Brief Online Cognitive Behavioural Intervention for Dysfunctional Worry Related to the COVID-19 Pandemic: A Randomised Controlled Trial

Fear of COVID-19 predicts increases in anxiety, depressive symptoms, health anxiety, psychosocial distress, and loneliness: Findings from a prospective two-year follow-up study

The role of fear of COVID-19 in prospectively predicting changes in psychopathological symptoms during the COVID-19 pandemic remains unclear. The present data were obtained from a longitudinal non-probability sample in Germany, initially assessed at the beginning of the COVID-19 pandemic in Germany (April-May 2020) and reassessed after two years (n = 846; 83% female; mean age: 44.59 years, SD = 12.32; response rate: 19.5%). Multiple linear regressions were used to examine associations of fear of COVID-19 at baseline with depressive symptoms, anxiety, health anxiety, psychosocial distress, and loneliness controlling for (a) the respective symptom measure, and (b) all psychopathological symptoms at baseline. The data were weighted to minimize attrition and representativeness biases. Overall, loneliness decreased from the beginning of the COVID-19 pandemic until the two-year follow-up, whereas all other symptoms did not change. Fear of COVID-19 at the beginning of the pandemic predicted an increase in anxiety symptoms, health anxiety, psychosocial distress, and loneliness two years later. In addition, fear of COVID-19 predicted higher health anxiety, depressive symptoms, psychosocial distress, and loneliness, but not anxiety symptoms when controlling for all baseline symptom measures at once. Fear of COVID-19 seems to play a central role in predicting negative mental health outcomes, emphasizing the necessity of indicated prevention and intervention to decrease worry and manage anxiety, thereby reducing the negative impact on mental health caused by fear during future pandemics.

The Association Between COVID-fear with Psychological Distress and Substance Use: the Moderating Effect of Treatment Engagement

The purpose of this brief report was to examine the association between COVID-fear with psychiatric symptoms severity and substance use risk in an outpatient population with co-occurring substance use and mental health disorders and whether these associations were moderated by treatment engagement, especially after providers had shifted from an in-person care model to a telehealth format. A total of 136 patients receiving outpatient treatment for comorbid substance use and mental health disorders completed self-report questionnaires on their psychiatric symptoms, substance use, and treatment engagement (i.e., frequency, length, and helpfulness of phone and video sessions with a mental health counselor, psychiatrist, or primary care provider) in the past month between November 2020 and March 2021. Results showed that COVID-fear was significantly associated with psychiatric symptom severity, but not substance use risk. Additionally, perceived helpfulness of phone counseling sessions moderated the associations between COVID-fear and global psychiatric symptom severity, such that COVID-fear and global psychiatric symptom severity were positively associated when perceived helpfulness was low, and not associated if perceived helpfulness was high. The present results highlight the importance of directly addressing fears specific to a national emergency, as well as for providers to build strong rapport with their clients.

The impact of reduced worry on general functioning: A mediation analysis from a randomized trial

Previous lab findings have indicated that excessive worry may impair cognitive performance and problem solving capabilities but it is unclear if excessive worry also leads to broader impairments in general functioning. We report a secondary process data analysis of a large randomized waitlist-controlled trial (N = 670) of a self-guided online psychological intervention for dysfunctional worry related to the Covid-19 pandemic. Specific aims were to investigate (1) if improvements in general functioning were mediated by reductions in worry related to Covid-19 during the acute intervention phase, and (2) if reduced worry related to Covid-19 during acute intervention phase had a positive long-term impact on general functioning up to 1 year after the end of the intervention. To address aim 1, we used a mediation analysis framework where outcome (general functioning measured with an adapted version of the Work and Social Adjustment Scale) and the hypothesized mediator (worry measured with an adapted version of the Generalised Anxiety Disorder 7-Item Scale) were administered weekly during the controlled phase of the trial of 3 weeks. To address aim 2, we investigated if reductions in worry during the 3-week treatment period predicted improved general functioning at 1- and 12 months after treatment completion. Results showed that improvements in general functioning at week 3 were mediated by reductions in worry during the first 2 weeks of treatment (indirect effect estimate -0.08; 95% CI -0.15, -0.02). A sensitivity analysis indicated that the mediation effects dropped significantly when the residual correlation values between the mediator and the outcome exceeded r = 0. A reversed causation model was not significant. Additionally, reductions in worry during treatment predicted subsequent improvements in general functioning at both 1- and 12-month follow-ups (p < .05, -.001). Altogether, these results provide further support of the importance of targeting worry as a way to improve functioning among the large population of individuals with high levels of worry.

Transdiagnostic and tailored internet intervention to improve mental health among university students: Research protocol for a randomized controlled trial

BACKGROUND

Emerging adulthood is often associated with mental health problems. About one in three university students report symptoms of depression and anxiety that can negatively affect their developmental trajectory concerning work, intimate relationships, and health. This can interfere with academic performance, as mood and anxiety disorders are key predictors of dropout from higher education. A treatment gap exists, where a considerable proportion of students do not seek help for mood and anxiety symptoms. Offering internet interventions to students with mental health problems could reduce the treatment gap, increase mental health, and improve academic performance. A meta-analysis on internet interventions for university students showed small effects for depression and none for anxiety. Larger trials are recommended to further explore effects of guidance, transdiagnostic approaches, and individual treatment components.

METHODS

This study will offer 1200 university students in Sweden participation in a three-armed randomized controlled trial (RCT) evaluating a guided or unguided transdiagnostic internet intervention for mild to moderate depression and anxiety, where the waitlist control group accesses the intervention at 6-month follow-up. Students reporting suicidal ideation/behaviors will be excluded and referred to treatment within the existing healthcare system. An embedded study within the trial (SWAT) will assess at week 3 of 8 whether participants in the guided and unguided groups are at higher risk of failing to benefit from treatment. Those at risk will be randomized to an adaptive treatment strategy, or to continue the treatment as originally randomized. Primary outcomes are symptoms of depression and anxiety. Follow-ups will occur at post-treatment and at 6-, 12-, and 24-month post-randomization. Between-group outcome analyses will be reported, and qualitative interviews about treatment experiences are planned.

DISCUSSION

This study investigates the effects of a transdiagnostic internet intervention among university students in Sweden, with an adaptive treatment strategy employed during the course of treatment to minimize the risk of treatment failure. The study will contribute knowledge about longitudinal trajectories of mental health and well-being following treatment, taking into account possible gender differences in responsiveness to treatment. With time, effective internet interventions could make treatment for mental health issues more widely accessible to the student group.

Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis

BACKGROUND

The prevalence of mental illness increased in children, adolescents, and young adults during the COVID-19 pandemic, while at the same time, access to treatment facilities has been restricted, resulting in a need for the quick implementation of remote or online interventions.

OBJECTIVE

This study aimed to give an overview of randomized controlled studies examining remote or online interventions for mental health in children, adolescents, and young adults and to explore the overall effectiveness of these interventions regarding different symptoms.

METHODS

A systematic literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, PsycInfo, Psyndex, Embase, and Google Scholar. A meta-analysis was conducted using a random effects model to calculate overall effect sizes for interventions using standardized mean differences (SMDs) for postintervention scores.

RESULTS

We identified 17 articles with 8732 participants in the final sample, and 13 were included in the quantitative analysis. The studies examined different digital interventions for several outcomes, showing better outcomes than the control in some studies. Meta-analyses revealed significant medium overall effects for anxiety (SMD=0.44, 95% CI 0.20 to 0.67) and social functioning (SMD=0.42, 95% CI -0.68 to -0.17) and a large significant effect for depression (SMD=1.31, 95% CI 0.34 to 2.95). In contrast, no significant overall treatment effects for well-being, psychological distress, disordered eating, and COVID-19-related symptoms were found.

CONCLUSIONS

The qualitative and quantitative analyses of the included studies show promising results regarding the effectiveness of online interventions, especially for symptoms of anxiety and depression and for training of social functioning. However, the effectiveness needs to be further investigated for other groups of symptoms in the future. All in all, more research with high-quality studies is required.

A qualitative interview study exploring the psychological health impacts of the SPIN-CHAT program among people with systemic sclerosis at the onset of COVID-19: perceptions of trial participants and research team members

PURPOSE

Explore trial participants' and research team members' perceptions of the impact of the videoconference-based, supportive care program (SPIN-CHAT Program) during early COVID-19 for individuals with systemic sclerosis (SSc).

METHODS

Data were collected cross-sectionally. A social constructivist paradigm was adopted, and one-on-one videoconference-based, semi-structured interviews were conducted with SPIN-CHAT Trial participants and research team members. A hybrid inductive-deductive approach and reflexive thematic analysis were used.

RESULTS

Of the 40 SPIN-CHAT Trial participants and 28 research team members approached, 30 trial participants (Mean age = 54.9; SD = 13.0 years) and 22 research team members agreed to participate. Those who took part in interviews had similar characteristics to those who declined. Five themes were identified: (1) The SPIN-CHAT Program conferred a range of positive psychological health outcomes, (2) People who don't have SSc don't get it: The importance of SSc-specific programming, (3) The group-based format of the SPIN-CHAT Program created a safe space to connect and meet similar others, (4) The structure and schedule of the SPIN-CHAT Program reduced feelings of boredom and contributed to enhanced psychological health, (5) The necessity of knowledge, skills, and tools to self-manage SSc and navigate COVID-19.

CONCLUSION

Participants' and research team members' perspectives elucidated SPIN-CHAT Program benefits and how these benefits may have been realized. Results underscore the importance of social support from similar others, structure, and self-management to enhance psychological health during COVID-19.

TRIAL REGISTRATION

clinicaltrials.gov (NCT04335279)IMPLICATIONS FOR REHABILITATIONThe videoconference-based, supportive care SPIN-CHAT Program enhanced psychological health amongst individuals affected by systemic sclerosis.SPIN-CHAT Program participants and research team members shared that being around similar others, program structure, and self-management support were important and may have contributed to enhanced psychological health.Further efforts are required to explore experiences within supportive care programs to better understand if and how psychological health is impacted.

Mental health disturbance in preclinical medical students and its association with screen time, sleep quality, and depression during the COVID-19 pandemic

BACKGROUND

Affected by various hurdles during COVID-19, preclinical medical students are at an elevated risk for mental health disturbances. However, the effects of modern mental health problems on preclinical medical students have not been adequately researched. Thus, this study was aimed to identify the proportions and implications of current mental health problems for depression, sleep quality and screen time among Indonesian medical preclinical students during the COVID-19 pandemic.

METHODS

This cross-sectional study was conducted using crowdsourcing between October 2020 and June 2021. During the study period, 1,335 subjects were recruited, and 1,023 datasets were identified as valid. General Health Questionnaire-12 (GHQ-12) was used to measure current mental health disturbances (categorized as without current mental health disturbances, psychological distress, social dysfunction, or both). The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, the Pittsburgh Sleep Quality Index (PSQI) was employed to assess sleep quality, and a questionnaire devised for this study was used to assess screen time length per day. Multivariate data analysis was conducted using SPSS version 24 for Mac.

RESULTS

According to the findings, 49.1% of the 1,023 participants had current mental health disturbances: 12.8% had psychological distress, 15.9% had social dysfunction, and the rest (20.4%) had both psychological distress and social dysfunction. The statistical analysis provided strong evidence of a difference (p < 0.001) between the medians of depression and sleep quality with at least one pair of current mental health disturbance groups, but the difference for screen time was not significant (p = 0.151). Dunn's post-hoc analysis showed that groups without current mental health problems had significantly lower mean ranks of depression and sleep quality compared to groups that had current mental health problems (p < 0.001).

CONCLUSION

Current mental health disturbances during the COVID-19 pandemic were significantly associated with preclinical medical students' depression and sleep quality in preclinical medical students. Thus, mental health programs for this specific population should be tailored to integrate mindfulness therapy, support groups, stress management, and skills training to promote mental wellbeing.

Severe COVID anxiety among adults in the United Kingdom: cohort study and nested feasibility trial

BACKGROUND

People with severe COVID anxiety have poor mental health and impaired functioning, but the course of severe COVID anxiety is unknown and the quality of evidence on the acceptability and impact of psychological interventions is low.

METHODS

A quantitative cohort study with a nested feasibility trial. Potential participants aged 18 and over, living in the UK with severe COVID anxiety, were recruited online and from primary care services. We examined levels of COVID anxiety in the six months after recruitment, and factors that influenced this, using linear regression. Those scoring above 20 on the short Health Anxiety Inventory were invited to participate in a feasibility trial of remotely delivered Cognitive Behavioural Therapy for Health Anxiety (CBT-HA). Exclusion criteria were recent COVID-19, current self-isolation, or current receipt of psychological treatment. Key outcomes for the feasibility trial were the level of uptake of CBT-HA and the rate of follow-up.

RESULTS

204 (70.2%) of 285 people who took part in the cohort study completed the six month follow-up, for whom levels of COVID anxiety fell from 12.4 at baseline to 6.8 at six months (difference = -5.5, 95% CI = -6.0 to -4.9). Reductions in COVID anxiety were lower among older people, those living with a vulnerable person, those with lower baseline COVID anxiety, and those with higher levels of generalised anxiety and health anxiety at baseline. 36 (90%) of 40 participants enrolled in the nested feasibility trial were followed up at six months. 17 (80.9%) of 21 people in the active arm of the trial received four or more sessions of CBT-HA. We found improved mental health and social functioning among those in the active, but not the control arm of the trial (Mean difference in total score on the Work and Social Adjustment Scale between baseline and follow up, was 9.7 (95% CI = 5.8-13.6) among those in the active, and 1.0 (95% C.I. = -4.6 to 6.6) among those in the control arm of the trial.

CONCLUSIONS

While the mental health of people with severe COVID anxiety appears to improve over time, many continue to experience high levels of anxiety and poor social functioning. Health anxiety is highly prevalent among people with severe COVID anxiety and may provide a target for psychological treatment.

TRIAL REGISTRATION

Retrospectively registered at ISRCTN14973494 on 09/09/2021.

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

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.

Tailored internet-based psychological treatment for psychological problems during the COVID-19 pandemic: A randomized controlled trial

The COVID-19 pandemic influence mental health in both infected and non-infected populations. In this study we examined if individually tailored internet-based cognitive behavioral therapy (ICBT) could be an effective treatment for psychological symptoms related to the pandemic. Following recruitment we included 76 participants who were randomized to either a treatment group (n = 37) or a waitlist control group (n = 39). The treatment group received 8 modules (out of 16 possible) during 8 weeks with weekly therapist support. We collected data on symptoms of depression, experienced quality of life, anxiety, stress, anger, insomnia, PTSD, and alcohol use before, after the treatment and at one year follow-up. Using multiple regression analysis, group condition was found to be a statistically significant predictor for a decrease, favoring the treatment group, in symptoms of depression, insomnia, and anger with small to moderate effect sizes. The improvements remained at one year follow-up. Group condition did not significantly predict changing symptoms regarding experienced quality of life, anxiety, stress, PTSD and alcohol use. Findings indicate that ICBT is an effective intervention for some psychological symptoms associated with the COVID-19 pandemic. There is a need for further studies on mechanisms of change and on tailored ICBT for problems associated with crises like the pandemic.

The effects of psychosocial and behavioral interventions on depressive and anxiety symptoms during the COVID-19 pandemic: a systematic review and meta-analysis

Psychosocial and behavioral interventions have been shown to significantly reduce depressive and anxiety symptoms in different populations. Recent evidence suggests that the mental health of the general population has deteriorated significantly since the start of Coronavirus Disease 2019 (COVID-19) pandemic. We conducted a systematic review and meta-analysis of studies on the therapeutic effects of psychosocial and behavioral interventions on depression and anxiety during the COVID-19 pandemic. We systematically searched six electronic databases between December 2019 and February 2022 including PubMed, PsycINFO, Scopus, Web of Science, CNKI, and Wanfang Data. We included randomized clinical trials of psychosocial and behavioral interventions in individuals with depressive or anxiety symptoms during the COVID-19 outbreak compared to various control conditions. A total of 35 eligible studies with 5457 participants were included. The meta-analysis results showed that psychosocial and behavioral interventions had statistically significant moderate effects on depression [SMD =  - 0.73, 95% CI (- 1.01, - 0.45), I2 = 90%] and large effects on anxiety [SMD =  - 0.90, 95% CI (- 1.19, - 0.60), I2 = 92%], especially in the general population and COVID-19 survivors. Exercise and cognitive behavioral therapy were found to be the most effective treatments with moderate-to-large effect size for depression and anxiety during the outbreak of COVID-19. We also found the internet-based approach could also achieve almost equally significant effects on depression and anxiety compared with face-to-face traditional approach. Our findings suggest that cognitive behavioral therapy and physical exercise intervention are significantly effective for depression and anxiety related to the COVID-19 pandemic regardless of the delivery modes, and gender differences should be taken into consideration for better implementation of interventions in clinical and community practice.

The compounding effects of income loss and change in living arrangement on emerging adult women's mental health during COVID's onset

Research suggests that young adult women were among those more susceptible to mental health declines in the initial months of COVID-19. Unfortunately, longitudinal data examining mental health before and after the pandemic's onset are extremely limited. In a sample of 240 women ages 18-29 who were surveyed online first in November-December 2019 and then again between May and July 2020, this study aimed to examine how major life changes associated with the pandemic (i.e. loss of income, loss of employment, change in relationship status, and change in living arrangement) impacted mental health (i.e. depression, anxiety, stress). Multivariate regression analyses were conducted on three models predicting stress, anxiety, and depression from the four life changes, controlling for the effects of mental health before the COVID-19 pandemic. Results showed that a change in living arrangement was uniformly associated with increased mental health problems among women who also experienced a decrease in income. Likewise, loss of income was uniformly related to increased mental health problems among women who also experienced a change in living arrangement. In contrast, job loss was associated with a decrease in stress, and changes in relationship status were not associated with mental health outcomes. These findings highlight the potential for COVID-19 to produce co-occurring and synergistic stressors. Meanwhile, the impact of job loss on mental health may have been attenuated by enhanced unemployment benefits. Mental health interventions that aim to support young women as the pandemic abates should be tailored to address the impact of multiple psychosocial stressors.

A Self-Help Virtual Therapeutic Experience Intervention for Overcoming Psychological Distress Related to the COVID-19 Pandemic: Results From the European Multicentric COVID Feel Good Trial

OBJECTIVE

The general objective of the current study was to investigate the efficacy of a novel self-help virtual therapeutic experience (specifically, the COVID Feel Good intervention) in lowering the psychological burden experienced during the COVID-19 lockdowns in four European countries.

METHODS

We focused on participants recruited from June 2020 to May 2021 in the context of a European multicenter project including four university/academic sites. The total number of participants in the longitudinal studies was 107 (study 1, N = 40; study 2, N = 29; study 3, N = 38). The randomized controlled trial (study 4) included 31 participants in total, 16 in the intervention group and 15 in the control group. Primary outcome measures were depression, anxiety, stress symptoms, perceived stress level, and perceived hopelessness. The secondary outcome was experienced social connectedness.

RESULTS

Using separate linear mixed-effects models, the most consistent result across countries was a reduction in perceived stress after the participation in the COVID Feel Good intervention. By pooling the results of the models using a random-effects meta-analysis, we found that after the COVID Feel Good intervention, participants reported a decrease in perceived general distress (mean standardized effect size for general distress in the treatment groups compared with the control conditions was -0.52 [ p = .008, 95% confidence interval = -0.89 to -0.14]) and an increase in the perceived social connection (mean standardized effect size for social connection using COVID Feel Good compared with the control conditions was 0.50 [ p ≤ .001, 95% confidence interval = 0.25 to 0.76]).

CONCLUSIONS

Findings of this study indicate that a virtual self-help intervention is effective in reducing psychological distress. These results contribute to the growing literature supporting the use of digital psychological therapies to relieve psychological distress among the general population during the COVID-19 pandemic.Trial Registration : ISRCTN63887521.

The Arab COVID-19 Anxiety Syndrome Scale (C-19ASS): COVID-19 anxiety syndrome and psychological symptoms in the Saudi Arabian population

INTRODUCTION

The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a reliable scale assessing dysfunctional coping strategies activated in response to COVID-19 fear and threat. The present study aimed to provide a validation of the Arabic version of the C-19ASS and to explore the association between the C-19ASS and psychological symptoms syndrome.

METHOD

In Study 1, a community sample of 404 participants completed the Arabic version of the C-19ASS and results were subjected to an exploratory factor analysis. In Study 2, a community sample of 903 participants completed the Arabic version of the C-19ASS and a series of measures assessing depressed mood and anhedonia, generalized anxiety and health anxiety. Internal consistency, construct validity and incremental validity were assessed. Associations between C-19ASS and psychological symptoms were assessed.

RESULTS

Factor analysis identified a two-factor solution (i.e., C-19ASS-Perseveration and C-19ASS-Avoidance), and confirmatory factor analysis suggested a two-factor model best fits the data. The Arabic version of the C-19ASS showed good internal consistency, good construct and incremental validity. COVID-19 anxiety syndrome was associated with more severe anxiety symptoms, depressive symptoms and health anxiety. Females had higher levels of COVID-19 anxiety syndrome than males. Participants diagnosed with COVID-19, and those who had experienced loss as a consequence of COVID-19, had higher levels of COVID-19 anxiety syndrome (Perseveration).

CONCLUSIONS

The Arabic version of the C-19ASS appears to be a reliable and valid measure of the COVID-19 anxiety syndrome. The COVID-19 anxiety syndrome could be a suitable therapeutic target to improve psychological recovery during the COVID-19 pandemic among Arabs.

Research on digital tool in cognitive assessment: a bibliometric analysis

Objective

The number of research into new cognitive assessment tools has increased rapidly in recent years, sparking great interest among professionals. However, there is still little literature revealing the current status and future trends of digital technology use in cognitive assessment. The aim of this study was to summarize the development of digital cognitive assessment tools through the bibliometric method.

Methods

We carried out a comprehensive search in the Web of Science Core Collection to identify relevant papers published in English between January 1, 2003, and April 3, 2023. We used the subjects such as "digital," "computer," and "cognitive," and finally 13,244 related publications were collected. Then we conducted the bibliometric analysis by Bibliometrix" R-package, VOSviewer and CiteSpace software, revealing the prominent countries, authors, institutions, and journals.

Results

11,045 articles and 2,199 reviews were included in our analyzes. The number of annual publications in this field was rising rapidly. The results showed that the most productive countries, authors and institutions were primarily located in economically developed regions, especially the North American, European, and Australian countries. Research cooperation tended to occur in these areas as well. The application of digital technology in cognitive assessment appealed to growing attention during the outbreak of the COVID-19 epidemic.

Conclusion

Digital technology uses have had a great impact on cognitive assessment and health care. There have been substantial papers published in these areas in recent years. The findings of the study indicate the great potential of digital technology in cognitive assessment.

COVID-19 exposure and depression-anxiety levels among Saudi adults in the Jazan region: a study with a predominantly female and undergraduate sample

Background

The COVID-19 pandemic has caused significant mental health challenges worldwide, as evidenced by numerous studies indicating high levels of depression and anxiety among individuals. However, the extent of mental health disorders following the pandemic and the association between anxiety and depression and COVID-19 exposure levels in the Jazan region of the Kingdom of Saudi Arabia have received little research attention.

Methods

A convenience sample of 377 participants, predominantly female (85.4%) with undergraduate education (74.5%) and Saudi nationality (92.8%), was included in the study. The study utilized a self-administered questionnaire to collect data from participants between 1st August and 8th September 2022. The questionnaire consisted of four parts, including demographic characteristics, COVID-19 exposure, the Patient Health Questionnaire-9 (PHQ-9) for depression assessment, and the Generalized Anxiety Disorders-7 (GAD-7) for anxiety evaluation. Statistical techniques such as descriptive statistics, independent t-tests, ANOVA (Analysis of Variance), and regression analysis were employed to analyze the collected data.

Results

The mean age of the study participants was 30.97 years (SD = 9.072). The mean score for COVID-19 exposure was 2.98 (SD = 1.48). The mean level of depression was 7.83 (SD = 6.43), with 20% of participants experiencing moderate to severe depression. Additionally, the study found that the mean score of anxiety level among participants was 6.75 (SD = 6.57), with 26% of the participants experiencing moderate to severe anxiety. Independent t-test revealed significant differences in mean depression and anxiety scores between participants with varying COVID-19 exposure levels (p = 0.001). The regression analysis demonstrated that anxiety levels were significant predictors of depression (p < 0.001). There is a significant difference in the depression mean between participants with high levels of anxiety (≥10) compared to others with levels <10. Furthermore, significant predictors of anxiety levels included either student or unemployment status (p < 0.001), increased age (≥35) (p = 0.049), female gender (p = 0.009), marital status of not being married, divorced, or widowed (p = 0.004), low monthly income (p = 0.019), and increased depression level (p < 0.001).

Conclusion

This study provides evidence of significant depression and anxiety levels among participants, with higher COVID-19 infection exposure correlating with increased scores for both. Anxiety was identified as a significant predictor of depression. Demographic factors, such as employment status, age, gender, and marital status, played a role in influencing anxiety levels. The findings highlight the need for targeted mental health interventions to address the psychological impact of COVID-19 infection exposure and support affected individuals effectively.

Digital Therapy: Alleviating Anxiety and Depression in Adolescent Students During COVID-19 Online Learning - A Scoping Review

The learning method has changed from offline to online since Coronavirus Disease 2019 pandemic cause mental health problems in students such as stress, anxiety, and even depression. Interventions to reduce mental health problems in adolescents need to be carried out digitally to reduce the transmission of Coronavirus Disease 2019. The purpose of this study is to explore methods of digital therapy to reduce symptoms of anxiety and depression among students during the Coronavirus Disease 2019. A scoping review study design was used in this study. Database the study from CINAHL, PubMed, and Scopus databases. This study used PRISMA Extension for Scoping Reviews (PRISMA-ScR) and for quality appraisal used JBI Quality Appraisal. The inclusion criteria for articles in this study are full text, randomized control trial or quasi-experiment research design, English language, students sample, and the publication period during COVID-19 pandemic (2019-2022). There were found 13 articles discussing digital therapy and it was found that the digital therapy model to reduce anxiety and depression includes directions through digital modules, directions via video, and asynchronous discussions via online meeting. The sample range in this study is 37-1986 students. Most of the articles come from developed countries. Delivery services of digital therapy consist of three phases, namely psycho-education, problem-solving, and implementation of problem-solving strategies. The authors found that there are four digital therapy methods, namely Improving psychological abilities, Bias-modification intervention, Self-help intervention, and Mindfulness intervention. The implementation of digital therapy must still pay attention to various aspects that affect students, so that therapists need to pay attention to physical, psychological, spiritual, and cultural aspects. Here we highlight, digital therapy interventions are proven for improving mental health by reducing depression and anxiety levels among students during the COVID-19 pandemic by paying attention to all aspects that affect students.

Use, satisfaction, and preference of online health services among older adults with multimorbidity in Hong Kong primary care during COVID-19

BACKGROUND

The use of online and mobile internet and social media has been increasing in healthcare service delivery. However, there is limited literature on the acceptance and use of online health services for older adults with multimorbidity who require more medical care and assistance. This study aims to explore the use of social media in older adults with multimorbidity in Hong Kong primary care and to assess the feasibility and usage of online health services in this population, including satisfaction, preference, and problems encountered.

METHODS

This is a cross-sectional study among older adults with multimorbidity conducted between November 2020 and March 2021 in a Hong Kong primary care programme. Online and face-to-face services were offered based on the needs of the participants. Demographic characteristics and health conditions were assessed at baseline. Participants using online services were invited to complete a feedback questionnaire.

RESULTS

The study included 752 participants, of which 66.1% use social media every day. Participants who declined to use online services were found to be significantly older, live alone, have lower income, have social security assistance, have greater cognitive decline, and be less depressed (p < 0.05). Non-responders to the online questionnaire had fewer years of education and greater cognitive decline (p < 0.05). The median satisfaction with the online services was 8 (interquartile range: 7, 9), and 14.6% of the participants preferred online more than face-to-face services. Lower education levels, fewer internet connection issues, and more self-efficacy on mobile apps were associated with a higher level of online satisfaction after adjustment (p < 0.05). Fewer internet connection issues and more self-efficacy on mobile apps were associated with participants' preference for online services (p < 0.05).

CONCLUSIONS

More than half of Hong Kong older adults with multimorbidity in primary care use social media daily. Internet connection issues can be a significant barrier to the usage of online services in this population. Prior use and training can be beneficial to enhance use and satisfaction in older adults.

ERS International Congress 2022: highlights from the Allied Respiratory Professionals Assembly

In this article, we provide a brief overview of some of the outstanding sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2022 European Respiratory Society International Congress, which was held in a hybrid format. Early Career Members from Assembly 9 summarised the content of the sessions, with the support of the Officers from the four Assembly groups: Respiratory Function Technologists and Scientists (Group 9.01); Physiotherapists (Group 9.02); Nurses (Group 9.03); and Psychologists and Behavioural Scientists (Group 9.04). The sessions covered the following topics: recent advances in cardiopulmonary exercise and challenge testing; the role and new trends in physiotherapy, exercise and physical activity promotion interventions in chronic respiratory diseases; development of the international curriculum for respiratory nurses and nursing aspects in disease management; and treatment adherence, e-health interventions and post-coronavirus disease 2019 challenges. This Highlights article targets delegates who attended the Congress sessions, as well as those who were unable to attend, and provides valuable insight into the latest scientific data and emerging areas affecting the clinical practice of Allied Respiratory Professionals.

Yes, I can! Development and validation of the self-efficacy for self-help scale

BACKGROUND

Self-help interventions for health complaints promise alleviation, for instance, of depressive symptoms, and have become increasingly popular. However, despite constant progress regarding digitally supported self-help, real-world uptake is low and motivational processes, like task-specific self-efficacy, are rarely investigated. Therefore, this study developed and tested the Self-Efficacy for Self-Help Scale (SESH).

METHODS

In a randomized controlled trial of a positive psychological online intervention to foster self-help, 344 adults (mean age = 49.26 years, SD = 27.85; 61.9 % female) completed SESH at three time points (pretest, posttest, 2-week follow-up). Psychometric testing included factorial validity, reliability (internal consistency, split-half), convergent validity (via depression coping self-efficacy), discriminant validity (via depression severity, depression literacy), sensitivity to change (due to the intervention), and predictive validity (via a theory of planned behavior questionnaire on self-help).

RESULTS

The unidimensional scale showed excellent reliability, construct validity, and predictive validity regarding self-help (the theory of planned behavior explained 49 % of variance in self-help intentions). The analysis did not clearly support sensitivity to change, however, as SESH scores did not change in the intervention group but were lower in the control group at posttest.

LIMITATIONS

The study was not representative of the population, and the intervention was not previously tested. Studies with longer follow-ups and more diverse samples are needed.

CONCLUSIONS

This study closes a gap in current self-help research by presenting a psychometrically sound measure to capture self-efficacy for self-help that can be used in epidemiological studies as well as clinical practice.

Effectiveness of a Virtual-Reality-Based Self-Help Intervention for Lowering the Psychological Burden during the COVID-19 Pandemic: Results from a Randomized Controlled Trial in Iran

BACKGROUND

The COVID-19 pandemic. In this framework, digital self-help interventions have the potential to provide flexible and scalable solutions for delivering evidence-based treatments that do not necessitate face-to-face meetings.

OBJECTIVE

as part of a multicentric project, the purpose of the current randomized controlled trial was to evaluate the efficacy of a Virtual-Reality-based self-help intervention (namely, COVID Feel Good) in lowering the psychological distress experienced during the COVID-19 pandemic in Iran.

METHODS

60 participants were randomly assigned to the experimental (COVID Feel Good intervention group) or the control (no-treatment control group) condition. At the beginning of the intervention (Day 0), at the end of the intervention (Day 7), and after a 2-week follow-up (Day 21), measurements of depressive and anxiety levels, general distress, perceived levels of stress, hopelessness (primary outcome measures), perceived interpersonal closeness with the social world, and fear of COVID-19 (secondary outcome measure) were collected. The protocol consists of two integrated parts: the first part includes a relaxing 10-min three-hundred-sixty-degree (360°) video, while the second one includes social tasks with specified objectives.

RESULTS

In terms of the primary outcomes, participants in the COVID Feel Good intervention group improved in depression, stress, anxiety, and perceived stress but not hopelessness. Secondary outcome results showed an improvement in perceived social connectedness and a substantial decrease in fear of COVID-19.

CONCLUSIONS

these findings on the efficacy of COVID Feel Good training add to the growing body of evidence demonstrating the feasibility of digital self-help interventions in promoting well-being during this unique period.

Psychological treatments for the mental health symptoms among individuals infected with COVID-19: a scoping review protocol

INTRODUCTION

Mental health symptoms such as depression, anxiety and sleep problems are commonly observed in individuals suffering from acute COVID-19 infection to post-COVID-19 syndrome. Studies have provided preliminary evidence for the efficacies of cognitive behavioural therapy, mindfulness-based interventions, acceptance and commitment therapy, and many other treatments for this population. Although there have been attempts to synthesise the literature on these psychological interventions, previous reviews have been limited in terms of the sources, symptoms and interventions that they included. Furthermore, most studies reviewed were conducted in early 2020, when COVID-19 had only recently been classified as a global pandemic. Since then, substantial research has been conducted. As such, we sought to provide an updated synthesis of the available evidence of treatments for the range of mental health symptoms associated with COVID-19.

METHODS AND ANALYSIS

This scoping review protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Systematic searches were carried out on scientific databases (PubMed, Web of Science, PsycINFO and Scopus) and clinical trial registries (ClinicalTrials.gov, WHO ICTRP, EU Clinical Trials Register and Cochrane Central Register of Controlled Trials) to identify studies that have or will assess the efficacy or any aspects of psychological treatment for acute to post-COVID-19 syndrome. The search was conducted on 14 October 2022 and identified 17 855 potentially eligible sources/studies published since 1 January 2020 (duplicates removed). Six investigators will independently carry out titles and abstract screening, full-text screening and data charting and the results will be summarised using descriptive statistics and narrative synthesis.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review. The results will be disseminated through a peer-reviewed journal, conference presentations and/or academic newspapers. This scoping review has been registered with Open Science Framework (https://osf.io/wvr5t).

Prediction of COVID-19-related distress: the role of anxiety and resiliency

OBJECTIVES

Among older adults, anxiety is a likely risk factor for COVID-19-related distress, whereas psychological resilience may attenuate the negative impact of the pandemic. In this longitudinal study, we hypothesized that pre-pandemic anxiety would predict higher COVID-19-related distress, whereas resiliency would predict lower distress. Further we hypothesized that resilience would moderate the association between anxiety and distress.

METHODS

Pre-pandemic data (July 2018) was obtained from a community sample of older adults and included measures of anxiety and resiliency. We conducted a follow-up survey (n = 571) during the pandemic (June 2020) and evaluated COVID-19-related distress. We used OLS regression to test our hypotheses.

RESULTS

Anxiety symptoms predicted higher COVID-19-related distress; resiliency predicted lower distress. Resiliency did not moderate the association between anxiety and distress. High levels of resiliency, compared to low levels, attenuated the influence of anxiety on COVID-19-related distress, but only among those with low-to-moderate levels of anxiety.

CONCLUSION

Older adults with anxiety may be more susceptible to COVID-19 related distress. Interventions that increase resilience, may mitigate distress, and promote healthy aging for those with low-to-moderate anxiety. Further research, however, is needed to help those older adults with high anxiety contend with such adverse experiences and build on psychological resources.

Types of Digital-Based Nursing Interventions for Reducing Stress and Depression Symptoms on Adolescents During COVID-19 Pandemic: A Scoping Review

COVID-19 pandemic can cause problems in adolescent mental health such as anxiety, depression, and stress. This is because the distance barrier becomes an obstacle in handling mental health in adolescents. The use of technology has the potential to deal with mental health problems. The purpose of this study was to describe the types of digital-based nursing interventions to reduce symptoms of stress and depression on adolescents during the COVID-19 pandemic. This study used the Scoping Review method. Literature from CINAHL, PubMed, and ProQuest databases. The keywords were adolescent, depression, stress, digital, application, and nursing intervention in English. The criteria for articles in this study were full-text articles, the sample of adolescents, digital-based intervention, articles are original research, and time setting 2018-2022. We found 11 articles discussing digital-based nursing interventions to reduce symptoms of stress and depression in adolescents. There are 2 types of intervention, namely mobile-based intervention, and web-based intervention. The two interventions can be combined to become a method of providing digital nursing interventions that are effective and can reach the entire community. Digital-based nursing interventions are carried out by paying attention to physical, psychological, spiritual, and cultural aspects to improve the goals of nursing care so that they can be significant in reducing stress and depression in adolescents during the Covid-19 pandemic. Digital-based nursing interventions consisting of mobile-based intervention and web-based intervention can improve mental health among adolescents by reducing stress, anxiety, depression, and increasing resilience, well-being, and self-efficacy.

Web-Based Psychosocial Interventions for Disaster-Related Distress: What Has Been Trialed in the Past, and What Can We Learn From This?

OBJECTIVES

To summarize reports describing implementation and evaluation of Web-based psychosocial interventions for disaster-related distress with suggestions for future intervention and research, and to determine whether a systematic literature review on the topic is warranted.

METHODS

Systematic searches of Embase, PsycINFO, and MEDLINE were conducted. Duplicate entries were removed. Two rounds of inclusion/exclusion were conducted (abstract and full-text review). Relevant data were systematically charted by 2 reviewers.

RESULTS

The initial search identified 112 reports. Six reports, describing and evaluating 5 interventions, were included in a data analysis. Four of the 5 interventions were asynchronous and self-guided modular programs, with interactive components. The fifth was a short-term, online supportive group intervention. Studies utilized a variety of evaluation methods, and only 1 of 14 outcome measures used across the studies was utilized in more than 1 project.

CONCLUSIONS

Several Web-based psychosocial interventions have been developed to target disaster-related distress, but few programs have been formally evaluated. A systematic review of the topic would not be recommended at this time due to heterogeneity in reported studies. Further research on factors impacting participation, generalizability, and methods of program delivery with consistent outcome measures is needed.

Post-COVID-19 Syndrome Comprehensive Assessment: From Clinical Diagnosis to Imaging and Biochemical-Guided Diagnosis and Management

The COVID-19 outbreak was first reported in 2019, causing massive morbidity and mortality. The majority of the COVID-19 patients survived and developed Post-COVID-19 Syndrome (PC19S) of varying severity. Currently, the diagnosis of PC19S is achieved through history and symptomatology that cannot be explained by an alternative diagnosis. However, the heavy reliance on subjective reporting is prone to reporting errors. Besides, there is no unified diagnostic assessment tool to classify the clinical severity of patients. This leads to significant difficulties when managing patients in terms of public resource utilization, clinical progression monitorization and rehabilitation plan formulation. This narrative review aims to review current evidence of diagnosis based on triple assessment: clinical symptomatology, biochemical analysis and imaging evidence. Further assessment tools can be developed based on triple assessment to monitor patient's clinical progression, prognosis and intervals of monitoring. It also highlights the high-risk features of patients for closer and earlier monitoring. Rehabilitation programs and related clinical trials are evaluated; however, most of them focus on cardiorespiratory fitness and psychiatric presentations such as anxiety and depression. Further research is required to establish an objective and comprehensive assessment tool to facilitate clinical management and rehabilitation plans.

The Usability, Feasibility, Acceptability, and Efficacy of Digital Mental Health Services in the COVID-19 Pandemic: Scoping Review, Systematic Review, and Meta-analysis

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.

Specific Pandemic-Related Worries Predict Higher Attention-Related Errors and Negative Affect Independent of Trait Anxiety in UK-Based Students

Background

The COVID-19 pandemic has resulted in many individuals experiencing increased symptoms of anxiety. We predict that this increase may be underpinned by pandemic-related worry (PRW), characterised by repetitive negative thinking about pandemic-specific outcomes; and that this relationship is mediated through reduced attentional capacity required to regulate negative affect.

Methods

We developed a novel scale to measure the contents of PRW in an initial sample of 255 participants, and explored its relationship with cognitive functioning and negative affect in a sample of 382 UK-based university students, whilst controlling for recalled pre-pandemic trait anxiety.

Results

A five-factor model of PRW was identified, with factors reflecting worry about decline in quality of life (QoL) and probability of infection correlating with attention and memory-related errors. Importantly, attention-related errors partially mediated the positive relationship between PRW and negative affect, even when controlling for pre-pandemic trait anxiety.

Conclusion

PRW's relationship with negative affect was partially mediated through attentional function, consistent with models of anxiety and attentional control. In UK-based students PRW may be predominantly focused on the decline in QoL; therefore, interventions targeting worry about the decline in QoL caused by COVID-19 are especially important in this population in the wake of the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-022-10336-7.

The effectiveness and associated factors of online psychotherapy on COVID-19 related distress: A systematic review and meta-analysis

Objective

A quantitative synthesis of online psychotherapies' effectiveness in managing COVID-19 related distress is lacking. This study aimed to estimate online psychological interventions' effectiveness and associated factors on COVID-19 related psychological distress.

Methods

Multi-databases including PubMed, EBSCO, ProQuest, and Cochrane were searched repeatedly till the end of June 2022. Hand-picking was also utilized for relevant papers. Depression, anxiety, stress, and quality of sleep were evaluated as outcomes. The risk of bias was evaluated using the Cochrane tool. Data analyses were conducted through Review Manager (version 5.4.1).

Results

A total of 13 studies involving 1,897 participants were included for meta-analysis. Results showed that online psychotherapy significantly reduced the levels of depression [standard mean difference, SMD = −0.45, 95% CI (−0.69, −0.20)], anxiety [SMD = −0.67, 95% CI (−0.99, −0.36)], and stress [SMD = −0.73, 95% CI (−1.11, −0.34)], but not quality of sleep [SMD = −0.53, 95% CI (−1.23, 0.17)]. In addition, guided therapies were more effective than self-help ones on reducing levels of anxiety (χ2 = 5.58, p = 0.02, and I2 = 82.1%), and ≤ 2 weeks' daily interventions were more effective on treating depression than 2-month weekly interventions (χ2 = 7.97, p = 0.005, I2 = 87.5%).

Conclusion

Online psychological interventions effectively reduced COVID-19 related depression, anxiety, and stress levels, and the effectiveness was influenced by settings like guidance and duration and frequency.

Systematic review registration

https://inplasy.com/inplasy-2022-7-0081/, identifier: INPLASY202270081.

The Italian COVID-19 Anxiety Syndrome Scale: Investigation of the COVID-19 anxiety syndrome and its association with psychological symptoms in an Italian population

INTRODUCTION

The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a quick and reliable scale assessing dysfunctional coping strategies activated in response to COVID-19 fear and threat. The present study aimed to provide a preliminary validation of the Italian version of the C-19ASS and investigated whether the C-19ASS would mediate the relationship between the Big Five personality traits and psychological outcomes.

METHOD

In Study 1, a community sample of 271 participants completed the Italian version of the C-19ASS and results were subjected to a Principal Component Analysis. In study 2, a community sample of 484 participants completed the Italian version of the C-19ASS and a series of measures assessing COVID-19 anxiety, COVID-19 fear, functional impairment, personality traits, depression, generalized anxiety and health anxiety. Internal consistency, concurrent and incremental validity were assessed. Path analyses were run.

RESULTS

Factor analysis identified a two-factor solution (i.e., C-19ASS Perseveration and C-19ASS Avoidance) and confirmatory factor analysis suggested a two-factor model best fits the data. The Italian version of the C-19ASS showed good internal consistency. There was also evidence of convergent validity and incremental validity. Path analyses showed that C-19ASS Perseveration mediates the relationship between emotional stability and psychological symptoms (depression, generalized anxiety and health anxiety).

CONCLUSION

The Italian version of the C-19ASS appears to be a reliable and valid measure of the COVID-19 anxiety syndrome. The COVID-19 anxiety syndrome could be a suitable therapeutic target to reduce psychological symptoms typically linked to pandemic events, such as depression generalized anxiety and health anxiety.

Online psychosocial interventions for improving mental health in people during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

During the COVID-19 pandemic, interventions for public mental health were mostly delivered through online modalities. Although many studies have explored the effectiveness of online psychosocial interventions through randomized controlled trials, there is a lack of quantitative synthesis of the effectiveness of online psychosocial interventions and an examination of their overall application.

OBJECTIVE

To understand the commonly used psychosocial interventions during the COVID-19 pandemic and the effectiveness of the interventions.

METHODS

Risk bias was assessed in the included studies according to the Cochrane Collaboration criteria, and data from post-test and follow-up were combined for standardized mean differences using Stata 16.0 software, and sources of heterogeneity were explored by subgroup analysis, and risk bias was assessed in the included studies using Review Manager 5.4 software. The study was written in strict accordance with PRISMA specifications, and registration was completed on the PROSPERO platform (CRD42022302917).

RESULTS

The online psychosocial intervention had an ameliorating effect on anxiety (SMD = -0.78), depression (SMD = -0.80), and insomnia (SMD = -0.19) in the public during the COVID-19 pandemic, was ineffective for the intervention on stress, and the effectiveness of the intervention on depression continued at follow-up. Subgroup analyses showed that the type of intervention, intervention form, Duration of intervention, and setting of the control group influenced the trial results to some extent, with cognitive behavioral therapy being the most effective intervention for anxiety and depressive symptoms, self-help interventions being more effective than interventions with therapist interventions, and 1-4 week interventions being more effective than 5-8 week interventions. Due to the limited number of studies included in the analysis and variability in quality, more randomized controlled trials are needed to test the findings.

CONCLUSION

Online psychosocial interventions can be effective in improving symptoms of anxiety, depression, stress, and insomnia in the public during the COVID-19 pandemic. However, additional randomized controlled trial studies are needed to determine which types of interventions are more appropriate for which populations and how they can be implemented to achieve better intervention outcomes.

Fear of Death during COVID-19 Does Not Explain Post-Infection Depression Symptoms beyond Reported Symptoms during the Infection in COVID-19 Survivors

The COVID-19 pandemic poses an unprecedented global burden to the general population and, in particular, to individuals who have been infected with SARS-CoV-2. In the context of the discussion about "post COVID-19", the aim of the study was to advance research on mental health and long-term consequences after COVID-19. In total, 214 COVID-19 survivors (female: 54.2%; hospitalized: 36.7%) participated in the repeated cross-sectional assessment. In addition to demographic data, mental and somatic symptoms, fear of death at the time of infection, and depressive (PHQ-8) and generalized anxiety symptoms (GAD-7) were assessed. Results showed an increased prevalence of depressive symptoms and symptoms of generalized anxiety compared to observations in the general population prior to the COVID-19 pandemic. Psychological symptoms of depression and reported levels of fear of death during the SARS-CoV-2 infection showed a negative association with the time interval since COVID-19 diagnosis. Furthermore, although fear of death during the acute COVID-19 was related to depression and generalized anxiety, this association was predominantly explained by the presence of mental and somatic symptoms. In conclusion, initial fear of death does not impact mental health beyond the overall symptom burden. Furthermore, depressive symptoms appear to vanish across time since infection.

The effect of cognitive behavior therapy on anxiety and depression during COVID-19 pandemic: a systematic review and meta-analysis

BACKGROUND

The global spread of coronavirus has caused many physical and mental health problems throughout the world. Depression and anxiety are among the issues that people are experiencing abundantly, along with other mental health disorders, during this period. Cognitive behavior therapy (CBT) is one of the approaches that is effective on improving most of the psychological issues including depression and anxiety. The objective of this systematic review and meta-analysis was to assess the effects of CBT on depression and anxiety during COVID-19 pandemic period.

METHODS

English databases such as Cochrane, PubMed, Google Scholar, Web of Science and Persian databases such as SID, MagIran and IranDoc were searched with a time limit of 2019 to 2022. Two researchers independently evaluated the quality of the entered studies based on Cochrane handbook. Subgroup analysis was conducted separately on the basis of being infected with coronavirus, not being infected with coronavirus, and having a history of depression or anxiety before the intervention and internet-based CBT for depression and anxiety. Meta-analysis results were reported using standardized mean difference (SMD) and 95% confidence interval (95% CI). Heterogeneity of studies was analyzed by means of I2 index; and in the case of heterogeneity presence, random effects model was used instead of fixed effects model. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used for evaluating the quality of evidence.

RESULTS

Totally, 2015 articles were analyzed of which 11 articles entered meta-analysis. The overall results of meta-analysis showed that mean score of anxiety in the group receiving CBT was significantly lower than the control group (SMD: - 0.95, 95% CI - 1.29 to - 0.62; P < 0.00001, I2 = 94%). In addition, mean score of depression in the intervention group was significantly lower than the control group (SMD: - 0.58; 95% CI - 1.00 to - 0.16, P < 0.00001, I2 = 94%). In addition, the results of subgroup meta-analysis showed that internet-based CBT was effective in reducing of depression (SMD - 0.35; 95% CI - 0.50 to - 0.20; P < 0.00001; I2 = 0%) and anxiety (SMD - 0.90; 95%CI - 1.47 to - 0.33; P = 0.002; I2 = 94%). The evidence about the effectiveness of CBT on depression and anxiety compared with control group on the basis of GRADE approach had low quality.

CONCLUSIONS

Meta-analysis results showed that CBT reduced the mean scores of anxiety and depression significantly during COVID-19 pandemic period. Due to the low quality of evidence, conducting more randomized controlled trials with rigorous design is suggested. Prospero registration This systematic review has been registered in Prospero (ID: CRD42021277213).

Online cognitive behavioural therapy as a psychological vaccine against stress during the COVID-19 pandemic in pregnant women: A randomised controlled trial

The COVID-19 pandemic has affected the population's levels of stress and anxiety due to its contagious nature and the uncertainties generated by its novelty. One population that is especially vulnerable to these psychological consequences are pregnant women. This is why the objective of this study was to test the efficacy of an online stress management programme of a cognitive behavioural nature on pregnant women during the COVID-19 pandemic, in Spain. The trial was controlled and randomised, with a total of 207 pregnant women divided into three groups: the Online Cognitive Behavioural Therapy group (o-CBT) (N = 70); the Online Psychological Support group (o-PS) (N = 69); and the Usual Care group (UC) (N = 68). To test the therapy's efficacy, the women's resilience, perceived stress, pregnancy-specific stress and psychopathological symptoms were assessed before and after the intervention. The o-CBT and o-PS consisted of a programme of 8 group sessions (one per week). The results showed that pregnant women who participated in the o-CBT group presented lower rates of pregnancy-specific stress and perceived stress, as well as greater resilience and lower anxiety, depression and obsessions-compulsions symptoms. These data show the efficacy of the treatment programme and thus confirm the importance of implementing these types of interventions during a woman's pregnancy, especially over periods of major stress, such as during a pandemic.

Predicting Parental Mental Health During COVID-19: Economic Pressure, COVID-19 Stress, and Coping Strategies

As the COVID-19 pandemic continues, understanding connections between economic pressures and mental health experiences is critical in comprehending how stressful global events can affect families. Although economic pressures and stress can negatively impact mental health, approach coping strategies may provide reductions in negative mental health experiences for parents compared to avoidant coping strategies. Despite recent work showing that stress resulting from the pandemic can have negative implications for the mental health of parents with young children, there is little known about the mental health of parents with adolescents. This study utilized a longitudinal sample of 198 parents (194 biological parents; 103 Fathers, and 91 Mothers) of adolescents and examined the mediating impact of COVID-19 stress on the relationship between economic pressure and subsequent depressive and anxious symptoms. Additionally, approach and avoidant coping strategies were examined as potential moderators between COVID-19 stress and later mental health. Results indicated that parents who experienced economic pressure reported worsening mental health across the school semester, with COVID-19 stress mediating this pathway. Further, approach coping strategies moderated the association between COVID-19 stress and later anxiety symptoms such that higher levels of coping associated with greater rates of later anxiety symptoms, while lower levels of coping associated with less anxiety symptoms later. Avoidant coping strategies also moderated these associations, such that greater use associated with greater depressive and anxious symptomology later. These findings emphasize that parents are experiencing worsening mental health following the onset of the pandemic and that there is an urgent need for increased mental health services to assist families during this time.

Efficacy of Internet-Based Cognitive Behavioral Therapy for Depression and Anxiety among Global Population during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis of a Randomized Controlled Trial Study

Background: Depression and anxiety have become the most common mental health disorders worldwide during the COVID-19 pandemic, and increasing interest in telemedicine has led to the innovation of using internet-based cognitive behavioral therapy (iCBT). Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of iCBT for depression and anxiety among the global population during the COVID-19 pandemic. Methods: A literature search was conducted on PubMed, Scopus, Cochrane, ProQuest, Wiley, and Web of Science using the PRISMA framework, and only randomized controlled trials (RCTs) were included in the study. A critical appraisal was also performed using Cochrane’s Risk of Bias (RoB) 2. The meta-analysis used random-effects models to analyze pooled mean difference (MD) and its p-value. Results: Twelve RCTs were included for qualitative analysis and nine RCTs, which yielded 6778 patients with depression and 6556 patients with anxiety during the COVID-19 pandemic, were included for quantitative analysis. Despite high heterogeneity, all studies had a low risk of bias. Pre- and post-iCBT intervention in the depression forest plot depicts a significant effect (p < 0.00001) with a pooled MD of 4.73 (95% CI: 4.55−4.90), while the pre- and post-iCBT intervention depicts a significant effect (p < 0.00001) with a pooled MD of 4.50 (95% CI: 4.34−4.67). This demonstrates that iCBT was found to significantly decrease depression and anxiety scores in patients during the COVID-19 pandemic. However, substantial heterogeneity was also found (I2 = 93%; p < 0.00001 and I2 = 90%) for the pre-/post-depression and anxiety forest plots, respectively. Conclusions: This meta-analysis comprises an evidence-based result for iCBT to treat depression and anxiety in the COVID-19 population, as indicated by the significantly lower assessment scores. Delivering iCBT in this situation needs to be considered more extensively, as it has promising results and yields the benefits of technological advancement in psychotherapy.

Age, Motivation, and Emotion Regulation Skills Predict Treatment Outcome in an Internet-Based Self-Help Intervention for COVID-19 Related Psychological Distress

Introduction

First evidence suggests that internet-based self-help interventions effectively reduce COVID-19 related psychological distress. However, it is yet unclear which participant characteristics are associated with better treatment outcomes. Therefore, we conducted secondary analyses on data from a randomized controlled trial investigating the efficacy of a 3-week internet-based self-help intervention for COVID-19 related psychological distress. In this exploratory analysis, we examined several predictors ranging from sociodemographic variables to psychological distress, resource-related, and treatment-related variables. This includes, for example, age, motivation, and emotion regulation skills. Treatment outcomes were defined as post-treatment depressive symptoms and post-treatment resilience.

Methods

In a total of 107 participants with at least mild depressive symptoms, possible predictor variables and treatment outcomes were assessed using self-report measures. For example, emotion regulation skills were assessed by the Self-report measure for the assessment of emotion regulation skills. In a first step, we performed a separate linear regression analysis for each potential predictor. In a second step, predictors meeting a significant threshold of p < 0.05 were entered in linear multiple regression models. Baseline scores of the respective outcome measure were controlled for.

Results

The mean age of the participants was 40.36 years (SD = 14.59, range = 18–81 years) with the majority being female (n = 87, 81.3%). Younger age predicted lower post-treatment depressive symptoms. Additionally, higher motivation to use the intervention and better pre-treatment emotion regulation skills predicted higher post-treatment resilience.

Conclusion

The current study provides preliminary evidence regarding the relationship between participant characteristics and treatment outcome in internet-based self-help interventions for COVID-19 related distress. Our results suggest that under the circumstances surrounding COVID-19 such interventions might be particularly beneficial for young adults regarding depressive symptoms. Moreover, focusing on participants' existing strengths might be a promising approach to promote resilience through internet-based self-help interventions. However, since this was an exploratory analysis in an uncontrolled setting, further studies are needed to draw firm conclusions about the relationship of participant characteristics and treatment outcome in internet-based self-help interventions for COVID-19 related psychological distress.

Synthesizing Stakeholders Perspectives on Online Psychological Interventions to Improve the Mental Health of the Italian Population during the COVID-19 Pandemic: An Online Survey Study

The COVID-19 pandemic is expected to significantly increase the prevalence of mental health problems, thus raising the need for psychological support interventions around the world. Online psychological interventions have already been shown to be an effective solution to promote psychological treatments. Nevertheless, planning and developing an online intervention, involving possible stakeholders, might facilitate the dissemination of, willingness to use, and success of the future intervention. This study aims to explore and compare the experiences that Italians living in Italy and abroad had with available support services during the COVID-19 pandemic, their needs, and attitudes, as well as possible barriers to online psychological interventions. A sample of 1024 Italians (F = 69.8%; mean age = 41.3; SD = 15.3) was recruited through social media platforms and personal contacts and they were asked to complete an online survey. Results showed that perceived psychological distress during the COVID-19 pandemic improved. In Europe, psychological support was delivered mainly in person (69.0%), while online interventions were primarily used in extra-European countries (57%). Then, only 44% of the total sample was interested in trying an online psychological intervention. Various advantages and disadvantages were defined by stakeholders: The main advantages were the reduction in geographical distances, economic reasons, and the reduction in the waiting list; The main disadvantages were problems with technology, low motivation of users, and privacy/safety reasons. These data made it possible to improve the knowledge regarding the views and attitudes that Italians have about online psychological interventions, and shed light on how to increase the uptake of digital health.

Psychological Interventions in a Pandemic Emergency: A Systematic Review and Meta-Analysis of SARS-CoV-2 Studies

Background: The study aim was to review the evidence and effectiveness of psychological interventions applied during Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. Methods: A literature search was run from April 2020 to April 2021. The inclusion criteria were: (1) RCTs or observational studies; (2) professional health carers and patients who had contracted coronavirus during the pandemic; (3) adults and elderly people with a viral infection diagnosis; (4) suitable measures to assess intervention effectiveness on clinical status and psychological and behavioral aspects. An internal validity assessment was planned using robvis. Data were synthesized according to PICO criteria. Results: A total of 12 studies were selected. Studies measuring mental health outcomes demonstrated the greatest reduction in symptoms, with eight out of the twelve studies demonstrating a reduction in symptoms that reached statistical significance (p < 0.05) and four of the studies reaching a higher significance level of p < 0.01. The type of psychological intervention was predominantly cognitive behavioral therapy (CBT). All studies except one was run online. Conclusion: Psychological interventions have a benefit on mental health outcomes, even if performed online. In particular, CBT seems to be the psychological intervention that is used more and also seems to have a larger effect size on the mitigation of mental health symptoms and increasing resilience.

Therapeutic Alliance in Online and Face-to-face Psychological Treatment: Comparative Study

BACKGROUND

Since the COVID-19 pandemic, the number of online mental health treatments have grown exponentially. Additionally, it seems inevitable that this technical resource is here to stay at health centers. However, there is still very little scholarly literature published on this topic, and therefore, the impact of the changes that have had to be dealt with in this regard has not been studied.

OBJECTIVE

This study aims to evaluate the differences in the establishment of the therapeutic alliance (TA) based on the intervention modality (online or face-to-face), the type of attachment, and diagnosis.

METHODS

A total of 291 subjects participated in the study, 149 (51.2%) of whom were men and 142 were (48.8%) women between the ages of 18 and 30 years. The instruments used were sociodemographic data, SOFTA-o (System for Observing Family Therapeutic Alliances-observational), and Relationship Questionnaire.

RESULTS

The results show that the treatments conducted face-to-face obtain significantly better scores in the creation of the TA than those conducted online (t=-42.045, df=289, P<.001). The same holds true with attachment, in that users with secure attachment show a better TA than those with insecure attachment (t=6.068, P<.001,), although there were no significant differences with the diagnosis (F=4.566, P=.44), age (r=0.02, P=.70), and sex (t=0.217, P=.33).

CONCLUSIONS

We believe that professionals are not yet prepared to conduct remote treatment with a degree of efficacy similar to that of face-to-face. It is essential for professionals to receive training in this new technical resource and to understand and incorporate the variants it entails into their daily practice.

Effects of COVID-19 Mental Health Interventions Among Children, Adolescents, and Adults Not Quarantined or Undergoing Treatment Due to COVID-19 Infection: A Systematic Review of Randomised Controlled Trials

OBJECTIVES

Our objective was to assess the effects of mental health interventions for children, adolescents, and adults not quarantined or undergoing treatment due to COVID-19 infection.

METHODS

We searched 9 databases (2 Chinese-language) from December 31, 2019, to March 22, 2021. We included randomised controlled trials of interventions to address COVID-19 mental health challenges among people not hospitalised or quarantined due to COVID-19 infection. We synthesized results descriptively due to substantial heterogeneity of populations and interventions and risk of bias concerns.

RESULTS

We identified 9 eligible trials, including 3 well-conducted, well-reported trials that tested interventions designed specifically for COVID-19 mental health challenges, plus 6 other trials with high risk of bias and reporting concerns, all of which tested standard interventions (e.g., individual or group therapy, expressive writing, mindfulness recordings) minimally adapted or not specifically adapted for COVID-19. Among the 3 well-conducted and reported trials, 1 (N  =  670) found that a self-guided, internet-based cognitive-behavioural intervention targeting dysfunctional COVID-19 worry significantly reduced COVID-19 anxiety (standardized mean difference [SMD] 0.74, 95% confidence interval [CI], 0.58 to 0.90) and depression symptoms (SMD 0.38, 95% CI, 0.22 to 0.55) in Swedish general population participants. A lay-delivered telephone intervention for homebound older adults in the United States (N  =  240) and a peer-moderated education and support intervention for people with a rare autoimmune condition from 12 countries (N  =  172) significantly improved anxiety (SMD 0.35, 95% CI, 0.09 to 0.60; SMD 0.31, 95% CI, 0.03 to 0.58) and depressive symptoms (SMD 0.31, 95% CI, 0.05 to 0.56; SMD 0.31, 95% CI, 0.07 to 0.55) 6-week post-intervention, but these were not significant immediately post-intervention. No trials in children or adolescents were identified.

CONCLUSIONS

Interventions that adapt evidence-based strategies for feasible delivery may be effective to address mental health in COVID-19. More well-conducted trials, including for children and adolescents, are needed.

Internet-Based Psychological Interventions during SARS-CoV-2 Pandemic: An Experience in South of Italy

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to an increasing demand for online psychological intervention. The aim of this study is to evaluate the efficacy of received support in internet-based psychological intervention group (I-IG) patients, compared with a wait-list control group (CG). The Impact of Event Scale—Revised, Patient Health Questionnaire 9-item and Generalized Anxiety Disorder scale 7-item were administered. After participants had used the internet-based solution, the System Usability Scale was administered. In total, 221 patients (194 patients supported by internet-based interventions and 27 patients supported onsite) were included in intervention group, and 194 patients were included in CG. In a 6-month follow-up, participants in the I-IG demonstrated significant improvements in terms of PTSD risk (p < 0.0001, d = 0.64), depression (p < 0.0001, d = 0.68), and anxiety (p < 0.0001, d = 1.33), compared to the CG. Significant improvements in onsite intervention group patients with a large to very large effect size of PTSD risk (p < 0.0001, d = 0.91), depression (p < 0.0001, d = 0.81), and anxiety (p < 0.0001, d = 1.62) were found. After internet-based solution use, I-IG patients reported a very high usability and functionality (72.87 ± 13.11) of online intervention. In conclusion, SARS-CoV-2-related mental health problems can be improved by internet-based psychological intervention. The usability and functionality evaluation of online solutions by technological tools showed very positive results for the I-IG patients.

Emotional Impact in Adolescents in Ecuador Six Months after the Beginning of the COVID-19 Pandemic

The COVID-19 pandemic has impacted the emotional health of adolescents, especially those with low resilience and life satisfaction. The aim is to analyze the predictors of anxiety, depression, and stress among adolescents in Ecuador during the COVID-19 pandemic.Participants were 586 adolescents from Ecuador aged between 12-18 years (M = 15.30; SD = 1.28). Satisfaction, resilience, anxiety, depression, stress and worries about COVID-19 were assessed. Structural equation models (SEM) and models based on qualitative comparative analysis (QCA) were performed. The results indicate that worries are associated with depression, anxiety, and stress. However, higher physical health worries are associated with lower emotional distress. SEM models indicate that life satisfaction is negatively associated with emotional distress. In QCA models, emotional distress is explained by high worries, low resilience, and life satisfaction. Life satisfaction plays a mediating role in emotional distress.In conclusion, adolescents are one of the groups particularly vulnerable to this situation of restriction created by COVID-19. It is necessary to detect signs of risk and protection in emotional adjustment, especially life satisfaction, that appears like principal damper variable.

Substance, use in relation to COVID-19: A scoping review

BACKGROUND

We conducted a scoping review focused on various forms of substance use amid the pandemic, looking at both the impact of substance use on COVID-19 infection, severity, and vaccine uptake, as well as the impact that COVID-19 has had on substance use treatment and rates.

METHODS

A scoping review, compiling both peer-reviewed and grey literature, focusing on substance use and COVID-19 was conducted on September 15, 2020 and again in April 15, 2021 to capture any new studies. Three bibliographic databases (Web of Science Core Collection, Embase, PubMed) and several preprint servers (EuropePMC, bioRxiv, medRxiv, F1000, PeerJ Preprints, PsyArXiv, Research Square) were searched. We included English language original studies only.

RESULTS

Of 1564 articles screened in the abstract and title screening phase, we included 111 research studies (peer-reviewed: 98, grey literature: 13) that met inclusion criteria. There was limited research on substance use other than those involving tobacco or alcohol. We noted that individuals engaging in substance use had increased risk for COVID-19 severity, and Black Americans with COVID-19 and who engaged in substance use had worse outcomes than white Americans. There were issues with treatment provision earlier in the pandemic, but increased use of telehealth as the pandemic progressed. COVID-19 anxiety was associated with increased substance use.

CONCLUSIONS

Our scoping review of studies to date during COVID-19 uncovered notable research gaps namely the need for research efforts on vaccines, COVID-19 concerns such as anxiety and worry, and low- to middle-income countries (LMICs) and under-researched topics within substance use, and to explore the use of qualitative techniques and interventions where appropriate. We also noted that clinicians can screen and treat individuals exhibiting substance use to mitigate effects of the pandemic.

FUNDING

Study was funded by the Institution for Social and Policy Studies, Yale University and The Horowitz Foundation for Social Policy. DH was funded by a NIDA grant (R01DA048860). The funding body had no role in the design, analysis, or interpretation of the data in the study.

The Effect of the Imacoco Care Psychoeducation Website on Improving Psychological Distress Among Workers During the COVID-19 Pandemic: Randomized Controlled Trial

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.

Effects of an internet-based self-help intervention for psychological distress due to COVID-19: Results of a randomized controlled trial

BACKGROUND

The COVID-19 pandemic and its far-reaching impact on physical and mental health generate high demand and, accordingly, a great need for treatment opportunities that promote well-being and manage psychological distress. Internet-based interventions are particularly suitable for this purpose. They are easily scalable, readily accessible, and the online format allows for adherence to social distancing. For this reason, we developed an internet-based self-help intervention called ROCO to address psychological distress due to the COVID-19 pandemic. This randomized controlled trial aimed to examine the efficacy of the ROCO intervention.

METHODS

A total of 107 German-speaking adults with at least mild depressive symptoms were randomized either to the intervention group with direct access to the three-week ROCO intervention plus care as usual or the waiting control group receiving care as usual. Primary outcome (depressive symptoms) and secondary outcomes (stress, anxiety, resilience, emotion regulation, health-related quality of life, embitterment, loneliness, optimism, and self-efficacy) were assessed pre- and post-treatment and at a 6-week follow-up using self-report questionnaires (e.g. Patient Health Questionnaire-9 for depressive symptoms).

RESULTS

The average age was 40.36 years (SD = 14.59) and 81.3% of participants were female. The intervention did not significantly reduce primary depressive symptoms (between-group effect size: d = 0.04) and secondary outcomes such as anxiety and stress symptoms (between-group effect size: d = -0.19). However, the intervention led to a significant increase in emotion regulation skills (between-group effect size d = 0.35) and resilience (between-group effect size d = 0.38).

CONCLUSIONS

The internet-based self-help intervention cannot be recommended for the purpose of reducing depressive symptoms. However, the increase in emotion regulation skills and resilience suggest that the intervention may be suitable for preventive purposes, like improving overall coping with psychological distress or potential stressors. Future research is needed to examine for whom and how the intervention is most effective.

Let’s color: An online coloring game improves subjective well-being and reduces anxiety during the COVID-19 pandemic (Preprint)

Background

COVID-19 has spread worldwide and generated tremendous stress on human beings. Unfortunately, it is often hard for distressed individuals to access mental health services under conditions of restricted movement or even lockdown.

Objective

The study first aims to develop an online digital intervention package based on a commercially released coloring game. The second aim is to test the effectiveness of difference intervention packages for players to increase subjective well-being (SWB) and reduce anxiety during the pandemic.

Methods

An evidence-based coloring intervention package was developed and uploaded to an online coloring game covering almost 1.5 million players worldwide in January 2021. Players worldwide participated to color either 4 rounds of images characterized by awe, pink, nature, and blue or 4 rounds of irrelevant images. Participants' SWB and anxiety and the perceived effectiveness of the game in reducing anxiety (subjective effectiveness [SE]) were assessed 1 week before the intervention (T1), after the participants completed pictures in each round (T2-T5), and after the intervention (T6). Independent 2-tailed t tests were conducted to examine the general intervention (GI) effect and the intervention effect of each round. Univariate analysis was used to examine whether these outcome variables were influenced by the number of rounds completed.

Results

In total, 1390 players worldwide responded and completed at least 1 assessment. Overall, the GI group showed a statistical significantly greater increase in SWB than the general control (GC) group (N=164, t162=3.59, Cohen d=0.59, 95% CI 0.36-1.24, P<.001). Compared to the control group, the best effectiveness of the intervention group was seen in the awe round, in which the increase in SWB was significant (N=171, t169=2.51, Cohen d=0.39, 95% CI 0.10-0.82, P=.01), and players who colored all 4 pictures had nearly significant improvements in SWB (N=171, F4,170=2.34, partial ŋ2=0.053, P=.06) and a significant decrease in anxiety (N=171, F4,170=3.39, partial ŋ2=0.075, P=.01).

Conclusions

These data indicate the effectiveness of online psychological interventions, such as coloring games, for mental health in the specific period. They also show the feasibility of applying existing commercial games embedded with scientific psychological interventions that can fill the gap in mental crises and services for a wider group of people during the pandemic. The results would inspire innovations to prevent the psychological problems caused by public emergencies and encourage more games, especially the most popular ones, to take more positive action for the common crises of humankind.

Psychological Effects of Online-Based Mindfulness Programs during the COVID-19 Pandemic: A Systematic Review of Randomized Controlled Trials

(1) Background: The COVID-19 outbreak has caused psychological problems worldwide. This review explored the psychological effects of online-based mindfulness programs during the COVID-19 pandemic. (2) Methods: This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials that were published in the English language from 1 January 2020 to 31 May 2021 on online-based mindfulness programs for psychological problems due to the COVID-19 pandemic were searched in electronic databases. Quality assessment was conducted on the retrieved RCTs using the Cochrane risk of bias tool for RCTs. (3) Results: Six RCTs were included in this review. Quality appraisal of included RCTs ranged from 1 for low risk of bias to 5 for high risk of bias. There is evidence from the six RCTs that online-based mindfulness interventions may have favorable effects for reducing the levels of psychological problems, such as anxiety, depression, and stress. (4) Conclusions: Online-based mindfulness programs may be used as complementary interventions for clinical populations, healthy individuals, and healthcare workers with psychological problems due to the COVID-19 pandemic.

Longitudinal development of depression and anxiety during COVID-19 pandemic in Germany: Findings from a population-based probability sample survey

The stress response to the COVID-19 pandemic might differ between early and later stages. Longitudinal data on the development of population mental health during COVID-19 pandemic is scarce. We have investigated mental health trajectories and predictors for change in a probability sample of the general population in Germany at the beginning and after 6 months of the pandemic. We conducted a longitudinal survey in a population-based probability sample of German adults. The current study analyzed data from a first assessment in May 2020 (T1; N = 1,412) and a second in November 2020 (T2; N = 743). Mental health was assessed in terms of anxiety and depression using the Patient Health Questionnaire-4 (PHQ-4). Mental health outcomes at T1 were compared with PHQ-4 norm data. Trajectories over time were investigated based on outcome classifications of PHQ-4 scores. Predictors of mental health outcomes and change were identified using multiple regression analysis. In spring 2020, participants showed significantly higher PHQ-4 scores as compared to the norm data, however, overall anxiety and depression remained low also 6 months later. 6.6% of respondents showed a mental health deterioration in autumn 2020, entering subclinical and clinical ranges, outweighing the proportion of people with improved outcomes. Sociodemographic variables associated with mental distress at T1 were mainly not predictive for change at T2. Even under prolonged pandemic-related stress, mental health remained mainly stable in the general population. Further development of the considerable subgroup experiencing deterioration of depression and anxiety should be monitored, in order to tailor prevention and intervention efforts.

Effectiveness of a Videoconferencing-Delivered Psychological Intervention for Mental Health Problems during COVID-19: A Proof-of-Concept Randomized Clinical Trial

INTRODUCTION

Anxiety and depression have increased markedly during the COVID-19 pandemic. There is a lack of evidence-based strategies to address these mental health needs during the pandemic.

OBJECTIVE

We aim to conduct a proof-of-concept trial of the efficacy of a brief group-based psychological intervention delivered via videoconferencing for adults in Australia distressed by the pandemic.

METHODS

In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-related psychological distress across Australia were randomly allocated to either a 6-session group-based program based on behavioural principles (n = 120) or enhanced usual care (EUC, n = 120). Primary outcome was total score on the Hospital Anxiety and Depression (HADS) anxiety and depression subscales assessed at baseline, 1 week posttreatment, 2 months (primary outcome time point), and 6 months after treatment, as well as secondary outcome measures of worry, sleep impairment, anhedonia, mood, and COVID-19-related stress.

RESULTS

Between May 20, 2020, and October 20, 2020, 240 patients were enrolled into the trial. Relative to EUC, at 2 months participants receiving intervention showed greater reduction on anxiety (mean difference, 1.4 [95% CI, 0.3 to 2.6], p = 0.01; effect size, 0.4 [95% CI, 0.1 to 0.7]) and depression (mean difference, 1.6 [95% CI, 0.4 to 2.8], p = 0.009; effect size, 0.4 [95% CI, 0.2 to 0.7]) scales. These effects were maintained at 6 months. There were also greater reductions of worry, anhedonia, COVID-19-related fears, and contamination fears.

CONCLUSIONS

This trial provides initial evidence that brief group-based behavioural intervention delivered via videoconferencing results in moderate reductions in common psychological problems arising during the COVID-19 pandemic. This program may offer a viable and scalable means to mitigate the rising mental health problems during the pandemic.