Disparities in COVID-19 infection, hospitalisation and death in people with schizophrenia, bipolar disorder, and major depressive disorder: a cohort study of the UK Biobank.

People with severe mental illness (SMI; including schizophrenia/psychosis, bipolar disorder (BD), major depressive disorder (MDD)) experience large disparities in physical health. Emerging evidence suggests this group experiences higher risks of infection and death from COVID-19, although the full extent of these disparities are not yet established. We investigated COVID-19 related infection, hospitalisation and mortality among people with SMI in the UK Biobank (UKB) cohort study. Overall, 447,296 participants from UKB (schizophrenia/psychosis = 1925, BD = 1483 and MDD = 41,448, non-SMI = 402,440) were linked with healthcare and death records. Multivariable logistic regression analysis was used to examine differences in COVID-19 outcomes by diagnosis, controlling for sociodemographic factors and comorbidities. In unadjusted analyses, higher odds of COVID-19 mortality were seen among people with schizophrenia/psychosis (odds ratio [OR] 4.84, 95% confidence interval [CI] 3.00-7.34), BD (OR 3.76, 95% CI 2.00-6.35), and MDD (OR 1.99, 95% CI 1.69-2.33) compared to people with no SMI. Higher odds of infection and hospitalisation were also seen across all SMI groups, particularly among people with schizophrenia/psychosis (OR 1.61, 95% CI 1.32-1.96; OR 3.47, 95% CI 2.47-4.72) and BD (OR 1.48, 95% CI 1.16-1.85; OR 3.31, 95% CI 2.22-4.73). In fully adjusted models, mortality and hospitalisation odds remained significantly higher among all SMI groups, though infection odds remained significantly higher only for MDD. People with schizophrenia/psychosis, BD and MDD have higher risks of COVID-19 infection, hospitalisation and mortality. Only a proportion of these disparities were accounted for by pre-existing demographic characteristics or comorbidities. Vaccination and preventive measures should be prioritised in these particularly vulnerable groups.

Digital mental health: challenges and next steps.

Digital innovations in mental health offer great potential, but present unique challenges. Using a consensus development panel approach, an expert, international, cross-disciplinary panel met to provide a framework to conceptualise digital mental health innovations, research into mechanisms and effectiveness and approaches for clinical implementation. Key questions and outputs from the group were agreed by consensus, and are presented and discussed in the text and supported by case examples in an accompanying appendix. A number of key themes emerged. (1) Digital approaches may work best across traditional diagnostic systems: we do not have effective ontologies of mental illness and transdiagnostic/symptom-based approaches may be more fruitful. (2) Approaches in clinical implementation of digital tools/interventions need to be creative and require organisational change: not only do clinicians and patients need training and education to be more confident and skilled in using digital technologies to support shared care decision-making, but traditional roles need to be extended, with clinicians working alongside digital navigators and non-clinicians who are delivering protocolised treatments. (3) Designing appropriate studies to measure the effectiveness of implementation is also key: including digital data raises unique ethical issues, and measurement of potential harms is only just beginning. (4) Accessibility and codesign are needed to ensure innovations are long lasting. (5) Standardised guidelines for reporting would ensure effective synthesis of the evidence to inform clinical implementation. COVID-19 and the transition to virtual consultations have shown us the potential for digital innovations to improve access and quality of care in mental health: now is the ideal time to act.

Heightened COVID-19 Mortality in People With Severe Mental Illness Persists After Vaccination: A Cohort Study of Greater Manchester Residents.

BACKGROUND AND HYPOTHESIS: Previous studies show that people with severe mental illness (SMI) are at higher risk of COVID-19 mortality, however limited evidence exists regarding risk postvaccination. We investigated COVID-19 mortality among people with schizophrenia and other SMIs before, during and after the UK vaccine roll-out. STUDY DESIGN: Using the Greater Manchester (GM) Care Record to access routinely collected health data linked with death records, we plotted COVID-19 mortality rates over time in GM residents with schizophrenia/psychosis, bipolar disorder (BD), and/or recurrent major depressive disorder (MDD) from February 2020 to September 2021. Multivariable logistic regression was used to compare mortality risk (risk ratios; RRs) between people with SMI (N = 193 435) and age-sex matched controls (N = 773 734), adjusted for sociodemographic factors, preexisting comorbidities, and vaccination status. STUDY RESULTS: Mortality risks were significantly higher among people with SMI compared with matched controls, particularly among people with schizophrenia/psychosis (RR 3.18, CI 2.94-3.44) and/or BD (RR 2.69, CI 2.16-3.34). In adjusted models, the relative risk of COVID-19 mortality decreased, though remained significantly higher than matched controls for people with schizophrenia (RR 1.61, CI 1.45-1.79) and BD (RR 1.92, CI 1.47-2.50), but not recurrent MDD (RR 1.08, CI 0.99-1.17). People with SMI continued to show higher mortality rate ratios relative to controls throughout 2021, during vaccination roll-out. CONCLUSIONS: People with SMI, notably schizophrenia and BD, were at greater risk of COVID-19 mortality compared to matched controls. Despite population vaccination efforts that have prioritized people with SMI, disparities still remain in COVID-19 mortality for people with SMI.

Global Proportion of Disordered Eating in Children and Adolescents: A Systematic Review and Meta-analysis.

Importance: The 5-item Sick, Control, One, Fat, Food (SCOFF) questionnaire is the most widely used screening measure for eating disorders. However, no previous systematic review and meta-analysis determined the proportion of disordered eating among children and adolescents. Objective: To establish the proportion among children and adolescents of disordered eating as assessed with the SCOFF tool. Data Sources: Four databases were systematically searched (PubMed, Scopus, Web of Science, and the Cochrane Library) with date limits from January 1999 to November 2022. Study Selection: Studies were required to meet the following criteria: (1) participants: studies of community samples of children and adolescents aged 6 to 18 years and (2) outcome: disordered eating assessed by the SCOFF questionnaire. The exclusion criteria included (1) studies conducted with young people who had a diagnosis of physical or mental disorders; (2) studies that were published before 1999 because the SCOFF questionnaire was designed in that year; (3) studies in which data were collected during COVID-19 because they could introduce selection bias; (4) studies based on data from the same surveys/studies to avoid duplication; and (5) systematic reviews and/or meta-analyses and qualitative and case studies. Data Extraction and Synthesis: A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures: Proportion of disordered eating among children and adolescents assessed with the SCOFF tool. Results: Thirty-two studies, including 63 181 participants, from 16 countries were included in this systematic review and meta-analysis. The overall proportion of children and adolescents with disordered eating was 22.36% (95% CI, 18.84%-26.09%; P < .001; n = 63 181) (I2 = 98.58%). Girls were significantly more likely to report disordered eating (30.03%; 95% CI, 25.61%-34.65%; n = 27 548) than boys (16.98%; 95% CI, 13.46%-20.81%; n = 26 170) (P < .001). Disordered eating became more elevated with increasing age (B, 0.03; 95% CI, 0-0.06; P = .049) and body mass index (B, 0.03; 95% CI, 0.01-0.05; P < .001). Conclusions and Relevance: In this systematic review and meta-analysis, the available evidence from 32 studies comprising large samples from 16 countries showed that 22% of children and adolescents showed disordered eating according to the SCOFF tool. Proportion of disordered eating was further elevated among girls, as well as with increasing age and body mass index. These high figures are concerning from a public health perspective and highlight the need to implement strategies for preventing eating disorders.

Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression.

OBJECTIVE: To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias. DESIGN: Systematic review and meta-analysis with meta-regression. DATA SOURCES: The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group. RESULTS: Forty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=-0.946, 95% CI -1.18 to -0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=-0.998, 95% CI -1.39 to -0.61, k=20), supervised exercise interventions (SMD=-1.026, 95% CI -1.28 to -0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=-0.666, 95% CI -0.99 to -0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)). CONCLUSION: Exercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.

Thirty years of research on physical activity, mental health, and wellbeing: A scientometric analysis of hotspots and trends.

The sheer volume of research publications on physical activity, mental health, and wellbeing is overwhelming. The aim of this study was to perform a broad-ranging scientometric analysis to evaluate key themes and trends over the past decades, informing future lines of research. We searched the Web of Science Core Collection from inception until December 7, 2021, using the appropriate search terms such as "physical activity" or "mental health," with no limitation of language or time. Eligible studies were articles, reviews, editorial material, and proceeding papers. We retrieved 55,353 documents published between 1905 and 2021. The annual scientific production is exponential with a mean annual growth rate of 6.8% since 1989. The 1988-2021 co-cited reference network identified 50 distinct clusters that presented significant modularity and silhouette scores indicating highly credible clusters (Q = 0.848, S = 0.939). This network identified 6 major research trends on physical activity, namely cardiovascular diseases, somatic disorders, cognitive decline/dementia, mental illness, athletes' performance, related health issues, and eating disorders, and the COVID-19 pandemic. A focus on the latest research trends found that greenness/urbanicity (2014), concussion/chronic traumatic encephalopathy (2015), and COVID-19 (2019) were the most active clusters of research. The USA research network was the most central, and the Chinese research network, although important in size, was relatively isolated. Our results strengthen and expand the central role of physical activity in public health, calling for the systematic involvement of physical activity professionals as stakeholders in public health decision-making process.

The Potential Impact of a Public Health Approach to Improving the Physical Health of People Living with Mental Illness.

With already wide disparities in physical health and life expectancy, COVID-19 presents people with mental illness with additional threats to their health: decreased access to health services, increased social isolation, and increased socio-economic disadvantage. Each of these factors has exacerbated the risk of poor health and early death for people with mental illness post-COVID-19. Unless effective primary care and preventative health responses are implemented, the physical illness epidemic for this group will increase post the COVID-19 pandemic. This perspective paper briefly reviews the literature on the impact of COVID-19 on service access, social isolation, and social disadvantage and their combined impact on physical health, particularly cancer, respiratory diseases, heart disease, smoking, and infectious diseases. The much-overlooked role of poor physical health on suicidality is also discussed. The potential impact of public health interventions is modelled based on Australian incidence data and current research on the percentage of early deaths of people living with mental illnesses that are preventable. Building on the lessons arising from services' response to COVID-19, such as the importance of ensuring access to preventive, screening, and primary care services, priority recommendations for consideration by public health practitioners and policymakers are presented.

Thirty years of research on physical activity, mental health, and wellbeing: A scientometric analysis of hotspots and trends

The sheer volume of research publications on physical activity, mental health, and wellbeing is overwhelming. The aim of this study was to perform a broad-ranging scientometric analysis to evaluate key themes and trends over the past decades, informing future lines of research. We searched the Web of Science Core Collection from inception until December 7, 2021, using the appropriate search terms such as “physical activity” or “mental health,” with no limitation of language or time. Eligible studies were articles, reviews, editorial material, and proceeding papers. We retrieved 55,353 documents published between 1905 and 2021. The annual scientific production is exponential with a mean annual growth rate of 6.8% since 1989. The 1988–2021 co-cited reference network identified 50 distinct clusters that presented significant modularity and silhouette scores indicating highly credible clusters (Q = 0.848, S = 0.939). This network identified 6 major research trends on physical activity, namely cardiovascular diseases, somatic disorders, cognitive decline/dementia, mental illness, athletes' performance, related health issues, and eating disorders, and the COVID-19 pandemic. A focus on the latest research trends found that greenness/urbanicity (2014), concussion/chronic traumatic encephalopathy (2015), and COVID-19 (2019) were the most active clusters of research. The USA research network was the most central, and the Chinese research network, although important in size, was relatively isolated. Our results strengthen and expand the central role of physical activity in public health, calling for the systematic involvement of physical activity professionals as stakeholders in public health decision-making process.

Neurological, Psychiatric, and Psychological Implications of the COVID-19 Pandemic: Protocol for a Large-Scale Umbrella Review of Observational Studies.

The severe acute respiratory syndrome coronavirus 2 disease (SARS-CoV-2) is the most severe manifestation of the coronavirus disease 2019 (COVID-19) pandemic. Accruing evidence indicates that the COVID-19 pandemic may have profound deleterious neurological, psychiatric, and psychological outcomes. The number of systematic reviews (SRs) and meta-analyses (MAs) on this topic has grown exponentially. This protocol aims to synthesize all evidence from SRs and MAs on the associations between the COVID-19 pandemic and neuropsychiatric outcomes. The following electronic databases will be systematically searched from inception up to 15 January 2022: PubMed, Embase, APA PsycINFO, and Cochrane Reviews. An umbrella review (UR) of SRs and MAs of observational studies will be conducted. SRs and/or MAs of observational studies examining any direct or indirect association of COVID-19 with the neuropsychiatric outcomes will be deemed eligible for potential inclusion in this UR. The direct associations include the impact on the (1) prognosis of COVID-19 and (2) neuropsychiatric sequelae after COVID-19 infection. The indirect associations include the influence of the COVID-19 pandemic on the (1) treatments and (2) outcomes of neurological and psychiatric conditions associated with the COVID-19 pandemic.

Digital mental health in China: a systematic review.

Mental health problems are highly prevalent in China; however, China's mental health services lack resources to deliver high-quality care to people in need. Digital mental health is a promising solution to this short-fall in view of the population's digital literacy. In this review, we aim to: (i) investigate the effectiveness, acceptability, usability, and safety of digital health technologies (DHTs) for people with mental health problems in China; (ii) critically appraise the literature; and (iii) make recommendations for future research directions. The databases MEDLINE, PsycINFO, EMBASE, Web of Science, CNKI, WANFANG, and VIP were systemically searched for English and Chinese language articles evaluating DHTs for people with mental health problems in mainland China. Eligible studies were systematically reviewed. The heterogeneity of studies included precluded a meta-analysis. In total, 39 articles were retrieved, reporting on 32 DHTs for various mental health problems. Compared with the digital mental health field in the West, the Chinese studies targeted schizophrenia and substance use disorder more often and investigated social anxiety mediated by shame and culturally specific variants, DHTs were rarely developed in a co-production approach, and methodology quality was less rigorous. To our knowledge, this is the first systematic review focused on digital mental health in the Chinese context including studies published in both English and the Chinese language. DHTs were acceptable and usable among Chinese people with mental health problems in general, similar to findings from the West. Due to heterogeneity across studies and a paucity of robust control trial research, conclusions about the efficacy of DHTs are lacking.

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality.

As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies - such as smartphone apps, vir-tual reality, chatbots, and social media - have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions - including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders - as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.

The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial.

BACKGROUND: It is currently unknown whether exergaming is efficacious in people with major neurocognitive disorder (MNCD) residing in long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality of life, and daily life functioning in people with MNCD residing in long-term care facilities. METHODS: Participants were randomly assigned to 8 weeks, three times weekly, 15 min of exergaming versus watching preferred music videos. The exergame device consisted of a pressure-sensitive step training platform on which participants performed stepping movements to play the games. The device automatically adapted the training level to the participants' capabilities. The Short Physical Performance Battery (SPPB), step reaction time test (SRTT), Montréal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Dementia Quality of Life (DQoL), and Katz Activities of Daily Living (Katz ADL) were assessed at baseline and post-intervention. A Quade's non-parametric ANCOVA controlling for baseline values with post hoc Bonferroni correction (p < 0.00625) was used to analyze pre- and post-differences between the groups. Partial eta-squared (η2p) effect sizes were calculated. RESULTS: Forty-five of 55 randomized inpatients with mild to moderate MNCD (Mini-Mental State Examination score = 17.2 ± 4.5; aged 70-91; 35 women) completed the study. The exergame group (n = 23) demonstrated improvements in gait speed (p < 0.001, η2p = 0.41), total SPPB (p < 0.001, η2p = 0.64), SRTT (p<0.001, η2p = 0.51), MoCA (p<0.001, η2p = 0.38), and reductions in CSDD (p<0.001, η2p = 0.43) compared to the control group (n = 22). There were no differences in NPI (p = 0.165, η2p = 0.05), DQoL (p = 0.012, η2p = 0.16), and ADL (p = 0.008, η2p = 0.16) post-intervention scores between the experimental and control group, albeit DQol and ADL measures showed large effect sizes in the exergame group. The mean attendance rate was 82.9% in the exergame group and 73.7% in the music control group. There were no study-related adverse events reported by the participants, nor observed by the research team. CONCLUSIONS: The findings of this pilot RCT suggest that an individually adapted exergame training improves lower extremity functioning, cognitive functioning and step reaction time and symptoms of depression in inpatients with MNCD residing in long-term care facilities. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04436302.

Alcohol use and mental health during COVID-19 lockdown: A cross-sectional study in a sample of UK adults.

BACKGROUND: The aim was to examine the correlates of increased alcohol consumption during the COVID-19 pandemic-related restrictions that were implemented in a sample of UK adults. METHODS: This paper presents analyses of data from a cross-sectional study. Adults aged 18 years and over, residing in the UK and self-isolating from others outside their own household were eligible to participate. Participants reported increase or no increase in their level of alcohol consumption from before to during lockdown, as well as symptoms of anxiety, depression and mental wellbeing. Socio-demographic characteristics were compared between adults with and without reported increased alcohol consumption. The associations between reported increased alcohol consumption and mental health outcomes were investigated using logistic and linear regression analyses. RESULTS: 691 adults (61.1 % women; 48.8 % aged 35-64 years) were included in the analysis. Of these, 17 % reported increased alcohol consumption after lockdown. A higher proportion of 18-34-year olds reported increased alcohol consumption compared to older groups. The prevalence of poor overall mental health was significantly higher in individuals with increased alcohol consumption (vs. no increase) (45.4 % versus 32.7 %; p-value = 0.01). There was a significant association between increased alcohol consumption and poor overall mental health (OR = 1.64; 95 % CI = 1.01, 2.66), depressive symptoms (unstandardized beta = 2.93; 95 % CI = 0.91, 4.95) and mental wellbeing (unstandardized beta=-1.38; 95 % CI=-2.38, -0.39). CONCLUSIONS: More than one in six UK adults increased their alcohol consumption during lockdown and a higher proportion of these were younger adults. Increased alcohol consumption was independently associated with poor overall mental health, increased depressive symptoms and lower mental wellbeing. These findings highlight the importance of planning targeted support as we emerge from lockdown and plan for potential second and subsequent waves.

Combating the Dangers of Sedentary Activity on Child and Adolescent Mental Health During the Time of COVID-19.

Although the impact of the coronavirus disease 2019 (COVID-19) pandemic, subsequent quarantine, and social distancing on physical activity has been covered extensively, there has been limited focus on the resulting sedentary behavior1 on existing and emerging psychopathology. This is particularly disconcerting regarding children and adolescents, who rely on the ability to play to meet developmental milestones and who require more exercise than adults. Youth populations have been significantly disrupted by school closures and home confinement and are in developmental periods that overlap with the emergence of serious mental illness. Therefore, it is important to consider the mental health consequences for youths, and also explore ways to combat sedentary activity for this vulnerable population.

Associations of moderate to vigorous physical activity and sedentary behavior with depressive and anxiety symptoms in self-isolating people during the COVID-19 pandemic: A cross-sectional survey in Brazil.

This is a cross-sectional study evaluating the associations of self-reported moderate to vigorous physical activity, and sedentary behavior with depressive, anxiety, and co-occurring depressive and anxiety symptoms (D&A) in self-isolating Brazilians during the COVID-19 pandemic. Depressive and anxiety symptoms were collected using the Beck Depression and Anxiety Inventories (BDI and BAI). Among the 937 participants (females=72.3%), those performing ≥30 min/day of moderate to vigorous or ≥15 min/day of vigorous physical activity had lower odds of prevalent depressive, anxiety, and co-occurring D&A symptoms. Those spending ≥10 h/day sedentary were more likely to have depressive symptoms.

The relationship between physical activity and mental health in a sample of the UK public: A cross-sectional study during the implementation of COVID-19 social distancing measures.

AIM: The aim of the present study was to investigate the cross-sectional association between physical activity levels with depressive symptoms, anxiety symptoms, and positive mental well-being in a sample of the UK public social distancing owing to COVID-19. METHOD: This paper presents pre-planned interim analyses of data from a cross-sectional epidemiological study. Levels of physical activity during COVID-I9 social distancing were self-reported. Mental health was measured using the Beck Anxiety and Depression Inventory. Mental wellbeing was measured using The Short Warwick-Edinburgh Mental Well-being Scale. Participants also reported on sociodemographic and clinical data. The association between physical activity and mental health was studied using regression models. RESULTS: 902 adults were included in this study (63.8% of women and 50.1% of people aged 35-64 years). After adjusting for covariates, there was a negative association between moderate-to-vigorous physical activity per day in hours and poor mental health (OR = 0.88, 95% CI = 0.80-0.97). Similar findings were obtained for moderate-to-severe anxiety symptoms, moderate-to-severe depressive symptoms and poor mental wellbeing. CONCLUSIONS: In the present sample of UK adults social distancing owing to COVID-19 those who were physically active have better overall mental health. Owing, to the cross-sectional design of the present study the direction of the association cannot be inferred.

Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow.

As interest in and use of telehealth during the COVID-19 global pandemic increase, the potential of digital health to increase access and quality of mental health is becoming clear. Although the world today must "flatten the curve" of spread of the virus, we argue that now is the time to "accelerate and bend the curve" on digital health. Increased investments in digital health today will yield unprecedented access to high-quality mental health care. Focusing on personal experiences and projects from our diverse authorship team, we share selected examples of digital health innovations while acknowledging that no single piece can discuss all the impressive global efforts past and present. Exploring the success of telehealth during the present crisis and how technologies like apps can soon play a larger role, we discuss the need for workforce training, high-quality evidence, and digital equity among other factors critical for bending the curve further.