - http://dx.doi.org/10.2196/25118 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481754 ID - info:doi/10.2196/25118 ER - TY - JOUR AU - Hull, D. Thomas AU - Levine, Jacob AU - Bantilan, Niels AU - Desai, N. Angel AU - Majumder, S. Maimuna PY - 2021/2/9 TI - Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages JO - JMIR Form Res SP - e26190 VL - 5 IS - 2 KW - digital phenotyping KW - COVID-19 KW - telehealth KW - digital mental health KW - natural language processing KW - machine learning KW - mental health KW - phenotyping KW - burden KW - treatment KW - symptom N2 - 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. UR - http://formative.jmir.org/2021/2/e26190/ UR - http://dx.doi.org/10.2196/26190 UR - http://www.ncbi.nlm.nih.gov/pubmed/33502999 ID - info:doi/10.2196/26190 ER - TY - JOUR AU - Boucher, M. Eliane AU - McNaughton, C. Emily AU - Harake, Nicole AU - Stafford, L. Julia AU - Parks, C. Acacia PY - 2021/2/8 TI - The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group JO - JMIR Ment Health SP - e26617 VL - 8 IS - 2 KW - loneliness KW - digital interventions KW - COVID-19 KW - qualitative research KW - perspective KW - impact KW - intervention KW - lonely KW - mental health KW - e-mental health KW - digital health KW - focus group N2 - 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. UR - http://mental.jmir.org/2021/2/e26617/ UR - http://dx.doi.org/10.2196/26617 UR - http://www.ncbi.nlm.nih.gov/pubmed/33498011 ID - info:doi/10.2196/26617 ER - TY - JOUR AU - Molfenter, Todd AU - Roget, Nancy AU - Chaple, Michael AU - Behlman, Stephanie AU - Cody, Olivia AU - Hartzler, Bryan AU - Johnson, Edward AU - Nichols, Maureen AU - Stilen, Patricia AU - Becker, Sara PY - 2021/2/8 TI - Use of Telehealth in Substance Use Disorder Services During and After COVID-19: Online Survey Study JO - JMIR Ment Health SP - e25835 VL - 8 IS - 2 KW - COVID-19 KW - substance use disorders KW - technology acceptance model KW - telehealth N2 - 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. UR - http://mental.jmir.org/2021/2/e25835/ UR - http://dx.doi.org/10.2196/25835 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481760 ID - info:doi/10.2196/25835 ER - TY - JOUR AU - Geronikolou, Styliani AU - Chrousos, George PY - 2021/2/3 TI - COVID-19?Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results JO - JMIR Form Res SP - e21156 VL - 5 IS - 2 KW - COVID-19 KW - social media KW - misinformation KW - infodemics KW - infodemiology KW - infoveillance KW - fear KW - meta-analysis N2 - 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. UR - https://formative.jmir.org/2021/2/e21156 UR - http://dx.doi.org/10.2196/21156 UR - http://www.ncbi.nlm.nih.gov/pubmed/33400681 ID - info:doi/10.2196/21156 ER - TY - JOUR AU - Wu, Xiaoyan AU - Tao, Shuman AU - Zhang, Yi AU - Li, Shiyue AU - Ma, Le AU - Yu, Yizhen AU - Sun, Guilong AU - Li, Tingting AU - Tao, Fangbiao PY - 2021/1/29 TI - Geographic Distribution of Mental Health Problems Among Chinese College Students During the COVID-19 Pandemic: Nationwide, Web-Based Survey Study JO - J Med Internet Res SP - e23126 VL - 23 IS - 1 KW - COVID-19 pandemic KW - college students KW - mental health problems KW - geographic location N2 - 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. UR - http://www.jmir.org/2021/1/e23126/ UR - http://dx.doi.org/10.2196/23126 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439853 ID - info:doi/10.2196/23126 ER - TY - JOUR AU - Nutley, K. Sara AU - Falise, M. Alyssa AU - Henderson, Rebecca AU - Apostolou, Vasiliki AU - Mathews, A. Carol AU - Striley, W. Catherine PY - 2021/1/27 TI - Impact of the COVID-19 Pandemic on Disordered Eating Behavior: Qualitative Analysis of Social Media Posts JO - JMIR Ment Health SP - e26011 VL - 8 IS - 1 KW - eating disorders KW - anorexia nervosa KW - binge eating disorder KW - COVID-19 KW - coronavirus KW - Reddit KW - social media KW - disorder KW - eating KW - qualitative KW - experience KW - mental health KW - theme N2 - 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. UR - http://mental.jmir.org/2021/1/e26011/ UR - http://dx.doi.org/10.2196/26011 UR - http://www.ncbi.nlm.nih.gov/pubmed/33465035 ID - info:doi/10.2196/26011 ER - TY - JOUR AU - Friis-Healy, A. Elsa AU - Nagy, A. Gabriela AU - Kollins, H. Scott PY - 2021/1/26 TI - It Is Time to REACT: Opportunities for Digital Mental Health Apps to Reduce Mental Health Disparities in Racially and Ethnically Minoritized Groups JO - JMIR Ment Health SP - e25456 VL - 8 IS - 1 KW - digital health KW - app KW - public mental health KW - health disparities KW - COVID-19 KW - pandemic KW - mental health KW - disparity KW - behavior UR - http://mental.jmir.org/2021/1/e25456/ UR - http://dx.doi.org/10.2196/25456 UR - http://www.ncbi.nlm.nih.gov/pubmed/33406050 ID - info:doi/10.2196/25456 ER - TY - JOUR AU - Yang, Xue AU - Song, Bo AU - Wu, Anise AU - Mo, H. Phoenix K. AU - Di, Jiangli AU - Wang, Qian AU - Lau, F. Joseph T. AU - Wang, Linhong PY - 2021/1/22 TI - 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 JO - J Med Internet Res SP - e24495 VL - 23 IS - 1 KW - eHealth KW - lockdown KW - quarantine KW - depression KW - anxiety KW - pregnant women N2 - 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 (?214=495.21; P<.05; comparative fit index=.99; nonnormed fit index=.98; root mean square error of approximation=.04, 90% CI 0.038-0.045) showed that quarantine was directly and indirectly strongly associated with poor mental health through decreased perceived social support and increased maladaptive cognition (B=.04; ?=.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; ?=.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. UR - http://www.jmir.org/2021/1/e24495/ UR - http://dx.doi.org/10.2196/24495 UR - http://www.ncbi.nlm.nih.gov/pubmed/33302251 ID - info:doi/10.2196/24495 ER - TY - JOUR AU - Tai, Yu-Lin AU - Chi, Hsin AU - Chiu, Nan-Chang AU - Tseng, Cheng-Yin AU - Huang, Ya-Ning AU - Lin, Chien-Yu PY - 2021/1/22 TI - 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 JO - JMIR Form Res SP - e21409 VL - 5 IS - 1 KW - coronavirus KW - COVID-19 KW - novel coronavirus KW - SARS-CoV-2 KW - mask KW - rationing KW - Taiwan KW - anxiety KW - mental health KW - observational KW - crisis KW - plan N2 - 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. UR - http://formative.jmir.org/2021/1/e21409/ UR - http://dx.doi.org/10.2196/21409 UR - http://www.ncbi.nlm.nih.gov/pubmed/33400678 ID - info:doi/10.2196/21409 ER - TY - JOUR AU - Ni, Jie AU - Wang, Fang AU - Liu, Yihai AU - Wu, Mingyue AU - Jiang, Yan AU - Zhou, Yujie AU - Sha, Dujuan PY - 2021/1/20 TI - Psychological Impact of the COVID-19 Pandemic on Chinese Health Care Workers: Cross-Sectional Survey Study JO - JMIR Ment Health SP - e23125 VL - 8 IS - 1 KW - 2019-nCoV KW - COVID-19 KW - frontline clinician KW - medical students KW - psychology N2 - 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. UR - http://mental.jmir.org/2021/1/e23125/ UR - http://dx.doi.org/10.2196/23125 UR - http://www.ncbi.nlm.nih.gov/pubmed/33341754 ID - info:doi/10.2196/23125 ER - TY - JOUR AU - Pinho, Lucena Rebeca Da Nóbrega AU - Costa, Ferreira Thais AU - Silva, Miranda Nayane AU - Barros-Areal, F. Adriana AU - Salles, Mattos André De AU - Oliveira, Pedrosa Andrea AU - Rassi, Carlos AU - Valero, Brero Caroline Elizabeth AU - Gomes, Martins Ciro AU - Mendonça-Silva, Dayde AU - Oliveira, Fernando AU - Jochims, Isadora AU - Ranulfo, Ivan AU - Neves, Seixas Juliana De Brito AU - Oliveira, Lucas AU - Dantas, Nogueira Maria AU - Rosal, Marta AU - Soares, Mayra AU - Kurizky, Patrícia AU - Peterle, Uliana Viviane AU - Faro, Furtado Yasmin AU - Gomides, Paula Ana AU - da Mota, Licia AU - Albuquerque, Cleandro AU - Simaan, Kozak Cezar AU - Amado, M. Veronica PY - 2021/1/19 TI - 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 JO - JMIR Res Protoc SP - e24298 VL - 10 IS - 1 KW - burnout syndrome KW - medical residency KW - multidisciplinary residency KW - COVID-19 KW - mental health KW - burnout KW - stress KW - anxiety KW - prospective KW - cohort KW - health care professional KW - medical student N2 - 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 UR - https://www.researchprotocols.org/2021/1/e24298 UR - http://dx.doi.org/10.2196/24298 UR - http://www.ncbi.nlm.nih.gov/pubmed/33290246 ID - info:doi/10.2196/24298 ER - TY - JOUR AU - Hummel, Svenja AU - Oetjen, Neele AU - Du, Junfeng AU - Posenato, Elisabetta AU - Resende de Almeida, Maria Rosa AU - Losada, Raquel AU - Ribeiro, Oscar AU - Frisardi, Vincenza AU - Hopper, Louise AU - Rashid, Asarnusch AU - Nasser, Habib AU - König, Alexandra AU - Rudofsky, Gottfried AU - Weidt, Steffi AU - Zafar, Ali AU - Gronewold, Nadine AU - Mayer, Gwendolyn AU - Schultz, Jobst-Hendrik PY - 2021/1/18 TI - Mental Health Among Medical Professionals During the COVID-19 Pandemic in Eight European Countries: Cross-sectional Survey Study JO - J Med Internet Res SP - e24983 VL - 23 IS - 1 KW - mental health KW - COVID-19 KW - Europe KW - medical professionals KW - stress KW - depression KW - anxiety KW - coping KW - stressors N2 - 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. UR - http://www.jmir.org/2021/1/e24983/ UR - http://dx.doi.org/10.2196/24983 UR - http://www.ncbi.nlm.nih.gov/pubmed/33411670 ID - info:doi/10.2196/24983 ER - TY - JOUR AU - Jiang, Hong AU - Jin, Longmei AU - Qian, Xu AU - Xiong, Xu AU - La, Xuena AU - Chen, Weiyi AU - Yang, Xiaoguang AU - Yang, Fengyun AU - Zhang, Xinwen AU - Abudukelimu, Nazhakaiti AU - Li, Xingying AU - Xie, Zhenyu AU - Zhu, Xiaoling AU - Zhang, Xiaohua AU - Zhang, Lifeng AU - Wang, Li AU - Li, Lingling AU - Li, Mu PY - 2021/1/18 TI - Maternal Mental Health Status and Approaches for Accessing Antenatal Care Information During the COVID-19 Epidemic in China: Cross-Sectional Study JO - J Med Internet Res SP - e18722 VL - 23 IS - 1 KW - COVID-19 KW - mental health KW - perceived stress KW - anxiety KW - depression KW - antenatal care information KW - social media platform KW - pregnancy KW - women N2 - 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. UR - http://www.jmir.org/2021/1/e18722/ UR - http://dx.doi.org/10.2196/18722 UR - http://www.ncbi.nlm.nih.gov/pubmed/33347423 ID - info:doi/10.2196/18722 ER - TY - JOUR AU - van Stekelenburg, Aart AU - Schaap, Gabi AU - Veling, Harm AU - Buijzen, Moniek PY - 2021/1/12 TI - Investigating and Improving the Accuracy of US Citizens? Beliefs About the COVID-19 Pandemic: Longitudinal Survey Study JO - J Med Internet Res SP - e24069 VL - 23 IS - 1 KW - infodemic KW - infodemiology KW - misinformation KW - COVID-19 pandemic KW - belief accuracy KW - boosting KW - trust in scientists KW - political orientation KW - media use N2 - 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. UR - http://www.jmir.org/2021/1/e24069/ UR - http://dx.doi.org/10.2196/24069 UR - http://www.ncbi.nlm.nih.gov/pubmed/33351776 ID - info:doi/10.2196/24069 ER - TY - JOUR AU - Kawakami, Norito AU - Sasaki, Natsu AU - Kuroda, Reiko AU - Tsuno, Kanami AU - Imamura, Kotaro PY - 2021/1/12 TI - The Effects of Downloading a Government-Issued COVID-19 Contact Tracing App on Psychological Distress During the Pandemic Among Employed Adults: Prospective Study JO - JMIR Ment Health SP - e23699 VL - 8 IS - 1 KW - coronavirus disease KW - digital contact tracing KW - mental health KW - working population KW - longitudinal study KW - COVID-19 KW - contact tracing KW - surveillance KW - tracking KW - anxiety KW - distress N2 - 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. UR - http://mental.jmir.org/2021/1/e23699/ UR - http://dx.doi.org/10.2196/23699 UR - http://www.ncbi.nlm.nih.gov/pubmed/33347424 ID - info:doi/10.2196/23699 ER - TY - JOUR AU - Sturgill, Ronda AU - Martinasek, Mary AU - Schmidt, Trine AU - Goyal, Raj PY - 2021/1/5 TI - A Novel Artificial Intelligence-Powered Emotional Intelligence and Mindfulness App (Ajivar) for the College Student Population During the COVID-19 Pandemic: Quantitative Questionnaire Study JO - JMIR Form Res SP - e25372 VL - 5 IS - 1 KW - mindfulness KW - COVID-19 KW - college students KW - emotional intelligence N2 - 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. UR - http://formative.jmir.org/2021/1/e25372/ UR - http://dx.doi.org/10.2196/25372 UR - http://www.ncbi.nlm.nih.gov/pubmed/33320822 ID - info:doi/10.2196/25372 ER - TY - JOUR AU - Zhong, Bu AU - Jiang, Zhibin AU - Xie, Wenjing AU - Qin, Xuebing PY - 2020/12/31 TI - Association of Social Media Use With Mental Health Conditions of Nonpatients During the COVID-19 Outbreak: Insights from a National Survey Study JO - J Med Internet Res SP - e23696 VL - 22 IS - 12 KW - COVID-19 KW - mental health KW - social media KW - health information support KW - secondary traumatic stress KW - vicarious trauma KW - social support N2 - 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 (?=.175; P<.001), anxiety (?=.224; P<.001), depression (?=.201; P<.001), STS (?=.307; P<.001), and VT (?=.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 (?=.165; P<.001) and emotional support (?=.144; P<.001) via social media increased their VT levels. Peer support received via social media increased both VT (?=.332; P<.001) and STS (?=.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. UR - https://www.jmir.org/2020/12/e23696 UR - http://dx.doi.org/10.2196/23696 UR - http://www.ncbi.nlm.nih.gov/pubmed/33302256 ID - info:doi/10.2196/23696 ER - TY - JOUR AU - Richardson, G. Chris AU - Slemon, Allie AU - Gadermann, Anne AU - McAuliffe, Corey AU - Thomson, Kimberly AU - Daly, Zachary AU - Salway, Travis AU - Currie, M. Leanne AU - David, Anita AU - Jenkins, Emily PY - 2020/12/30 TI - Use of Asynchronous Virtual Mental Health Resources for COVID-19 Pandemic?Related Stress Among the General Population in Canada: Cross-Sectional Survey Study JO - J Med Internet Res SP - e24868 VL - 22 IS - 12 KW - virtual health KW - digital health KW - virtual mental health KW - mental health KW - public health KW - COVID-19 KW - coping KW - stress KW - implementation KW - utilization N2 - 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. UR - http://www.jmir.org/2020/12/e24868/ UR - http://dx.doi.org/10.2196/24868 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315583 ID - info:doi/10.2196/24868 ER - TY - JOUR AU - Burnett, Dayle AU - Eapen, Valsamma AU - Lin, Ping-I PY - 2020/12/30 TI - Time Trends of the Public?s Attention Toward Suicide During the COVID-19 Pandemic: Retrospective, Longitudinal Time-Series Study JO - JMIR Public Health Surveill SP - e24694 VL - 6 IS - 4 KW - COVID-19 KW - suicide KW - infodemiology KW - infoveillance KW - Google Trends KW - time trend KW - school closure KW - attention KW - mental health KW - crisis KW - time series N2 - 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. UR - http://publichealth.jmir.org/2020/4/e24694/ UR - http://dx.doi.org/10.2196/24694 UR - http://www.ncbi.nlm.nih.gov/pubmed/33326407 ID - info:doi/10.2196/24694 ER - TY - JOUR AU - Pramukti, Iqbal AU - Strong, Carol AU - Sitthimongkol, Yajai AU - Setiawan, Agus AU - Pandin, Rumambo Moses Glorino AU - Yen, Cheng-Fang AU - Lin, Chung-Ying AU - Griffiths, D. Mark AU - Ko, Nai-Ying PY - 2020/12/24 TI - Anxiety and Suicidal Thoughts During the COVID-19 Pandemic: Cross-Country Comparative Study Among Indonesian, Taiwanese, and Thai University Students JO - J Med Internet Res SP - e24487 VL - 22 IS - 12 KW - anxiety KW - COVID-19 KW - cross-country KW - suicidal thoughts KW - university students N2 - 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. UR - http://www.jmir.org/2020/12/e24487/ UR - http://dx.doi.org/10.2196/24487 UR - http://www.ncbi.nlm.nih.gov/pubmed/33296867 ID - info:doi/10.2196/24487 ER - TY - JOUR AU - Cheng, Cecilia AU - Lau, Yan-Ching AU - Luk, W. Jeremy PY - 2020/12/24 TI - 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 JO - J Med Internet Res SP - e22740 VL - 22 IS - 12 KW - coping KW - coronavirus KW - COVID-19 KW - cyberaggression KW - cybervictimization KW - epidemic KW - gaming KW - mental health KW - psychological well-being KW - social networking KW - social support N2 - 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. UR - http://www.jmir.org/2020/12/e22740/ UR - http://dx.doi.org/10.2196/22740 UR - http://www.ncbi.nlm.nih.gov/pubmed/33320824 ID - info:doi/10.2196/22740 ER - TY - JOUR AU - Guinart, Daniel AU - Marcy, Patricia AU - Hauser, Marta AU - Dwyer, Michael AU - Kane, M. John PY - 2020/12/22 TI - Patient Attitudes Toward Telepsychiatry During the COVID-19 Pandemic: A Nationwide, Multisite Survey JO - JMIR Ment Health SP - e24761 VL - 7 IS - 12 KW - telehealth KW - telepsychiatry KW - telemedicine KW - attitude KW - patients KW - survey KW - COVID-19 KW - mental health N2 - 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. UR - http://mental.jmir.org/2020/12/e24761/ UR - http://dx.doi.org/10.2196/24761 UR - http://www.ncbi.nlm.nih.gov/pubmed/33302254 ID - info:doi/10.2196/24761 ER - TY - JOUR AU - Martinez-Martin, Nicole AU - Dasgupta, Ishan AU - Carter, Adrian AU - Chandler, A. Jennifer AU - Kellmeyer, Philipp AU - Kreitmair, Karola AU - Weiss, Anthony AU - Cabrera, Y. Laura PY - 2020/12/22 TI - Ethics of Digital Mental Health During COVID-19: Crisis and Opportunities JO - JMIR Ment Health SP - e23776 VL - 7 IS - 12 KW - ethics KW - digital mental health KW - neuroethics KW - mental health KW - COVID-19 KW - crisis KW - opportunity KW - implementation KW - online tool KW - telehealth UR - https://mental.jmir.org/2020/12/e23776 UR - http://dx.doi.org/10.2196/23776 UR - http://www.ncbi.nlm.nih.gov/pubmed/33156811 ID - info:doi/10.2196/23776 ER - TY - JOUR AU - Severe, Jennifer AU - Tang, Ruiqi AU - Horbatch, Faith AU - Onishchenko, Regina AU - Naini, Vidisha AU - Blazek, Carol Mary PY - 2020/12/22 TI - Factors Influencing Patients? Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey JO - JMIR Form Res SP - e25469 VL - 4 IS - 12 KW - telepsychiatry KW - COVID-19 KW - video visit KW - telephone visit KW - telehealth KW - mental health KW - United States KW - decision making KW - virtual care N2 - 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. UR - https://formative.jmir.org/2020/12/e25469 UR - http://dx.doi.org/10.2196/25469 UR - http://www.ncbi.nlm.nih.gov/pubmed/33320823 ID - info:doi/10.2196/25469 ER - TY - JOUR AU - Agyapong, Ouoku Vincent Israel AU - Hrabok, Marianne AU - Vuong, Wesley AU - Shalaby, Reham AU - Noble, Marie Jasmine AU - Gusnowski, April AU - Mrklas, J. Kelly AU - Li, Daniel AU - Urichuk, Liana AU - Snaterse, Mark AU - Surood, Shireen AU - Cao, Bo AU - Li, Xin-Min AU - Greiner, Russell AU - Greenshaw, James Andrew PY - 2020/12/18 TI - 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 JO - JMIR Ment Health SP - e22423 VL - 7 IS - 12 KW - COVID-19 KW - mobile technology KW - text KW - anxiety KW - depression KW - stress KW - outbreak KW - pandemic KW - mental health KW - outreach N2 - 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 UR - http://mental.jmir.org/2020/12/e22423/ UR - http://dx.doi.org/10.2196/22423 UR - http://www.ncbi.nlm.nih.gov/pubmed/33296330 ID - info:doi/10.2196/22423 ER - TY - JOUR AU - Alavi, Nazanin AU - Yang, Megan AU - Stephenson, Callum AU - Nikjoo, Niloofar AU - Malakouti, Niloufar AU - Layzell, Gina AU - Jagayat, Jasleen AU - Shirazi, Amirhossein AU - Groll, Dianne AU - Omrani, Mohsen AU - O'Riordan, Anne AU - Khalid-Khan, Sarosh AU - Freire, Rafael AU - Brietzke, Elisa AU - Gomes, Alves Fabiano AU - Milev, Roumen AU - Soares, N. Claudio PY - 2020/12/18 TI - 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 JO - JMIR Res Protoc SP - e24913 VL - 9 IS - 12 KW - mental health KW - COVID-19 KW - depression KW - anxiety KW - psychotherapy KW - cognitive behavioural therapy KW - online KW - internet KW - electronic KW - mental health care N2 - 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 UR - http://www.researchprotocols.org/2020/12/e24913/ UR - http://dx.doi.org/10.2196/24913 UR - http://www.ncbi.nlm.nih.gov/pubmed/33290245 ID - info:doi/10.2196/24913 ER - TY - JOUR AU - Pelletier, Jean-Francois AU - Houle, Janie AU - Goulet, Marie-Hélène AU - Juster, Robert-Paul AU - Giguère, Charles-Édouard AU - Bordet, Jonathan AU - Hénault, Isabelle AU - Lesage, Alain AU - De Benedictis, Luigi AU - Denis, Frédéric AU - Ng, Roger PY - 2020/12/18 TI - Online and Recovery-Oriented Support Groups Facilitated by Peer Support Workers in Times of COVID-19: Protocol for a Feasibility Pre-Post Study JO - JMIR Res Protoc SP - e22500 VL - 9 IS - 12 KW - peer support workers KW - internet-based peer support groups KW - personal-civic recovery KW - clinical recovery KW - COVID-19 Stress Scales KW - peer support KW - feasibility KW - mental health KW - COVID-19 KW - intervention KW - recovery N2 - 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 UR - http://www.researchprotocols.org/2020/12/e22500/ UR - http://dx.doi.org/10.2196/22500 UR - http://www.ncbi.nlm.nih.gov/pubmed/33259326 ID - info:doi/10.2196/22500 ER - TY - JOUR AU - Wang, Yilin AU - Wu, Peijing AU - Liu, Xiaoqian AU - Li, Sijia AU - Zhu, Tingshao AU - Zhao, Nan PY - 2020/12/17 TI - Subjective Well-Being of Chinese Sina Weibo Users in Residential Lockdown During the COVID-19 Pandemic: Machine Learning Analysis JO - J Med Internet Res SP - e24775 VL - 22 IS - 12 KW - COVID-19 KW - residential lockdown KW - subjective well-being KW - online ecological recognition N2 - 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. UR - http://www.jmir.org/2020/12/e24775/ UR - http://dx.doi.org/10.2196/24775 UR - http://www.ncbi.nlm.nih.gov/pubmed/33290247 ID - info:doi/10.2196/24775 ER - TY - JOUR AU - Kleiman, M. Evan AU - Yeager, L. April AU - Grove, L. Jeremy AU - Kellerman, K. John AU - Kim, S. Joanne PY - 2020/12/15 TI - Real-time Mental Health Impact of the COVID-19 Pandemic on College Students: Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e24815 VL - 7 IS - 12 KW - ecological momentary assessment KW - college students KW - COVID-19, anxiety KW - real-time KW - mental health KW - impact KW - student N2 - 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. UR - http://mental.jmir.org/2020/12/e24815/ UR - http://dx.doi.org/10.2196/24815 UR - http://www.ncbi.nlm.nih.gov/pubmed/33207308 ID - info:doi/10.2196/24815 ER - TY - JOUR AU - Ngoc Cong Duong, Khanh AU - Nguyen Le Bao, Tien AU - Thi Lan Nguyen, Phuong AU - Vo Van, Thanh AU - Phung Lam, Toi AU - Pham Gia, Anh AU - Anuratpanich, Luerat AU - Vo Van, Bay PY - 2020/12/15 TI - Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study JO - JMIR Form Res SP - e24776 VL - 4 IS - 12 KW - COVID-19 KW - mental health KW - psychological distress KW - depression KW - anxiety KW - Vietnam KW - psychology KW - distress KW - lockdown KW - survey N2 - 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. UR - http://formative.jmir.org/2020/12/e24776/ UR - http://dx.doi.org/10.2196/24776 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284778 ID - info:doi/10.2196/24776 ER - TY - JOUR AU - Adamou, Marios AU - Fullen, Tim AU - Galab, Nazmeen AU - Mackintosh, Isobel AU - Abbott, Karl AU - Lowe, Deborah AU - Smith, Claire PY - 2020/12/15 TI - Psychological Effects of the COVID-19 Imposed Lockdown on Adults with Attention Deficit/Hyperactivity Disorder: Cross-Sectional Survey Study JO - JMIR Form Res SP - e24430 VL - 4 IS - 12 KW - adult ADHD KW - pandemic KW - lockdown KW - COVID-19 KW - well-being KW - psychological KW - intervention KW - ADHD N2 - 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. UR - https://formative.jmir.org/2020/12/e24430 UR - http://dx.doi.org/10.2196/24430 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108312 ID - info:doi/10.2196/24430 ER - TY - JOUR AU - Davenport, A. Tracey AU - Cheng, Sze Vanessa Wan AU - Iorfino, Frank AU - Hamilton, Blake AU - Castaldi, Eva AU - Burton, Amy AU - Scott, M. Elizabeth AU - Hickie, B. Ian PY - 2020/12/15 TI - Flip the Clinic: A Digital Health Approach to Youth Mental Health Service Delivery During the COVID-19 Pandemic and Beyond JO - JMIR Ment Health SP - e24578 VL - 7 IS - 12 KW - health information technologies KW - clinical staging KW - youth KW - mental health KW - transdiagnostic KW - eHealth KW - routine outcome monitoring KW - adolescent KW - mental health services KW - health services KW - telemedicine KW - monitoring KW - outcome KW - young adult KW - COVID-19 UR - http://mental.jmir.org/2020/12/e24578/ UR - http://dx.doi.org/10.2196/24578 UR - http://www.ncbi.nlm.nih.gov/pubmed/33206051 ID - info:doi/10.2196/24578 ER - TY - JOUR AU - Valdez, Danny AU - ten Thij, Marijn AU - Bathina, Krishna AU - Rutter, A. Lauren AU - Bollen, Johan PY - 2020/12/14 TI - Social Media Insights Into US Mental Health During the COVID-19 Pandemic: Longitudinal Analysis of Twitter Data JO - J Med Internet Res SP - e21418 VL - 22 IS - 12 KW - social media KW - analytics KW - infodemiology KW - infoveillance KW - COVID-19 KW - United States KW - mental health KW - informatics KW - sentiment analysis KW - Twitter N2 - 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. UR - http://www.jmir.org/2020/12/e21418/ UR - http://dx.doi.org/10.2196/21418 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284783 ID - info:doi/10.2196/21418 ER - TY - JOUR AU - Balcombe, Luke AU - De Leo, Diego PY - 2020/12/14 TI - Psychological Screening and Tracking of Athletes and Digital Mental Health Solutions in a Hybrid Model of Care: Mini Review JO - JMIR Form Res SP - e22755 VL - 4 IS - 12 KW - athletes KW - screening KW - tracking KW - engagement KW - well-being KW - stress KW - adjustment KW - COVID-19 KW - hybrid model of care KW - digital mental health KW - machine learning KW - artificial intelligence N2 - 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. UR - http://formative.jmir.org/2020/12/e22755/ UR - http://dx.doi.org/10.2196/22755 UR - http://www.ncbi.nlm.nih.gov/pubmed/33271497 ID - info:doi/10.2196/22755 ER - TY - JOUR AU - Chiauzzi, Emil AU - Clayton, Ashley AU - Huh-Yoo, Jina PY - 2020/12/8 TI - Videoconferencing-Based Telemental Health: Important Questions for the COVID-19 Era From Clinical and Patient-Centered Perspectives JO - JMIR Ment Health SP - e24021 VL - 7 IS - 12 KW - telehealth KW - telemental health KW - COVID-19 KW - videoconferencing KW - ethics KW - privacy KW - mental health KW - psychotherapy KW - patient-centered KW - lived experience UR - http://mental.jmir.org/2020/12/e24021/ UR - http://dx.doi.org/10.2196/24021 UR - http://www.ncbi.nlm.nih.gov/pubmed/33180739 ID - info:doi/10.2196/24021 ER - TY - JOUR AU - Kubb, Christian AU - Foran, M. Heather PY - 2020/12/3 TI - Measuring COVID-19 Related Anxiety in Parents: Psychometric Comparison of Four Different Inventories JO - JMIR Ment Health SP - e24507 VL - 7 IS - 12 KW - COVID-19 KW - coronavirus KW - anxiety KW - parents KW - parenting KW - scale KW - inventory KW - well-being KW - mental health KW - stress N2 - 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 (?=.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. UR - https://mental.jmir.org/2020/12/e24507 UR - http://dx.doi.org/10.2196/24507 UR - http://www.ncbi.nlm.nih.gov/pubmed/33197233 ID - info:doi/10.2196/24507 ER - TY - JOUR AU - Pizzoli, Maria Silvia Francesca AU - Marzorati, Chiara AU - Mazzoni, Davide AU - Pravettoni, Gabriella PY - 2020/12/3 TI - Web-Based Relaxation Intervention for Stress During Social Isolation: Randomized Controlled Trial JO - JMIR Ment Health SP - e22757 VL - 7 IS - 12 KW - relaxation KW - guided meditation KW - web-based intervention KW - social isolation KW - intervention KW - COVID-19 KW - anxiety KW - stress KW - internet N2 - 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 UR - https://mental.jmir.org/2020/12/e22757 UR - http://dx.doi.org/10.2196/22757 UR - http://www.ncbi.nlm.nih.gov/pubmed/33200990 ID - info:doi/10.2196/22757 ER - TY - JOUR AU - Du, Junfeng AU - Mayer, Gwendolyn AU - Hummel, Svenja AU - Oetjen, Neele AU - Gronewold, Nadine AU - Zafar, Ali AU - Schultz, Jobst-Hendrik PY - 2020/12/2 TI - Mental Health Burden in Different Professions During the Final Stage of the COVID-19 Lockdown in China: Cross-sectional Survey Study JO - J Med Internet Res SP - e24240 VL - 22 IS - 12 KW - mental health KW - COVID-19 KW - China KW - depression KW - anxiety KW - lockdown KW - coping strategies KW - stressors KW - stress KW - doctors KW - nurses KW - students KW - media consumption KW - WeChat N2 - 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. UR - https://www.jmir.org/2020/12/e24240 UR - http://dx.doi.org/10.2196/24240 UR - http://www.ncbi.nlm.nih.gov/pubmed/33197231 ID - info:doi/10.2196/24240 ER - TY - JOUR AU - Sobowale, Kunmi AU - Hilliard, Heather AU - Ignaszewski, J. Martha AU - Chokroverty, Linda PY - 2020/12/1 TI - Real-Time Communication: Creating a Path to COVID-19 Public Health Activism in Adolescents Using Social Media JO - J Med Internet Res SP - e21886 VL - 22 IS - 12 KW - social media KW - digital health KW - COVID-19 KW - adolescent KW - public health KW - disaster KW - communication KW - affordances UR - https://www.jmir.org/2020/12/e21886 UR - http://dx.doi.org/10.2196/21886 UR - http://www.ncbi.nlm.nih.gov/pubmed/33226956 ID - info:doi/10.2196/21886 ER - TY - JOUR AU - Humer, Elke AU - Stippl, Peter AU - Pieh, Christoph AU - Pryss, Rüdiger AU - Probst, Thomas PY - 2020/11/27 TI - Experiences of Psychotherapists With Remote Psychotherapy During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study JO - J Med Internet Res SP - e20246 VL - 22 IS - 11 KW - psychotherapists KW - remote psychotherapy KW - telephone KW - internet KW - experiences KW - expectations KW - COVID-19 KW - telehealth KW - therapy KW - psychology N2 - 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. UR - http://www.jmir.org/2020/11/e20246/ UR - http://dx.doi.org/10.2196/20246 UR - http://www.ncbi.nlm.nih.gov/pubmed/33151896 ID - info:doi/10.2196/20246 ER - TY - JOUR AU - BinDhim, F. Nasser AU - Althumiri, A. Nora AU - Basyouni, H. Mada AU - Alageel, A. Asem AU - Alghnam, Suliman AU - Al-Qunaibet, M. Ada AU - Almubark, A. Rasha AU - Aldhukair, Shahla AU - Ad-Dab'bagh, Yasser PY - 2020/11/26 TI - A Mental Health Surveillance System for the General Population During the COVID-19 Pandemic: Protocol for a Multiwave Cross-sectional Survey Study JO - JMIR Res Protoc SP - e23748 VL - 9 IS - 11 KW - mental health KW - depression KW - anxiety KW - screening KW - surveillance KW - COVID-19 N2 - 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 UR - http://www.researchprotocols.org/2020/11/e23748/ UR - http://dx.doi.org/10.2196/23748 UR - http://www.ncbi.nlm.nih.gov/pubmed/33156802 ID - info:doi/10.2196/23748 ER - TY - JOUR AU - Saha, Koustuv AU - Torous, John AU - Caine, D. Eric AU - De Choudhury, Munmun PY - 2020/11/24 TI - Psychosocial Effects of the COVID-19 Pandemic: Large-scale Quasi-Experimental Study on Social Media JO - J Med Internet Res SP - e22600 VL - 22 IS - 11 KW - social media KW - Twitter KW - language KW - psychosocial effects KW - mental health KW - transfer learning KW - depression KW - anxiety KW - stress KW - social support KW - emotions KW - COVID-19 KW - coronavirus KW - crisis N2 - 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. UR - http://www.jmir.org/2020/11/e22600/ UR - http://dx.doi.org/10.2196/22600 UR - http://www.ncbi.nlm.nih.gov/pubmed/33156805 ID - info:doi/10.2196/22600 ER - TY - JOUR AU - Zhang, Boyu AU - Zaman, Anis AU - Silenzio, Vincent AU - Kautz, Henry AU - Hoque, Ehsan PY - 2020/11/23 TI - The Relationships of Deteriorating Depression and Anxiety With Longitudinal Behavioral Changes in Google and YouTube Use During COVID-19: Observational Study JO - JMIR Ment Health SP - e24012 VL - 7 IS - 11 KW - mental health KW - anxiety KW - depression KW - Google Search KW - YouTube KW - pandemic KW - COVID-19 N2 - 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. UR - http://mental.jmir.org/2020/11/e24012/ UR - http://dx.doi.org/10.2196/24012 UR - http://www.ncbi.nlm.nih.gov/pubmed/33180743 ID - info:doi/10.2196/24012 ER - TY - JOUR AU - Li, Mengyao AU - Liu, Li AU - Yang, Yilong AU - Wang, Yang AU - Yang, Xiaoshi AU - Wu, Hui PY - 2020/11/18 TI - Psychological Impact of Health Risk Communication and Social Media on College Students During the COVID-19 Pandemic: Cross-Sectional Study JO - J Med Internet Res SP - e20656 VL - 22 IS - 11 KW - COVID-19 KW - anxiety KW - panic KW - health risk KW - communication KW - social media N2 - 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. UR - http://www.jmir.org/2020/11/e20656/ UR - http://dx.doi.org/10.2196/20656 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108308 ID - info:doi/10.2196/20656 ER - TY - JOUR AU - Zhang, Lunbo AU - Yan, Ming AU - Takashima, Kaito AU - Guo, Wenru AU - Yamada, Yuki PY - 2020/11/18 TI - The Effect of the COVID-19 Pandemic on Health Care Workers? Anxiety Levels: Protocol for a Meta-Analysis JO - JMIR Res Protoc SP - e24136 VL - 9 IS - 11 KW - COVID-19 KW - health care worker KW - anxiety KW - meta-analysis KW - review KW - protocol KW - mental health KW - literature KW - bias N2 - 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 UR - http://www.researchprotocols.org/2020/11/e24136/ UR - http://dx.doi.org/10.2196/24136 UR - http://www.ncbi.nlm.nih.gov/pubmed/33170800 ID - info:doi/10.2196/24136 ER - TY - JOUR AU - Dominguez-Rodriguez, Alejandro AU - De La Rosa-Gómez, Anabel AU - Hernández Jiménez, Jesús M. AU - Arenas-Landgrave, Paulina AU - Martínez-Luna, Cristina Sofía AU - Alvarez Silva, Joabian AU - García Hernández, Ernesto José AU - Arzola-Sánchez, Carlos AU - Acosta Guzmán, Victoria PY - 2020/11/16 TI - A Self-Administered Multicomponent Web-Based Mental Health Intervention for the Mexican Population During the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e23117 VL - 9 IS - 11 KW - e-health KW - positive psychology KW - cognitive behavioral therapy, behavioral activation therapy, COVID-19 KW - internet KW - intervention KW - telepsychology, Mexican sample N2 - 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 (?) 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 UR - http://www.researchprotocols.org/2020/11/e23117/ UR - http://dx.doi.org/10.2196/23117 UR - http://www.ncbi.nlm.nih.gov/pubmed/33196449 ID - info:doi/10.2196/23117 ER - TY - JOUR AU - Turkington, Robin AU - Mulvenna, Maurice AU - Bond, Raymond AU - Ennis, Edel AU - Potts, Courtney AU - Moore, Ciaran AU - Hamra, Louise AU - Morrissey, Jacqui AU - Isaksen, Mette AU - Scowcroft, Elizabeth AU - O'Neill, Siobhan PY - 2020/11/6 TI - Behavior of Callers to a Crisis Helpline Before and During the COVID-19 Pandemic: Quantitative Data Analysis JO - JMIR Ment Health SP - e22984 VL - 7 IS - 11 KW - COVID-19 KW - coronavirus KW - pandemic KW - mental health KW - crisis helplines KW - machine learning KW - clustering KW - caller behavior N2 - 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. UR - http://mental.jmir.org/2020/11/e22984/ UR - http://dx.doi.org/10.2196/22984 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112759 ID - info:doi/10.2196/22984 ER - TY - JOUR AU - Xue, Jia AU - Chen, Junxiang AU - Chen, Chen AU - Hu, Ran AU - Zhu, Tingshao PY - 2020/11/6 TI - The Hidden Pandemic of Family Violence During COVID-19: Unsupervised Learning of Tweets JO - J Med Internet Res SP - e24361 VL - 22 IS - 11 KW - Twitter KW - family violence KW - COVID-19 KW - machine learning KW - big data KW - infodemiology KW - infoveillance N2 - 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. UR - http://www.jmir.org/2020/11/e24361/ UR - http://dx.doi.org/10.2196/24361 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108315 ID - info:doi/10.2196/24361 ER - TY - JOUR AU - Shah, Sarwar Syed Ghulam AU - Nogueras, David AU - van Woerden, Cornelis Hugo AU - Kiparoglou, Vasiliki PY - 2020/11/5 TI - The COVID-19 Pandemic: A Pandemic of Lockdown Loneliness and the Role of Digital Technology JO - J Med Internet Res SP - e22287 VL - 22 IS - 11 KW - COVID-19 KW - coronavirus KW - pandemic KW - social isolation KW - loneliness KW - lockdown KW - social distancing KW - digital technology KW - social connectedness KW - social networking KW - online digital tools UR - http://www.jmir.org/2020/11/e22287/ UR - http://dx.doi.org/10.2196/22287 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108313 ID - info:doi/10.2196/22287 ER - TY - JOUR AU - De Boni, Brandini Raquel AU - Balanzá-Martínez, Vicent AU - Mota, Correa Jurema AU - Cardoso, Azevedo Taiane De AU - Ballester, Pedro AU - Atienza-Carbonell, Beatriz AU - Bastos, I. Francisco AU - Kapczinski, Flavio PY - 2020/10/30 TI - Depression, Anxiety, and Lifestyle Among Essential Workers: A Web Survey From Brazil and Spain During the COVID-19 Pandemic JO - J Med Internet Res SP - e22835 VL - 22 IS - 10 KW - COVID-19 KW - depression KW - anxiety KW - lifestyle KW - Brazil KW - Spain N2 - 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. UR - http://www.jmir.org/2020/10/e22835/ UR - http://dx.doi.org/10.2196/22835 UR - http://www.ncbi.nlm.nih.gov/pubmed/33038075 ID - info:doi/10.2196/22835 ER - TY - JOUR AU - Hsu, Michael AU - Ahern, K. David AU - Suzuki, Joji PY - 2020/10/26 TI - Digital Phenotyping to Enhance Substance Use Treatment During the COVID-19 Pandemic JO - JMIR Ment Health SP - e21814 VL - 7 IS - 10 KW - digital phenotyping KW - digital psychiatry KW - addiction KW - psychiatry KW - coronavirus KW - COVID-19 KW - digital health KW - treatment KW - drugs KW - substance use disorder UR - http://mental.jmir.org/2020/10/e21814/ UR - http://dx.doi.org/10.2196/21814 UR - http://www.ncbi.nlm.nih.gov/pubmed/33031044 ID - info:doi/10.2196/21814 ER - TY - JOUR AU - Jewell, S. Jennifer AU - Farewell, V. Charlotte AU - Welton-Mitchell, Courtney AU - Lee-Winn, Angela AU - Walls, Jessica AU - Leiferman, A. Jenn PY - 2020/10/23 TI - Mental Health During the COVID-19 Pandemic in the United States: Online Survey JO - JMIR Form Res SP - e22043 VL - 4 IS - 10 KW - COVID-19 KW - mental health KW - pandemic KW - depression KW - anxiety KW - well-being KW - stress N2 - 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. UR - http://formative.jmir.org/2020/10/e22043/ UR - http://dx.doi.org/10.2196/22043 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006939 ID - info:doi/10.2196/22043 ER - TY - JOUR AU - Low, M. Daniel AU - Rumker, Laurie AU - Talkar, Tanya AU - Torous, John AU - Cecchi, Guillermo AU - Ghosh, S. Satrajit PY - 2020/10/12 TI - Natural Language Processing Reveals Vulnerable Mental Health Support Groups and Heightened Health Anxiety on Reddit During COVID-19: Observational Study JO - J Med Internet Res SP - e22635 VL - 22 IS - 10 KW - COVID-19 KW - mental health KW - psychiatry KW - infodemiology KW - infoveillance KW - infodemic KW - social media KW - Reddit KW - natural language processing KW - ADHD KW - eating disorders KW - anxiety KW - suicidality N2 - 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 (?=?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. UR - http://www.jmir.org/2020/10/e22635/ UR - http://dx.doi.org/10.2196/22635 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936777 ID - info:doi/10.2196/22635 ER - TY - JOUR AU - Stull, W. Samuel AU - McKnight, R. Erin AU - Bonny, E. Andrea PY - 2020/10/9 TI - Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward? JO - JMIR Pediatr Parent SP - e23463 VL - 3 IS - 2 KW - adolescent KW - opioid use disorder KW - treatment KW - telehealth KW - drug KW - perspective KW - opioid KW - COVID-19 KW - young adult UR - http://pediatrics.jmir.org/2020/2/e23463/ UR - http://dx.doi.org/10.2196/23463 UR - http://www.ncbi.nlm.nih.gov/pubmed/33016885 ID - info:doi/10.2196/23463 ER - TY - JOUR AU - Pan, Yihang AU - Xin, Meiqi AU - Zhang, Changhua AU - Dong, Willa AU - Fang, Yuan AU - Wu, Wenhui AU - Li, Mingzhe AU - Pang, Jun AU - Zheng, Zilong AU - Wang, Zixin AU - Yuan, Jinqiu AU - He, Yulong PY - 2020/10/8 TI - 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 JO - J Med Internet Res SP - e22596 VL - 22 IS - 10 KW - COVID-19 KW - information exposure KW - risk KW - communication KW - mental health KW - personal preventive measures KW - China KW - cross-sectional KW - public health KW - prevention N2 - 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. UR - http://www.jmir.org/2020/10/e22596/ UR - http://dx.doi.org/10.2196/22596 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936776 ID - info:doi/10.2196/22596 ER - TY - JOUR AU - Bierbooms, A. Joyce J. P. AU - van Haaren, Monique AU - IJsselsteijn, A. Wijnand AU - de Kort, W. Yvonne A. AU - Feijt, Milou AU - Bongers, B. Inge M. PY - 2020/10/8 TI - Integration of Online Treatment Into the ?New Normal? in Mental Health Care in Post?COVID-19 Times: Exploratory Qualitative Study JO - JMIR Form Res SP - e21344 VL - 4 IS - 10 KW - online treatment KW - sustainability KW - mental health care KW - COVID-19 N2 - 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. UR - http://formative.jmir.org/2020/10/e21344/ UR - http://dx.doi.org/10.2196/21344 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001835 ID - info:doi/10.2196/21344 ER - TY - JOUR AU - Serlachius, Anna AU - Schache, Kiralee AU - Boggiss, Anna AU - Lim, David AU - Wallace-Boyd, Kate AU - Brenton-Peters, Jennifer AU - Buttenshaw, Elise AU - Chadd, Stephanie AU - Cavadino, Alana AU - Cao, Nicholas AU - Morunga, Eva AU - Thabrew, Hiran PY - 2020/10/8 TI - Coping Skills Mobile App to Support the Emotional Well-Being of Young People During the COVID-19 Pandemic: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e23716 VL - 9 IS - 10 KW - COVID-19 KW - pandemic KW - mental health KW - mobile applications KW - apps KW - mHealth KW - coping skills KW - wellbeing KW - adolescent KW - young adult KW - coping N2 - Background: The COVID-19 pandemic is likely to increase anxiety and distress in young people worldwide. It is important to prioritize mental health during crisis events to mitigate the negative and often long-term effects of the crises on young people, families, and society. Mental health and well-being apps represent a scalable approach for improving psychological outcomes in young people and have potential to improve the equity of service access. Objective: The Whitu: 7 Ways in 7 Days well-being app was recently developed by our group to address the urgent need for innovative approaches to reach young New Zealanders who are struggling to cope with the COVID-19 pandemic. The aim of this study is twofold: to evaluate the acceptability of the prototype app and to examine the effectiveness of the refined app at improving mental and emotional well-being and reducing depression, anxiety, and stress in young people in New Zealand. Methods: A two-phase mixed methods study will be undertaken to achieve these aims. During the first phase, 20 young people aged 16-30 years (including those of M?ori and Pacific ethnicity) will participate in a qualitative study to help refine the prototype app. During the second phase, 90 young people aged 16-30 years will participate in a randomized waitlist-controlled trial (RCT) to evaluate the efficacy of the refined Whitu app at 4 weeks and 3 months after baseline. Outcomes will be evaluated using validated web-based questionnaires at baseline, 4 weeks, and 3 months. Results: The study received ethics approval in May 2020, and recruitment for the focus groups commenced in June 2020. Recruitment for the RCT is expected to commence in October 2020. Participants for both study phases will be recruited via social media and web-based communities. Data collection for the RCT is expected to be completed by January 2021, and analyses are expected to be completed by March 2021. Linear mixed modelling will be used to determine between-group differences in psychological outcomes. Conclusions: There is an urgent need to develop culturally appropriate, scalable mental health interventions to address the psychological consequences of the COVID-19 pandemic. In this study, we will develop and test an evidence-based well-being app that, if effective, can be made available to all young people in New Zealand and internationally. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12620000516987); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379597. International Registered Report Identifier (IRRID): PRR1-10.2196/23716 UR - https://www.researchprotocols.org/2020/10/e23716 UR - http://dx.doi.org/10.2196/23716 UR - http://www.ncbi.nlm.nih.gov/pubmed/32991303 ID - info:doi/10.2196/23716 ER - TY - JOUR AU - Deng, Cheng-Hu AU - Wang, Jing-Qiang AU - Zhu, Li-Ming AU - Liu, He-Wang AU - Guo, Yu AU - Peng, Xue-Hua AU - Shao, Jian-Bo AU - Xia, Wei PY - 2020/10/5 TI - Association of Web-Based Physical Education With Mental Health of College Students in Wuhan During the COVID-19 Outbreak: Cross-Sectional Survey Study JO - J Med Internet Res SP - e21301 VL - 22 IS - 10 KW - COVID-19 KW - college students KW - mental status KW - physical education KW - young adults KW - web-based education KW - global health KW - web-based survey KW - physical activity KW - mental health N2 - 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. UR - http://www.jmir.org/2020/10/e21301/ UR - http://dx.doi.org/10.2196/21301 UR - http://www.ncbi.nlm.nih.gov/pubmed/32997639 ID - info:doi/10.2196/21301 ER - TY - JOUR AU - Sasangohar, Farzan AU - Bradshaw, R. Major AU - Carlson, Millen Marianne AU - Flack, N. James AU - Fowler, C. James AU - Freeland, Diana AU - Head, John AU - Marder, Kate AU - Orme, William AU - Weinstein, Benjamin AU - Kolman, M. Jacob AU - Kash, Bita AU - Madan, Alok PY - 2020/10/1 TI - Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective JO - J Med Internet Res SP - e22523 VL - 22 IS - 10 KW - telemedicine KW - psychiatry KW - preventive psychiatry KW - SARS virus KW - pandemic KW - prevention KW - COVID-19 KW - telehealth KW - perspective UR - https://www.jmir.org/2020/10/e22523 UR - http://dx.doi.org/10.2196/22523 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936768 ID - info:doi/10.2196/22523 ER - TY - JOUR AU - Reilly, E. Shannon AU - Zane, L. Katherine AU - McCuddy, T. William AU - Soulliard, A. Zachary AU - Scarisbrick, M. David AU - Miller, E. Liv AU - Mahoney III, J. James PY - 2020/10/1 TI - Mental Health Practitioners? Immediate Practical Response During the COVID-19 Pandemic: Observational Questionnaire Study JO - JMIR Ment Health SP - e21237 VL - 7 IS - 9 KW - COVID-19 KW - clinical practice KW - tele?mental health KW - mental health KW - survey N2 - 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. UR - https://mental.jmir.org/2020/10/e21237/ UR - http://dx.doi.org/10.2196/21237 UR - http://www.ncbi.nlm.nih.gov/pubmed/32931440 ID - info:doi/10.2196/21237 ER - TY - JOUR AU - Tsai, Jiun-Yi AU - Phua, Joe AU - Pan, Shuya AU - Yang, Chia-chen PY - 2020/9/25 TI - 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 JO - J Med Internet Res SP - e22767 VL - 22 IS - 9 KW - COVID-19 KW - prejudice KW - news exposure KW - news trust KW - infodemic KW - media bias KW - racism KW - social media use KW - intergroup contact KW - regression KW - moderation analysis KW - cross-sectional survey N2 - 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 (?=.08, P=.02), had a personal infection history (?=.10, P=.004), and interacted with Asian people frequently in their daily lives (?=.46, P<.001) reported more negative attitudes toward Asians after controlling for sociodemographic variables. Relying more on traditional news media (?=.08, P=.04) and higher levels of trust in social media (?=.13, P=.007) were positively associated with prejudice against Asians. In contrast, consuming news from left-leaning outlets (?=?.15, P=.001) and neutral outlets (?=?.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. UR - http://www.jmir.org/2020/9/e22767/ UR - http://dx.doi.org/10.2196/22767 UR - http://www.ncbi.nlm.nih.gov/pubmed/32924948 ID - info:doi/10.2196/22767 ER - TY - JOUR AU - Liu, J. Jean C. AU - Tong, W. Eddie M. PY - 2020/9/25 TI - The Relation Between Official WhatsApp-Distributed COVID-19 News Exposure and Psychological Symptoms: Cross-Sectional Survey Study JO - J Med Internet Res SP - e22142 VL - 22 IS - 9 KW - mental health KW - social media KW - pandemic KW - depression KW - anxiety KW - stress KW - COVID-19 KW - app KW - risk factor KW - psychology N2 - 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 UR - http://www.jmir.org/2020/9/e22142/ UR - http://dx.doi.org/10.2196/22142 UR - http://www.ncbi.nlm.nih.gov/pubmed/32877349 ID - info:doi/10.2196/22142 ER - TY - JOUR AU - Mrklas, Kelly AU - Shalaby, Reham AU - Hrabok, Marianne AU - Gusnowski, April AU - Vuong, Wesley AU - Surood, Shireen AU - Urichuk, Liana AU - Li, Daniel AU - Li, Xin-Min AU - Greenshaw, James Andrew AU - Agyapong, Opoku Vincent Israel PY - 2020/9/25 TI - 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 JO - JMIR Ment Health SP - e22408 VL - 7 IS - 9 KW - health care worker KW - COVID-19 KW - pandemic KW - mental health KW - depression KW - anxiety KW - stress KW - obsessive compulsive N2 - 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 UR - http://mental.jmir.org/2020/9/e22408/ UR - http://dx.doi.org/10.2196/22408 UR - http://www.ncbi.nlm.nih.gov/pubmed/32915764 ID - info:doi/10.2196/22408 ER - TY - JOUR AU - Clavier, Thomas AU - Popoff, Benjamin AU - Selim, Jean AU - Beuzelin, Marion AU - Roussel, Melanie AU - Compere, Vincent AU - Veber, Benoit AU - Besnier, Emmanuel PY - 2020/9/24 TI - 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 JO - JMIR Mhealth Uhealth SP - e23153 VL - 8 IS - 9 KW - social network KW - nurse KW - physician KW - anxiety KW - emergency medicine, anesthesiology, critical care medicine KW - coronavirus disease 2019 KW - mental health KW - COVID-19 N2 - 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. UR - http://mhealth.jmir.org/2020/9/e23153/ UR - http://dx.doi.org/10.2196/23153 UR - http://www.ncbi.nlm.nih.gov/pubmed/32924946 ID - info:doi/10.2196/23153 ER - TY - JOUR AU - Lin, Yu-Hsuan AU - Chiang, Ting-Wei AU - Lin, Yu-Lun PY - 2020/9/21 TI - Increased Internet Searches for Insomnia as an Indicator of Global Mental Health During the COVID-19 Pandemic: Multinational Longitudinal Study JO - J Med Internet Res SP - e22181 VL - 22 IS - 9 KW - internet search KW - Google Trends KW - infodemiology KW - infoveillance KW - COVID-19 KW - insomnia KW - mental health N2 - 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 (?=0.64, P=.003). By contrast, there was no significant correlation between the number of deaths and increases in searches for depression (?=?0.12, P=.63) or suicide (?=?0.07, P=.79). Conclusions: Our analysis suggests that insomnia could be a part of routine mental health screening during the COVID-19 pandemic. UR - http://www.jmir.org/2020/9/e22181/ UR - http://dx.doi.org/10.2196/22181 UR - http://www.ncbi.nlm.nih.gov/pubmed/32924951 ID - info:doi/10.2196/22181 ER - TY - JOUR AU - Huang, Huaping AU - Zhao, Wen-Jun AU - Li, Gui-Rong PY - 2020/9/18 TI - Knowledge and Psychological Stress Related to COVID-19 Among Nursing Staff in a Hospital in China: Cross-Sectional Survey Study JO - JMIR Form Res SP - e20606 VL - 4 IS - 9 KW - COVID-19 KW - nursing staff KW - knowledge KW - psychological stress N2 - 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. UR - https://formative.jmir.org/2020/9/e20606 UR - http://dx.doi.org/10.2196/20606 UR - http://www.ncbi.nlm.nih.gov/pubmed/32640419 ID - info:doi/10.2196/20606 ER - TY - JOUR AU - Ramtekkar, Ujjwal AU - Bridge, A. Jeffrey AU - Thomas, Glenn AU - Butter, Eric AU - Reese, Jennifer AU - Logan, Erica AU - Lin, Simon AU - Axelson, David PY - 2020/9/18 TI - Pediatric Telebehavioral Health: A Transformational Shift in Care Delivery in the Era of COVID-19 JO - JMIR Ment Health SP - e20157 VL - 7 IS - 9 KW - telepsychiatry KW - telebehavioral health KW - child and adolescent psychiatry KW - COVID-19 UR - https://mental.jmir.org/2020/9/e20157 UR - http://dx.doi.org/10.2196/20157 UR - http://www.ncbi.nlm.nih.gov/pubmed/32525485 ID - info:doi/10.2196/20157 ER - TY - JOUR AU - Singh, Parvati AU - Cumberland, G. William AU - Ugarte, Dominic AU - Bruckner, Tim-Allen AU - Young, D. Sean PY - 2020/9/10 TI - Association Between Generalized Anxiety Disorder Scores and Online Activity Among US Adults During the COVID-19 Pandemic: Cross-Sectional Analysis JO - J Med Internet Res SP - e21490 VL - 22 IS - 9 KW - online activity KW - COVID-19 KW - anxiety KW - generalized anxiety disorder KW - GAD KW - scores KW - stress KW - internet KW - survey KW - cross-sectional N2 - 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. UR - http://www.jmir.org/2020/9/e21490/ UR - http://dx.doi.org/10.2196/21490 UR - http://www.ncbi.nlm.nih.gov/pubmed/32841152 ID - info:doi/10.2196/21490 ER - TY - JOUR AU - Chivers, R. Bonnie AU - Garad, M. Rhonda AU - Boyle, A. Jacqueline AU - Skouteris, Helen AU - Teede, J. Helena AU - Harrison, L. Cheryce PY - 2020/9/7 TI - Perinatal Distress During COVID-19: Thematic Analysis of an Online Parenting Forum JO - J Med Internet Res SP - e22002 VL - 22 IS - 9 KW - pregnancy KW - perinatal KW - maternal KW - COVID-19 KW - communication KW - social support KW - qualitative research KW - mental health KW - health information KW - online support KW - thematic analysis KW - sentiment analysis KW - word frequency N2 - 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. UR - http://www.jmir.org/2020/9/e22002/ UR - http://dx.doi.org/10.2196/22002 UR - http://www.ncbi.nlm.nih.gov/pubmed/32857707 ID - info:doi/10.2196/22002 ER - TY - JOUR AU - Son, Changwon AU - Hegde, Sudeep AU - Smith, Alec AU - Wang, Xiaomei AU - Sasangohar, Farzan PY - 2020/9/3 TI - Effects of COVID-19 on College Students? Mental Health in the United States: Interview Survey Study JO - J Med Internet Res SP - e21279 VL - 22 IS - 9 KW - COVID-19 KW - pandemic KW - college student KW - mental health KW - stress KW - anxiety KW - self-management N2 - 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. UR - https://www.jmir.org/2020/9/e21279 UR - http://dx.doi.org/10.2196/21279 UR - http://www.ncbi.nlm.nih.gov/pubmed/32805704 ID - info:doi/10.2196/21279 ER - TY - JOUR AU - Jain, Nikhil AU - Jayaram, Mahesh PY - 2020/8/21 TI - Comment on "Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow" JO - JMIR Ment Health SP - e23023 VL - 7 IS - 8 KW - telepsychiatry KW - COVID-19 KW - Australia UR - https://mental.jmir.org/2020/8/e23023 UR - http://dx.doi.org/10.2196/23023 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750003 ID - info:doi/10.2196/23023 ER - TY - JOUR AU - Zhang, Melvyn AU - Smith, Elizabeth Helen PY - 2020/8/21 TI - Digital Tools to Ameliorate Psychological Symptoms Associated With COVID-19: Scoping Review JO - J Med Internet Res SP - e19706 VL - 22 IS - 8 KW - COVID-19 KW - digital tool KW - psychiatry KW - mental health KW - digital health KW - psychology KW - distress KW - stress KW - anxiety KW - depression N2 - 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. UR - http://www.jmir.org/2020/8/e19706/ UR - http://dx.doi.org/10.2196/19706 UR - http://www.ncbi.nlm.nih.gov/pubmed/32721922 ID - info:doi/10.2196/19706 ER - TY - JOUR AU - Li, Guanjian AU - Tang, Dongdong AU - Song, Bing AU - Wang, Chao AU - Qunshan, Shen AU - Xu, Chuan AU - Geng, Hao AU - Wu, Huan AU - He, Xiaojin AU - Cao, Yunxia PY - 2020/8/6 TI - Impact of the COVID-19 Pandemic on Partner Relationships and Sexual and Reproductive Health: Cross-Sectional, Online Survey Study JO - J Med Internet Res SP - e20961 VL - 22 IS - 8 KW - COVID-19 KW - survey KW - novel coronavirus KW - sexual behavior KW - sexual health KW - reproductive health KW - young adults KW - youth KW - China N2 - 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. UR - https://www.jmir.org/2020/8/e20961 UR - http://dx.doi.org/10.2196/20961 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716895 ID - info:doi/10.2196/20961 ER - TY - JOUR AU - Pahayahay, Amber AU - Khalili-Mahani, Najmeh PY - 2020/8/6 TI - 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 JO - J Med Internet Res SP - e20186 VL - 22 IS - 8 KW - Netflix KW - social network KW - stress KW - COVID-19 KW - information and communication technologies KW - survey KW - media KW - coping KW - infodemic KW - infodemiology N2 - 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 (?23=11.76, P=.008), television (?23=12.40, P=.006), YouTube (?23=8.577, P=.04), and streaming services such as Netflix (?23=10.71, P=.01). Respondents who considered their mental health ?not good? were twice as likely to prefer streaming services as a coping tool for self-isolation. Women and nonbinary respondents were twice as likely than men to pick social media for coping. Individuals younger than 35 years were 3 times more likely to pick computer games, and individuals older than 55 years were more likely to pick network television or print media. Gender affected the appraisal of media (less in men than others) in terms of avoid (F1,637=5.84, P=.02) and approach scores (F1,637=14.31, P<.001). Subjective mental health affected the ignore score (less in those who said ?good? than others; F1,637=13.88, P<.001). The appraisal score and use increase explained variations in worrying about physical and mental health stress due to increased screen time. A qualitative analysis of open-ended questions revealed that media (especially social networks) were important for coping if they provided support and connection through the dissemination of factual and positive information while avoiding the overflow of sensational and false news. Conclusions: The relationship between appraisal of media?s positive and negative facets vary with demographic differences in mental health resiliency. The media repertoire approach is an important tool in studies that focus on assessing the benefits and harms of screen overuse in different populations, especially in the context of the COVID-19 pandemic. UR - https://www.jmir.org/2020/8/e20186 UR - http://dx.doi.org/10.2196/20186 UR - http://www.ncbi.nlm.nih.gov/pubmed/32701459 ID - info:doi/10.2196/20186 ER - TY - JOUR AU - Fortuna, L. Karen AU - Myers, L. Amanda AU - Walsh, Danielle AU - Walker, Robert AU - Mois, George AU - Brooks, M. Jessica PY - 2020/7/23 TI - Strategies to Increase Peer Support Specialists? Capacity to Use Digital Technology in the Era of COVID-19: Pre-Post Study JO - JMIR Ment Health SP - e20429 VL - 7 IS - 7 KW - COVID-19 KW - peer support KW - telemental health KW - mental health KW - training N2 - 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. UR - http://mental.jmir.org/2020/7/e20429/ UR - http://dx.doi.org/10.2196/20429 UR - http://www.ncbi.nlm.nih.gov/pubmed/32629424 ID - info:doi/10.2196/20429 ER - TY - JOUR AU - Balcombe, Luke AU - De Leo, Diego PY - 2020/7/22 TI - An Integrated Blueprint for Digital Mental Health Services Amidst COVID-19 JO - JMIR Ment Health SP - e21718 VL - 7 IS - 7 KW - digital mental health KW - mental well-being online assessments KW - machine learning KW - automation KW - COVID-19 KW - well-being services UR - https://mental.jmir.org/2020/7/e21718 UR - http://dx.doi.org/10.2196/21718 UR - http://www.ncbi.nlm.nih.gov/pubmed/32668402 ID - info:doi/10.2196/21718 ER - TY - JOUR AU - Inkster, Becky AU - O?Brien, Ross AU - Selby, Emma AU - Joshi, Smriti AU - Subramanian, Vinod AU - Kadaba, Madhura AU - Schroeder, Knut AU - Godson, Suzi AU - Comley, Kerstyn AU - Vollmer, J. Sebastian AU - Mateen, A. Bilal PY - 2020/7/6 TI - Digital Health Management During and Beyond the COVID-19 Pandemic: Opportunities, Barriers, and Recommendations JO - JMIR Ment Health SP - e19246 VL - 7 IS - 7 KW - digital mental health KW - call to action KW - due diligence KW - data insights KW - COVID-19 UR - https://mental.jmir.org/2020/7/e19246 UR - http://dx.doi.org/10.2196/19246 UR - http://www.ncbi.nlm.nih.gov/pubmed/32484783 ID - info:doi/10.2196/19246 ER - TY - JOUR AU - van Agteren, Joep AU - Bartholomaeus, Jonathan AU - Fassnacht, B. Daniel AU - Iasiello, Matthew AU - Ali, Kathina AU - Lo, Laura AU - Kyrios, Michael PY - 2020/6/11 TI - Using Internet-Based Psychological Measurement to Capture the Deteriorating Community Mental Health Profile During COVID-19: Observational Study JO - JMIR Ment Health SP - e20696 VL - 7 IS - 6 KW - psychological measurement KW - positive mental health KW - resilience KW - mental health KW - psychological distress KW - internet KW - COVID-19 KW - pandemic N2 - 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. UR - http://mental.jmir.org/2020/6/e20696/ UR - http://dx.doi.org/10.2196/20696 UR - http://www.ncbi.nlm.nih.gov/pubmed/32490845 ID - info:doi/10.2196/20696 ER - TY - JOUR AU - Jacobson, C. Nicholas AU - Lekkas, Damien AU - Price, George AU - Heinz, V. Michael AU - Song, Minkeun AU - O?Malley, James A. AU - Barr, J. Paul PY - 2020/6/1 TI - Flattening the Mental Health Curve: COVID-19 Stay-at-Home Orders Are Associated With Alterations in Mental Health Search Behavior in the United States JO - JMIR Ment Health SP - e19347 VL - 7 IS - 6 KW - COVID-19 KW - coronavirus KW - stay-at-home orders KW - mental health KW - suicide KW - anxiety KW - infodemiology KW - infoveillance KW - search trends KW - health information needs N2 - 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. UR - https://mental.jmir.org/2020/6/e19347 UR - http://dx.doi.org/10.2196/19347 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459186 ID - info:doi/10.2196/19347 ER - TY - JOUR AU - Ni, Y. Michael AU - Yang, Lin AU - Leung, C. Candi M. AU - Li, Na AU - Yao, I. Xiaoxin AU - Wang, Yishan AU - Leung, M. Gabriel AU - Cowling, J. Benjamin AU - Liao, Qiuyan PY - 2020/5/12 TI - 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 JO - JMIR Ment Health SP - e19009 VL - 7 IS - 5 KW - COVID-19 KW - nonpharmaceutical interventions KW - population mental health KW - depression KW - anxiety KW - community KW - health professionals KW - social media KW - WeChat KW - pandemic KW - outbreak KW - public health KW - mental health KW - intervention N2 - 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. UR - https://mental.jmir.org/2020/5/e19009 UR - http://dx.doi.org/10.2196/19009 UR - http://www.ncbi.nlm.nih.gov/pubmed/32365044 ID - info:doi/10.2196/19009 ER - TY - JOUR AU - Whelan, Pauline AU - Stockton-Powdrell, Charlotte AU - Jardine, Jenni AU - Sainsbury, John PY - 2020/4/27 TI - Comment on ?Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow?: A UK Perspective JO - JMIR Ment Health SP - e19547 VL - 7 IS - 4 KW - digital mental health KW - digital psychiatry KW - COVID-19 KW - mhealth KW - mobile apps KW - learning health system UR - http://mental.jmir.org/2020/4/e19547/ UR - http://dx.doi.org/10.2196/19547 UR - http://www.ncbi.nlm.nih.gov/pubmed/32330113 ID - info:doi/10.2196/19547 ER - TY - JOUR AU - Torous, John AU - Jän Myrick, Keris AU - Rauseo-Ricupero, Natali AU - Firth, Joseph PY - 2020/3/26 TI - Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow JO - JMIR Ment Health SP - e18848 VL - 7 IS - 3 KW - digital health KW - emergency response KW - telehealth KW - apps UR - http://mental.jmir.org/2020/3/e18848/ UR - http://dx.doi.org/10.2196/18848 UR - http://www.ncbi.nlm.nih.gov/pubmed/32213476 ID - info:doi/10.2196/18848 ER -