Supporting mental health during COVID-19 using a digital behaviour change intervention: an open-label, single-arm, pre-post intervention research study (Preprint)

2021 ◽  
Author(s):  
Charlotte Summers ◽  
Philip Wu
Keyword(s):  
Mental Health ◽  
Behaviour Change ◽  
Perceived Stress ◽  
Digital Health ◽  
Mental Wellbeing ◽  
Behaviour Change Intervention ◽  
Open Label ◽  
Post Intervention ◽  
Convenience Sample ◽  
Health Technologies

BACKGROUND COVID-19 is taking its toll on people's mental health, particularly as people are advised to adhere to social distancing, self-isolation measures and government imposed national lockdowns. Digital health technologies have an important role to play in keeping people connected and supporting mental health and wellbeing. Particularly in the wake of the COVID-19 pandemic as even before this unprecedented time, mental health and social services were already stretched. OBJECTIVE Our objective was to evaluate the 12-week outcomes of the digitally delivered Gro Health platform, a digital behaviour change intervention for self-management of mental wellbeing, sleep, activity, and nutrition. METHODS The study used a quasi-experimental research design consisting of an open-label, single-arm, pre-post intervention engagement using a convenience sample. From adults who had joined the intervention and had a complete baseline dataset (GAD-7 Anxiety Test Questionnaire, Perceived Stress Scale, PHQ-9 Patient Health Questionnaire), we followed all users for 12 weeks (N=273), including 33 (12.1%) who reported a positive COVID-19 diagnosis during the study period. Users engagement with the Gro Health platform was tracked by active minutes. RESULTS Of the 347 study participants, 273 (78.67%) completed both baseline and follow up surveys. Change in scores for anxiety, perceived stress and depression was predicted by app engagement with the strongest effect being seen in change perceived stress scores F(1,271)=251.397, p<0.001, with an R2 of .479. CONCLUSIONS A digital behaviour change platform that provides remote mental wellbeing support can be effective in managing depression, anxiety, and perceived stress during times of crisis such as the current COVID-19 pandemic. CLINICALTRIAL Approved by Royal Holloway, University of London Ethics Board.

Supporting mental health during COVID-19 using a digital behaviour change intervention: an open-label, single-arm, pre-post intervention research study (Preprint)

2021 ◽  
Author(s):  
Charlotte Summers ◽  
Philip Wu ◽  
Alisdair J G Taylor
Keyword(s):  
Mental Health ◽  
Behaviour Change ◽  
Perceived Stress ◽  
Digital Health ◽  
Mental Wellbeing ◽  
Behaviour Change Intervention ◽  
Open Label ◽  
Post Intervention ◽  
Convenience Sample ◽  
Health Technologies

BACKGROUND COVID-19 is taking its toll on people's mental health, particularly as people are advised to adhere to social distancing, self-isolation measures and government imposed national lockdowns. Digital health technologies have an important role to play in keeping people connected and supporting mental health and wellbeing. Particularly in the wake of the COVID-19 pandemic as even before this unprecedented time, mental health and social services were already stretched. OBJECTIVE Our objective was to evaluate the 12-week outcomes of the digitally delivered Gro Health platform, a digital behaviour change intervention for self-management of mental wellbeing, sleep, activity, and nutrition. METHODS The study used a quasi-experimental research design consisting of an open-label, single-arm, pre-post intervention engagement using a convenience sample. From adults who had joined the intervention and had a complete baseline dataset (GAD-7 Anxiety Test Questionnaire, Perceived Stress Scale, PHQ-9 Patient Health Questionnaire), we followed all users for 12 weeks (N=273), including 33 (12.1%) who reported a positive COVID-19 diagnosis during the study period. Users engagement with the Gro Health platform was tracked by active minutes. RESULTS Of the 347 study participants, 273 (78.67%) completed both baseline and follow up surveys. Change in scores for anxiety, perceived stress and depression was predicted by app engagement with the strongest effect being seen in change perceived stress scores F(1,271)=251.397, p<0.001, with an R2 of .479. CONCLUSIONS A digital behaviour change platform that provides remote mental wellbeing support can be effective in managing depression, anxiety, and perceived stress during times of crisis such as the current COVID-19 pandemic.

Computer incursion in psychiatry via e-mental health: Innovation and implications to keep in mind

2020 ◽  
pp. 33-44
Author(s):  
Sally Hardy ◽  
Fabian Van Essen ◽  
Luca Pingani
Keyword(s):  
Mental Health ◽  
Digital Health ◽  
Evidence Base ◽  
Outcome Data ◽  
Mental Wellbeing ◽  
Discussion Paper ◽  
Health Technologies ◽  
Ethical Implications ◽  
Published Evidence ◽  
The Subject

The digital health technologies have gained dramatic levels of interest and offer potential for self-managed, at scale, cost effective e-mental health. In this discussion paper, we aim to outline some of the contemporary issues arising from the computer's incursion in the field of psychiatry, as the global demand for improved mental wellbeing advances. The authors bring their personal reflections and areas of interest on the subject of e-mental health, taking into consideration both potential pitfalls and therapeutic possibilities. The paper outlines as an introduction what is meant by e-mental health and explores how it is being utilized in areas such as depression, anxiety management, alongside emergent outcome data on, for example, rates of admissions to hospital, as an initial measure of e-mental health's success. Having undertaken a review of the published evidence from the past five years, it can be seen how the subject is gaining attention, yet results are as yet limited to small numbers, and thus there is a limited evidence base. However, we also consider the implications for inclusion, through the application of e-health strategies for people living with additional neurological aspects such as intellectual disabilities, which as a population tends to limit uptake and exposure to online digital activity to date. We conclude with consideration of two critical questions on how to monitor, evaluate and regulate e-mental health activities, plus the ethical implications of e-exposure.

A Prospective, Non-randomized Feasibility and Preliminary Efficacy Study of a Telemedicine-Enabled Co-management Intervention for Adults With Type 2 Diabetes and Moderate Anxiety and/or Depression

2021 ◽  
Vol 47 (2) ◽  
pp. 144-152
Author(s):  
Michelle F. Magee ◽  
Stacey I. Kaltman ◽  
Mihriye Mete ◽  
Carine M. Nassar
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Management Program ◽  
Post Intervention ◽  
Convenience Sample ◽  
Intervention Delivery ◽  
Management Intervention ◽  
Moderate Depression ◽  
Patient Health

Purpose The primary aim of this pilot study was to examine the feasibility of codelivering a mental health intervention with an evidence-based type 2 diabetes (T2DM) boot camp care management program. The preliminary impact of participation on symptom scores for depression and anxiety and A1C was also examined. Methods This was a 12-week, non-randomized pilot intervention conducted with a convenience sample of adults with uncontrolled T2DM and moderate depression and/or anxiety at an urban teaching hospital. Co-management intervention delivery was via in-person and telehealth visits. Participants were assessed at baseline and 90 days. Results Participants (n = 18) were African American, majority female (83%), and age 50.7 ± 13.4 years. Significant improvements in mental health outcomes were demonstrated, as measured by a reduction in Patient Health Questionnaire − 9 scores of 2.4 ± 2.9 ( P = .01) and in Generalized Anxiety Disorder − 7 scores of 2.3 ± 1.9 ( P = .001). The pre-post intervention mean A1C improved by 3.4 ± 2.1 units from 12% ± 1.4% to 8.5% ± 1.7% ( P < .001). Conclusion The data generated in this pilot support the feasibility of delivering a diabetes and mental health co-management intervention using a combination of in-person and telemedicine visits to engage adults with T2DM and coexisting moderate depression and/or anxiety. Further research is warranted.

scholarly journals Mental health and wellbeing implications of the COVID-19 quarantine for disabled and disadvantaged children and young people: evidence from a cross-cultural study in Zambia and Sierra Leone

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Darren Sharpe ◽  
Mohsen Rajabi ◽  
Clement Chileshe ◽  
Sitali Mayamba Joseph ◽  
Ibrahim Sesay ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Sierra Leone ◽  
Peer Relationships ◽  
Well Being ◽  
Mental Wellbeing ◽  
Planning Tool ◽  
Income Loss ◽  
Convenience Sample ◽  
Children And Young People

Abstract Background The mental health impact of the COVID-19 pandemic and quarantining on children and young people (CYP) living in low- and middle-income countries (LMICs) has yet to be fully comprehended. CYP in LMICs are at utmost risk, given the COVID-19-related restrictions and social distancing measures, resulting in reduced access to school-based services for nutritional and mental health needs. This study examined mental health of CYP during the first COVID-19 lockdown in Zambia and Sierra Leone. Method A total of 468 disabled and disadvantaged CYP aged 12 to 25 completed a planning tool that comprised the short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), as well as open-ended questions covering social connectedness, physical distancing and educational challenges during the lockdown. The community coaches screened individuals and families who could be eligible to receive emergency aid, and based on a convenience sample following distribution of aid, recipients were invited to complete the planning tool. Results The data showed that participants in the global south have increasing anxieties and fears centred on accessing offline educational resources and income loss in the family effecting food security and their ability to return to education. Mean (SD) SWEMWBS scores for all participants in Zambia and Sierra Leone, were 19.61 (3.45) and 21.65 (2.84), respectively. Mental well-being scores were lower in females, children aged 12–14 and participants with two or more disabilities. Factors significantly associated with poor mental wellbeing in the sample were: type of disability, nationality, peer relationships, connection to others during the pandemic, knowledge about COVID-19, worry about the long-term impact of COVID-19, and the types of self-isolating. Conclusion The study shows that participants who self-reported low levels of COVID-19 health literacy also scored low on the mental wellbeing self-assessment. Yet, despite undoubted limited resources, these CYP are doing well in identifying their needs and maintaining hope in the face of the problems associated with COVID-19 in countries where stigma persists around mental ill-health.

scholarly journals Development and Evaluation of a Digital Health Intervention for Substance Use Reduction in Young Refugees With Problematic Use of Alcohol and/or Cannabis—Study Protocol for a Single-Armed Feasibility Trial

2021 ◽  
Vol 9 ◽  
Author(s):  
Laura Charlotte Fischer ◽  
Vera Kölligan ◽  
Nuri Wieland ◽  
Michael Klein
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Digital Health ◽  
Health Intervention ◽  
Target Group ◽  
Feasibility Trial ◽  
Secondary Outcome ◽  
Post Intervention ◽  
Problematic Use ◽  
Digital Interventions

Background: Refugee populations are at substantial risk of developing substance use disorder (SUD) and other mental health disorders. At the same time, refugee populations face numerous barriers to accessing mental health services. Digital interventions can address some of these issues, as emerging evidence indicates that digital interventions offer an effective, low-cost alternative with high accessibility and similar efficacy as standard SUD prevention programs. As an add-on to traditional services, they further present a viable approach to the lack of personnel available for foreign language communication in preventive and therapeutic settings. In the present study, we thus aim to develop and evaluate a digital health intervention (DHI) for the reduction of substance use for young refugees with problematic use of alcohol and/or cannabis. The intervention will be implemented in a smartphone app, translated into Arabic, English, Farsi, German, and Pashto, and is to be used stand-alone. It is based on methods from cognitive behavioral therapy, contains culturally adapted elements, provides practical information on how to deal safely with alcohol and cannabis, and motivates behavior change through increased self-reflection and behavioral, cognitive, and emotional skills-training in interactive exercises.Methods: We conduct a single-armed feasibility trial among 150 young refugees with problematic use of alcohol and/or cannabis. Participants will receive a digital screening and digital health intervention (DHI) for the reduction of problematic substance use, carried out over a 4-week time frame. The primary outcomes are the intervention's feasibility and the target population's acceptance of the intervention. The secondary outcome is a change in substance use post-intervention from baseline. Measurements are taken pre-intervention (baseline), post-intervention (after 4 weeks), and at 3- and 6-month follow-ups. We expect the intervention to be feasible and accepted by the target group.Discussion: The present study will establish to what degree the digital intervention (the “BePrepared App”) is feasible and accepted by the target group. The evaluation of an easily accessible, feasible, and accepted intervention may impact refugees' mental health and health-related consequences. It aims at overcoming barriers to preventive health care in the substance use field for underserved refugee populations as a tool within a larger set of urgently needed interventions.Trial Registration: DRKS00021095 at the “German Clinical Trials Register” (30.03.2020).

scholarly journals Preliminary Evaluation of the Engagement and Effectiveness of a Mental Health Chatbot

2020 ◽  
Author(s):  
Kate Daley
Keyword(s):  
Mental Health ◽  
Digital Health ◽  
Preliminary Evaluation ◽  
Real World Data ◽  
Post Intervention ◽  
Middle Income ◽  
Middle Income Countries ◽  
Cohen’S D ◽  
Cohen's D ◽  
Human Support

Background: Mental health difficulties are highly prevalent yet access to support is impeded by barriers of stigma, cost and availability. These issues are even more prevalent in low- and middle-income countries, and use of digital technology is one way to overcome these barriers. Digital health interventions have been shown to be effective but often struggle with low engagement rates, particularly in the absence of any human support. Chatbots could offer a scalable solution, simulating human support at a lower cost. Objective: To complete a preliminary evaluation of engagement and effectiveness of Vitalk, a mental health chatbot, at reducing anxiety, depression and stress. Methods: Real world data was analysed from 3629 Vitalk users who had completed the first phase of a Vitalk program (‘less anxiety’, ‘less stress’ or ‘better mood’). Programs were delivered through written conversation with the chatbot. Engagement was calculated from the number of responses sent to the chatbot divided by days in the program. Results: Users sent an average of 8.17 responses / day. For all three programs, target outcome scores reduced between baseline and follow up with large effect sizes for anxiety (Cohen's d = -0.85), depression (Cohen's d = -0.91) and stress (Cohen's d =-0.81). Increased engagement resulted in improved post-intervention values for anxiety and depression. Conclusion: This study highlights the potential of a chatbot to reduce mental health symptoms in the general population within Brazil. Whilst findings show promise, further research is required.

Displacement during Hurricane Sandy: The impact on mental health

2018 ◽  
Vol 16 (1) ◽  
pp. 17 ◽  
Author(s):  
Rebecca M. Schwartz, PhD ◽  
Rehana Rasul, MA ◽  
Samantha M. Kerath, MS ◽  
Alexis R. Watson, BS ◽  
Wil Lieberman-Cribbin, MPH ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Outcomes ◽  
Perceived Stress ◽  
Hurricane Sandy ◽  
Mental Health Outcomes ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Convenience Sample ◽  
Illicit Substance ◽  
The Impact

Objective: To assess the effect of displacement due to Hurricane Sandy on mental health outcomes among residents of the greater New York City (NYC) area.Design: Prospective, cross sectional.Setting: NYC area residents, including Queens, Staten Island, and Long Island.Participants: In a 4.25 year period (June 2012 to September 2016), a convenience sample of 1,615 adult residents from the greater NYC area completed validated measures of hurricane exposure (including displacement), perceived stress, depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms as well as indicators of alcohol, illicit substance, and tobacco use.Main Outcome Measures: Perceived stress, depression, anxiety and PTSD symptoms and alcohol, illicit substance, and tobacco use.Results: Multivariable analyses indicated that displaced participants were more likely to have PTSD (adjusted Odds Ratio (AOR): 2.21, 95%CI: 1.73-2.82), depression (AOR: 1.37, 95%CI: 1.05-1.79) and anxiety symptoms (AOR: 1.30, 95%CI: 1.01-1.67) and had a 1.16 unit increase in perceived stress score (SE = 0.38) compared to nondisplaced participants. Staying with friends/family vs. at a shelter was significantly associated with a 48 percent decreased odds of having PTSD symptoms (AOR: 0.52, 95%CI: 0.31-0.88) and of being a current tobacco user (AOR: 0.52, 95%CI: 0.30-0.92).Conclusions: Displacement is associated with negative mental health outcomes, particularly displacement to shelters. Disaster preparedness efforts should involve increasing mental health resources to those who are displaced and providing support services within the shelter setting.

Brief Report on the Outcomes of an Integrated Approach on Stress, Anxiety, and Persistent Pain for Veterans; Mindful Yoga and Auricular Acupuncture

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Brosmer J ◽  
◽  
Gibson J ◽  
Keyword(s):  
Mental Health ◽  
Perceived Stress ◽  
Integrated Treatment ◽  
Persistent Pain ◽  
Small Sample ◽  
Mental Health Provider ◽  
Auricular Acupuncture ◽  
Acupuncture Points ◽  
Post Intervention ◽  
Sample Mean

Objective: The aim of this study was to pilot test an integrated treatment approach, including mindful yoga and auricular acupuncture, for Veterans with overlapping mental health disorders and persistent pain. Design: A single-arm, quasi-experimental study with a 12-week intervention period. Methods: Veterans were referred to the program through their established mental health provider, which was marketed as a trauma sensitive mindful yoga program with optional auricular acupuncture for Veterans currently undergoing mental health treatment. The program consisted of 12 weekly 90-minute group yoga sessions that included mindful breathing, mindful movement, and guided relaxation. Auricular acupuncture was also offered but not required prior to each yoga session, where five acupuncture points were targeted for relaxation and stress relief. Stress, pain, and anxiety were assessed pre and post intervention using the Perceived Stress Scale, the PEG scale, and the Generalized Anxiety Disorder-7 Scale. Results: Out of fifty-five Veterans entering the program with a mental health diagnosis, twenty-seven Veterans completed the 12-week Mindful Yoga program. For those that completed the program, the average attendance was 9.5 out of 12 sessions. Means scores show improvement in perceived stress, pain, and anxiety compared with baseline scores. Statistically significant improvements were noted in both perceived stress (P = 0.0007) and anxiety (P = 0.0093). Conclusions: This study suggests that combining mindful yoga with auricular acupuncture can reduce symptoms of stress, pain, and anxiety in Veterans that commit to the program. Although this was a small sample, mean scores showed statistically significant improvements in perceived stress and anxiety and modest improvements in pain, warranting further study.

scholarly journals Enhancing Health Through Access to Nature: How Effective are Interventions in Woodlands in Deprived Urban Communities? A Quasi-experimental Study in Scotland, UK

2019 ◽  
Vol 11 (12) ◽  
pp. 3317 ◽  
Author(s):  
Catharine Ward Thompson ◽  
Aldo Elizalde ◽  
Steven Cummins ◽  
Alastair H. Leyland ◽  
Willings Botha ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Engagement ◽  
Perceived Stress ◽  
Green Space ◽  
Landscape Planning ◽  
Public Health Problem ◽  
Natural Environments ◽  
Major Public Health Problem ◽  
Post Intervention

High prevalence of poor mental health is a major public health problem. Natural environments may contribute to mitigating stress and enhancing health. However, there is little evidence on whether community-level interventions intended to increase exposure to natural environments can improve mental health and related behaviours. In the first study of its kind, we evaluated whether the implementation of a programme designed to improve the quality of, and access to, local woodlands in deprived communities in Scotland, UK, was associated with lower perceived stress or other health-related outcomes, using a controlled, repeat cross-sectional design with a nested prospective cohort. Interventions included physical changes to the woodlands and community engagement activities within the woodlands, with data collected at baseline (2013) and post-intervention (2014 and 2015). The interventions were, unexpectedly, associated with increased perceived stress compared to control sites. However, we observed significantly greater increases in stress for those living >500 m from intervention sites. Visits to nearby nature (woods and other green space) increased overall, and moderate physical activity levels also increased. In the intervention communities, those who visited natural environments showed smaller increases in stress than those who did not; there was also some evidence of increased nature connectedness and social cohesion. The intervention costs were modest but there were no significant changes in quality of life on which to base cost-effectiveness. Findings suggest factors not captured in the study may have contributed to the perceived stress patterns found. Wider community engagement and longer post-intervention follow-up may be needed to achieve significant health benefits from woodland interventions such as those described here. The study points to the challenges in evidencing the effectiveness of green space and forestry interventions to enhance health in urban environments, but also to potential benefits from more integrated approaches across health and landscape planning and management practice.

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