Closing the Psychological Treatment Gap During the COVID-19 Pandemic With a Supportive Text Messaging Program: Protocol for Implementation and Evaluation

Background Coronavirus disease (COVID-19) has spread globally with far-reaching, significant, and unprecedented impacts on health and everyday life. Threats to mental health, psychological safety, and well-being are now emerging, increasing the impact of this virus on world health. Providing support for these challenges is difficult because of the high number of people requiring support in the context of a need to maintain physical distancing. This protocol describes the use of SMS text messaging (Text4Hope) as a convenient, cost-effective, and accessible population-level mental health intervention. This program is evidence-based, with prior research supporting good outcomes and high user satisfaction. Objective The project goal is to implement a program of daily supportive SMS text messaging (Text4Hope) to reduce distress related to the COVID-19 crisis, initially among Canadians. The prevalence of stress, anxiety, and depressive symptoms; the demographic correlates of the same; and the outcomes of the Text4Hope intervention in mitigating distress will be evaluated. Methods Self-administered anonymous online questionnaires will be used to assess stress (Perceived Stress Scale), anxiety (Generalized Anxiety Disorder-7 scale [GAD-7]), and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]). Data will be collected at baseline (onset of SMS text messaging), the program midpoint (6 weeks), and the program endpoint (12 weeks). Results Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, stress, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. Given the large size of the data set, machine learning and data mining methods will also be used. Conclusions This COVID-19 project will provide key information regarding prevalence rates of stress, anxiety, and depressive symptoms during the pandemic; demographic correlates of distress; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for practitioners and useful for informing policy and decision making regarding psychological interventions during the pandemic. International Registered Report Identifier (IRRID) DERR1-10.2196/19292

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Closing the Psychological Treatment Gap During the COVID-19 Pandemic With a Supportive Text Messaging Program: Protocol for Implementation and Evaluation (Preprint)

10.2196/preprints.19292 ◽

2020 ◽

Cited By ~ 1

Author(s):

Vincent Israel Opoku Agyapong ◽

Marianne Hrabok ◽

Wesley Vuong ◽

April Gusnowski ◽

Reham Shalaby ◽

...

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

User Satisfaction ◽

Text Messaging ◽

Population Level ◽

World Health ◽

Data Set ◽

Demographic Correlates ◽

The Impact ◽

Sms Text Messaging

BACKGROUND Coronavirus disease (COVID-19) has spread globally with far-reaching, significant, and unprecedented impacts on health and everyday life. Threats to mental health, psychological safety, and well-being are now emerging, increasing the impact of this virus on world health. Providing support for these challenges is difficult because of the high number of people requiring support in the context of a need to maintain physical distancing. This protocol describes the use of SMS text messaging (Text4Hope) as a convenient, cost-effective, and accessible population-level mental health intervention. This program is evidence-based, with prior research supporting good outcomes and high user satisfaction. OBJECTIVE The project goal is to implement a program of daily supportive SMS text messaging (Text4Hope) to reduce distress related to the COVID-19 crisis, initially among Canadians. The prevalence of stress, anxiety, and depressive symptoms; the demographic correlates of the same; and the outcomes of the Text4Hope intervention in mitigating distress will be evaluated. METHODS Self-administered anonymous online questionnaires will be used to assess stress (Perceived Stress Scale), anxiety (Generalized Anxiety Disorder-7 scale [GAD-7]), and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]). Data will be collected at baseline (onset of SMS text messaging), the program midpoint (6 weeks), and the program endpoint (12 weeks). RESULTS Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, stress, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. Given the large size of the data set, machine learning and data mining methods will also be used. CONCLUSIONS This COVID-19 project will provide key information regarding prevalence rates of stress, anxiety, and depressive symptoms during the pandemic; demographic correlates of distress; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for practitioners and useful for informing policy and decision making regarding psychological interventions during the pandemic. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19292

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Implementation and Evaluation of a Text Message–Based Addiction Counseling Program (Text4Hope-Addiction Support): Protocol for a Questionnaire Study

JMIR Research Protocols ◽

10.2196/22047 ◽

2020 ◽

Vol 9 (11) ◽

pp. e22047

Author(s):

Vincent Israel Opoku Agyapong ◽

Marianne Hrabok ◽

Wesley Vuong ◽

April Gusnowski ◽

Reham Shalaby ◽

...

Keyword(s):

Substance Use ◽

Depressive Symptoms ◽

Substance Use Disorders ◽

User Satisfaction ◽

Text Messaging ◽

Addiction Treatment ◽

Population Level ◽

Text Messages ◽

Anxiety And Depression ◽

Demographic Correlates

Background With the emergence of the COVID-19 pandemic, providing counseling to people with drug or alcohol addiction while maintaining physical distance has been challenging. This protocol describes the use of text messaging (as used in the Text4Hope-Addiction Support program) as a convenient, evidence-based, cost-effective, and accessible population-level mental health intervention with high user satisfaction proven in prior research. Objective The project goal is to implement a program of daily supportive text messaging (Text4Hope-Addiction Support) to reduce drug or alcohol cravings as well as anxiety and depression, typically associated with alcohol and substance use disorders. The aim of this study is to evaluate the prevalence of cravings, anxiety, and depressive symptoms; demographic correlates of the same; and the outcomes of the Text4Hope-Addiction Support intervention in mitigating cravings, anxiety, and depressive symptoms. Methods Self-administered, anonymous, online questionnaires will be used to assess cravings for the primary substance of addiction (Brief Substance Craving Scale), anxiety (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9). Data will be collected at baseline (onset of receiving text messages), program midpoint (6 weeks), and program end (12 weeks). Results As of October 2020, data collection is in progress; and it is expected to be completed by fall 2021. Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, cravings, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. Conclusions This Text4Hope-Addiction Support project will provide key information regarding the prevalence rates of cravings, anxiety, and depressive symptoms among persons with alcohol and substance use disorders; demographic correlates of cravings, anxiety, and depression; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for addiction care practitioners; it will inform the policy and decision making regarding population-level addiction treatment and support during emergencies. International Registered Report Identifier (IRRID) DERR1-10.2196/22047

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Implementation and Evaluation of a Text Message–Based Addiction Counseling Program (Text4Hope-Addiction Support): Protocol for a Questionnaire Study (Preprint)

10.2196/preprints.22047 ◽

2020 ◽

Author(s):

Vincent Israel Opoku Agyapong ◽

Marianne Hrabok ◽

Wesley Vuong ◽

April Gusnowski ◽

Reham Shalaby ◽

...

Keyword(s):

Substance Use ◽

Depressive Symptoms ◽

Substance Use Disorders ◽

User Satisfaction ◽

Text Messaging ◽

Addiction Treatment ◽

Population Level ◽

Text Messages ◽

Anxiety And Depression ◽

Demographic Correlates

BACKGROUND With the emergence of the COVID-19 pandemic, providing counseling to people with drug or alcohol addiction while maintaining physical distance has been challenging. This protocol describes the use of text messaging (as used in the Text4Hope-Addiction Support program) as a convenient, evidence-based, cost-effective, and accessible population-level mental health intervention with high user satisfaction proven in prior research. OBJECTIVE The project goal is to implement a program of daily supportive text messaging (Text4Hope-Addiction Support) to reduce drug or alcohol cravings as well as anxiety and depression, typically associated with alcohol and substance use disorders. The aim of this study is to evaluate the prevalence of cravings, anxiety, and depressive symptoms; demographic correlates of the same; and the outcomes of the Text4Hope-Addiction Support intervention in mitigating cravings, anxiety, and depressive symptoms. METHODS Self-administered, anonymous, online questionnaires will be used to assess cravings for the primary substance of addiction (Brief Substance Craving Scale), anxiety (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9). Data will be collected at baseline (onset of receiving text messages), program midpoint (6 weeks), and program end (12 weeks). RESULTS As of October 2020, data collection is in progress; and it is expected to be completed by fall 2021. Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, cravings, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. CONCLUSIONS This Text4Hope-Addiction Support project will provide key information regarding the prevalence rates of cravings, anxiety, and depressive symptoms among persons with alcohol and substance use disorders; demographic correlates of cravings, anxiety, and depression; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for addiction care practitioners; it will inform the policy and decision making regarding population-level addiction treatment and support during emergencies. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/22047

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When Words Hurt: Affective Word Use in Daily News Coverage Impacts Mental Health

Frontiers in Psychology ◽

10.3389/fpsyg.2018.01333 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 5

Author(s):

Jolie B. Wormwood ◽

Madeleine Devlin ◽

Yu-Ru Lin ◽

Lisa Feldman Barrett ◽

Karen S. Quigley

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Computational Linguistics ◽

News Coverage ◽

Physical Symptoms ◽

Physiological Reactivity ◽

Data Set ◽

Affective Content ◽

Aversive Stimuli ◽

The Impact

Media exposure influences mental health symptomology in response to salient aversive events, like terrorist attacks, but little has been done to explore the impact of news coverage that varies more subtly in affective content. Here, we utilized an existing data set in which participants self-reported physical symptoms, depressive symptoms, and anxiety symptoms, and completed a potentiated startle task assessing their physiological reactivity to aversive stimuli at three time points (waves) over a 9-month period. Using a computational linguistics approach, we then calculated an average ratio of words with positive vs. negative affective connotations for only articles from news sources to which each participant self-reported being exposed over the prior 2 weeks at each wave of data collection. As hypothesized, individuals exposed to news coverage with more negative affective tone over the prior 2 weeks reported significantly greater physical and depressive symptoms, and had significantly greater physiological reactivity to aversive stimuli.

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Closing the COVID-19 Psychological Treatment Gap for Cancer Patients in Alberta: Protocol for the Implementation and Evaluation of Text4Hope-Cancer Care (Preprint)

10.2196/preprints.20240 ◽

2020 ◽

Author(s):

Vincent Israel Opoku Agyapong ◽

Marianne Hrabok ◽

Reham Shalaby ◽

Kelly Mrklas ◽

Wesley Vuong ◽

...

Keyword(s):

Depressive Symptoms ◽

Cancer Diagnosis ◽

User Satisfaction ◽

Cancer Care ◽

Text Messaging ◽

Care Program ◽

Population Level ◽

Text Messages ◽

Anxiety And Depression ◽

Close Relatives

BACKGROUND Cancer diagnoses and treatments usually engender significant anxiety and depressive symptoms in patients, close relatives, and caregivers. Providing psychological support during the coronavirus disease (COVID-19) pandemic presents additional challenges due to self-isolation and social or physical distancing measures in place to limit viral spread. This protocol describes the use of text messaging (Text4Hope-Cancer Care) as a convenient, cost-effective, and accessible population-level mental health intervention. As demonstrated in previous research, this evidence-based program supports good outcomes and high user satisfaction. OBJECTIVE We will implement daily supportive text messaging as a way of reducing and managing anxiety and depression related to cancer diagnosis and treatment in Alberta, Canada. Prevalence of anxiety and depressive symptoms, their demographic correlates, and Text4Hope-Cancer Care–induced changes in anxiety and depression will be evaluated. METHODS Alberta residents with a cancer diagnosis and the close relatives of those dealing with a cancer diagnosis can self-subscribe to the Text4Hope-Cancer Care program by texting “CancerCare” to a dedicated text number. Self-administered, anonymous, online questionnaires will be used to assess anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS). Data will be collected at onset from individuals receiving text messages, and at the mid- and endpoints of the program (ie, at 6 and 12 weeks, respectively). Data will be analyzed with parametric and nonparametric statistics for primary outcomes (ie, anxiety and depressive symptoms) and usage metrics, including the number of subscribers and user satisfaction. In addition, data mining and machine learning analysis will focus on determining subscriber characteristics that predict high levels of symptoms of mental disorders, and may subsequently predict changes in those measures in response to the Text4Hope-Cancer Care program. RESULTS The first research stage, which was completed in April 2020, involved the creation and review of the supportive text messages and uploading of messages into a web-based text messaging service. The second stage, involving the launch of the Text4Hope-Cancer Care program, occurred in May 2020. CONCLUSIONS Text4Hope-Cancer Care has the potential to provide key information regarding the prevalence rates of anxiety and depressive symptoms in patients diagnosed or receiving care for cancer and their caregivers. The study will generate demographic correlates of anxiety and depression, and outcome data related to this scalable, population-level intervention. Information from this study will be valuable for health care practitioners working in cancer care and may help inform policy and decision making regarding psychological interventions for cancer care. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/20240

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Patients’ expectations and experiences with a mental health supportive text messaging program: a mixed-methods evaluation (Preprint)

10.2196/preprints.33438 ◽

2021 ◽

Author(s):

Reham Shalaby ◽

Wesley Vuong ◽

Ejemai Eboreime ◽

Shireen Surood ◽

Andrew Greenshaw ◽

...

Keyword(s):

Mental Health ◽

User Satisfaction ◽

Text Messaging ◽

Univariate Analysis ◽

Primary Diagnosis ◽

Text Messages ◽

Ethics Research ◽

Significant Difference ◽

Acute Psychiatric Care ◽

The Impact

BACKGROUND Web-based services are economic and easily scalable means of support that use existing technology. Text4Support is a supportive complementary texting service provided remotely to support people with different mental health conditions after they are discharged from the hospital. OBJECTIVE We aimed to assess user satisfaction with the Text4Support service for a better understanding of subscribers’ experiences METHODS This is a mixed-method assessment using quantitative and qualitative secondary data of a pilot observational controlled trial. The trial included 181 patients discharged from acute psychiatric care and distributed into four randomized groups. Out of the four study groups in the initial study, two groups were included in this analysis who received supportive text messages (89 patients), either alone or alongside peer support service. Thematic and descriptive analyses were employed. Univariate analysis was conducted to examine differences in feedback based on sex at birth and primary diagnosis. RESULTS Out of 89 participants, 39 completed the follow-up survey yielding a response rate of 40.4%. The principal findings were that Text4Support was well-perceived with a high satisfaction rate either regarding the feedback of the messages or their perceived impact. Meanwhile, there was no statistically significant difference between satisfactory items based on subscriber’s sex at birth or primary diagnosis. The initial patients’ expectations were either neutral or positive in relation to the expected nature and/or the impact of the received messages upon their mental wellbeing. Additionally, the subscribers were satisfied with the frequency of the messages as provided once daily for six consecutive months. The participants recommended more personalized messages and/or mutual interaction with healthcare personnel. CONCLUSIONS Text4Support was generally well perceived by patients after their hospital discharge, regardless of their sex at birth or mental health diagnosis. Further personalization and interactive platforms were recommended that may need to be considered when designing similar future services. CLINICALTRIAL The study received ethics approval from the Health Ethics Research Board of the University of Alberta (Ref # Pro00078427) and operational approval from Alberta Health Services, the regional health authority. All patients provided written informed consent. The study was registered with clinicaltrials.gov (Trial registration number NCT03404882).

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Social Support and Suicide Risk Among Chinese University Students: A Mental Health Perspective

Frontiers in Public Health ◽

10.3389/fpubh.2021.566993 ◽

2021 ◽

Vol 9 ◽

Author(s):

Haiyun Chu ◽

Yanjie Yang ◽

Jiawei Zhou ◽

Wenbo Wang ◽

Xiaohui Qiu ◽

...

Keyword(s):

Mental Health ◽

Social Support ◽

Depressive Symptoms ◽

University Students ◽

Indirect Effect ◽

Suicide Risk ◽

World Health ◽

Chinese University ◽

Chinese University Students ◽

The Impact

Background: World Health Organization recognizes suicide as a public health priority. This study aimed to investigate the risk life events which led university students to consider suicide and explore the protective mechanism of social support (including subjective support, objective support, and support utilization) on suicide risk.Methods: Three thousand nine hundred and seventy-two university students were recruited in Harbin, China. Social Support Rating Scale, Self-Rating Anxiety Scale, the Beck Depression Inventory, and the 25-item scale of suicide acceptability were used to collect participants' information. Descriptive statistics, Pearson's correlation, and mediation analysis were employed for statistical analysis.Results: “Drug addict,” “infected with HIV,” and “incurable illness” were the top three events that led university students to consider suicide. Social support played an important protective role against suicide risk. Subjective support and support utilization had total effects on suicide acceptability, including direct and indirect effects. Anxiety (indirect effect = −0.022, 95% CI = −0.037 ~ −0.009) and depressive symptoms (indirect effect = −0.197, 95% CI = −0.228 ~ −0.163) mediated the relationship between subjective support and suicide acceptability; meanwhile, the association between support utilization and suicide acceptability was mediated by anxiety (indirect effect = −0.054, 95% CI = −0.088 ~ −0.024) and depressive symptoms (indirect effect = −0.486, 95% CI = −0.558 ~ −0.422). However, the protective impact of objective support worked totally through decreasing anxiety (indirect effect = −0.018, 95% CI = −0.035 ~ −0.006) and depressive symptoms (indirect effect = −0.196, 95% CI = −0.246 ~ −0.143). Moreover, the mediation effects of depressive symptoms had stronger power than anxiety in the impact of social support on suicide risk.Conclusions: Among Chinese university students, suicide acceptability was elevated when there was a health scare. Social support effectively reduced suicide risk via decreasing anxiety and depressive symptoms. From the mental health perspective, families, peers, teachers, and communities should work together to establish a better social support system for university students, if necessary, help them to seek professional psychological services.

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COVID-19 Lockdown: Housing Built Environment’s Effects on Mental Health

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165973 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5973 ◽

Cited By ~ 6

Author(s):

Andrea Amerio ◽

Andrea Brambilla ◽

Alessandro Morganti ◽

Andrea Aguglia ◽

Davide Bianchi ◽

...

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Public Mental Health ◽

Interdisciplinary Approach ◽

Well Being ◽

World Health ◽

Design Strategies ◽

Housing Design ◽

Increased Risk ◽

The Impact

Since the World Health Organization (WHO) declared the coronavirus infectious disease 2019 (COVID-19) outbreak a pandemic on 11 March, severe lockdown measures have been adopted by the Italian Government. For over two months of stay-at-home orders, houses became the only place where people slept, ate, worked, practiced sports, and socialized. As consolidated evidence exists on housing as a determinant of health, it is of great interest to explore the impact that COVID-19 response-related lockdown measures have had on mental health and well-being. We conducted a large web-based survey on 8177 students from a university institute in Milan, Northern Italy, one of the regions most heavily hit by the pandemic in Europe. As emerged from our analysis, poor housing is associated with increased risk of depressive symptoms during lockdown. In particular, living in apartments <60 m2 with poor views and scarce indoor quality is associated with, respectively, 1.31 (95% CI: 1046–1637), 1.368 (95% CI: 1166–1605), and 2.253 (95% CI: 1918–2647) times the risk of moderate–severe and severe depressive symptoms. Subjects reporting worsened working performance from home were over four times more likely to also report depression (OR = 4.28, 95% CI: 3713–4924). Housing design strategies should focus on larger and more livable living spaces facing green areas. We argue that a strengthened multi-interdisciplinary approach, involving urban planning, public mental health, environmental health, epidemiology, and sociology, is needed to investigate the effects of the built environment on mental health, so as to inform welfare and housing policies centered on population well-being.

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Depressive Symptoms among Chinese Informal Employees in the Digital Era

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105211 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5211

Author(s):

Yang Cai ◽

Weiwei Kong ◽

Yongsheng Lian ◽

Xiangxin Jin

Keyword(s):

Mental Health ◽

Labor Market ◽

Depressive Symptoms ◽

Rapid Development ◽

Informal Employment ◽

Probit Regression ◽

Cross Sectional ◽

Data Set ◽

Digital Era ◽

The Impact

The mental health status of informal employees is rarely studied in China. Nowadays, new economic forms such as gig economy and platform economy are emerging with the rapid development of information and communication technology, which has brought great changes to the labor market, especially to the informal employment field. Thus, it is of great significance to investigate the depressive symptoms among informal employees in the digital era. Based on the cross-sectional data of CFPS (China Family Panel Studies, 2018), this study takes a quantitative analysis framework to explore and analyze the association between informal employment and depressive symptoms in the Chinese labor market. After screening, a data set of 8893 employees (60.5% male and 39.5% female) was established. Several statistical methods, including the Mann–Whitney test and probit regression model, were used in the sample data analysis. The results show that the prevalence of depressive symptoms among informal employees is significantly higher than that among formal employees. Depressive symptoms are highly related to informal work and other factors, such as education, physical health, household income, etc. The impact of Internet use on informal employees’ depressive symptoms is not significant. The mental health inequality between formal and informal employees still exists in the digital era, and corresponding labor market regulations and social policies should be perfected to address this issue.

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Factors associated with mental health and quality of life during the COVID-19 pandemic in Brazil

BJPsych Open ◽

10.1192/bjo.2021.62 ◽

2021 ◽

Vol 7 (3) ◽

Author(s):

Luciano Magalhães Vitorino ◽

Gerson Hiroshi Yoshinari Júnior ◽

Gabriela Gonzaga ◽

Isabela Faria Dias ◽

João Pedro Lambert Pereira ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Depressive Symptoms ◽

Anxiety Disorder ◽

Religious Coping ◽

Anxiety Symptoms ◽

Community Dwelling ◽

World Health ◽

The Impact

Background Although mental distress and quality of life (QoL) impairments because of the pandemic have increased worldwide, the way that each community has been affected has varied. Aims This study evaluated the impact of social distancing imposed by coronavirus disease-2019 (COVID-19) on Brazilians’ mental health and QoL. Method In this cross-sectional community-based online survey, data from 1156 community-dwelling adults were gathered between 11 May and 3 June 2020. We examined independent correlates of depression, anxiety and QoL, including sociodemographic and clinical characteristics, optimism/pessimism and spiritual/religious coping. Dependent variables were assessed using the 9-item Patient Health Questionnaire for depressive symptoms, the 7-item Generalized Anxiety Disorder Scale for anxiety symptoms, and the World Health Organization Quality of Life-BREF for QoL. Correlates of depressive and anxiety disorder were estimated using logistic regression. Results There were high levels of depressive symptoms (41.9%) and anxiety symptoms (29.0%) in participants. Negative spiritual/religious coping was positively correlated with depressive disorder (odds ratio (OR) = 2.14 95% CI 1.63–2.80; P < 0.001) and with anxiety disorder (OR = 2.46 95% CI 1.90–3.18; P < 0.001), and associated with worse social and environmental QoL (P < 0.001). Healthcare professionals were less likely to have depressive symptoms (OR = 0.71, 95% CI 0.55–0.93; P < 0.001). Participants with friend/family with COVID-19 scored lower on psychological and environmental QoL (P < 0.05). Participants with a longer duration of social isolation were less likely to experience anxiety disorder (OR = 0.99, 95% CI 0.98–0.99; P = 0.004). Conclusions We found high levels of depressive and anxiety symptoms and low levels of QoL in Brazil, which has become a pandemic epicentre. Several characteristics were associated with negative mental health symptoms in this study. This information may contribute to local health policies in dealing with the mental health consequences of COVID-19.

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