COVID-19 pandemic: influence of relationship status on stress, anxiety, and depression in Canada.

OBJECTIVE: To examine the impact of relationship status on levels of stress, anxiety, and depression during the coronavirus (COVID-19) pandemic to identify relationship status groups who are at greater risk of mental health difficulties. METHODS: The sample was drawn from individuals who subscribed to the Text4Hope program, a cognitive behavioral therapy inspired text messaging service developed to support Albertans during the COVID-19 pandemic. A survey link was sent to the subscribers to ascertain their relationship status and assess psychopathology using the Perceived Stress Scale-10 (PSS-10), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9). Data analysis was carried out using SPSS-26 for descriptive statistics. RESULTS: Within the first 6 weeks of the pandemic, 8267 of 44·992 subscribers responded to the online survey giving a response rate of 19.4%. Mean scores on the PSS, GAD-7, and PHQ-9 were highest among those who were single and lowest among those who were widowed. Overall, mean scores on the PHQ-9 were higher in groups who self-identified as separated or divorced when compared with groups who identified as having partners, including the categories of married or cohabiting. CONCLUSIONS: Relationship status during the COVID-19 pandemic has an influence on the mental health of individuals. Our findings highlight relationship groups at risk of mental health problems during the pandemic and for whom treatments and mitigation should be targeted.

Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature.

BACKGROUND: The number of readmissions to the emergency department (ED) for mental health services each year is significant, which increases healthcare costs and negatively affects the morale and quality of life of patients and their families. OBJECT: This scoping review aimed to establish a better understanding of interventions that have been implemented to reduce psychiatric patient readmission and ED use within the ED, to identify areas for improvement, and therefore to assist in the development of more effective actions in the future. METHOD: The scoping review was conducted on several bibliographic databases to identify relevant studies. Two researchers independently screened and reviewed titles, abstracts, and full-text articles that met the inclusion criteria. Using Covidence software, 26 out of 6951 studies were eligible for inclusion in this scoping review based on the PRISMA checklist. Data were extracted, collated, summarized, presented, and discussed. RESULT: This review identified 26 studies which examined interventions aimed to reduce ED visits, such as the High Alert Program (HAP), the Patient-Centered Medical Home (PCMH), the Primary Behavioral Health Care Integration (PBHCI), and the Collaborative Care (CC) Program, etc. Twenty-three of the studies were conducted in North America, while the rest were conducted in Europe and Australia. A total of 16 studies examined interventions directed to any mental health conditions, while the rest addressed specific health conditions, such as substance use disorders, schizophrenia, anxiety, depression. Interventions involved comprehensive and multidisciplinary services, incorporation of evidence-based behavioral and pharmacological strategies, and emphasized the case management that was found to be effective. Additionally, there was a marked consideration for diverse mental health groups, such as those with substance use disorder and of young age. Most interventions showed a positive effect on reducing psychiatric ED visits. CONCLUSION: Various initiatives have been implemented worldwide to reduce the number of emergency department visits and the associated burden on healthcare systems. This review highlights the greater need for developing more accessible interventions, as well as setting up a comprehensive community health care system aiming to reduce frequent ED presentations.

Text4Hope Effectiveness in Reducing Psychological Symptoms among Young Adults in Canada: Longitudinal and Naturalistic Controlled Program Evaluation.

BACKGROUND: Chronic stress, anxiety, and depression are psychological problems that can hurt young adults, interfering with their everyday function, academic achievement, and interpersonal relationships. This study aimed to assess the impact of Text4Hope, an online mental health service, on the psychological well-being of young adults. METHODS: This study adopted both longitudinal and naturalistic controlled trial designs. It examined clinical outcomes in young adult (≤26 years old) subscribers of Text4Hope who completed surveys at baseline and six weeks and compared clinical parameters in two groups of subscribers. The first group comprised the intervention group (IG) (young adult subscribers who received once-daily supportive text messages for six weeks and completed sixth-week evaluation measures between 26 April and 12 July 2020), and the second group was the control group (CG) (young adult subscribers who joined Text4Hope in the same time frame and completed a baseline survey and were yet to receive any text messages). The prevalence of moderate to high stress, anxiety, and depression was measured at baseline and six weeks in the longitudinal study and between the two groups for the naturalistic controlled study using the Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder 7-item (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Inferential statistics, including the t-test, McNemar test, chi-square, and binary logistic regression analyses, were used to evaluate the differences in the prevalence and severity of the psychological symptoms. RESULTS: In the longitudinal study, of the 9214 subscribers to Text4Hope who completed the baseline survey, 1047 (11.4%) were identified as youth. For the young adult subscribers who completed both the baseline and sixth-week surveys (n = 114), a significant reduction in the prevalence of moderate to high stress (8%) and likely GAD (20%) from baseline to six weeks was reported. Similarly, there was a significant reduction in the mean scores on the PSS-10, GAD-7, and Composite Mental Health score but not the PHQ-9 from baseline to six weeks. The largest reduction in mean scores was for the GAD-7 scale (18.4%), with a small effect size overall. For the naturalistic study, the IG included 173 young adult subscribers of Text4Hope who completed the sixth-week survey compared to 92 subscribers in the CG who completed the baseline survey during the designated period. There was a significantly lower prevalence for likely Moderate Depressive Disorder (MDD) (25.2%) and suicidal thoughts/thoughts of self-harm (48.4%), with a small effect size in the IG compared to the CG. Similarly, lower mean scores were reported for all outcome variables in the IG compared to the CG, with a small to medium effect size. The receipt of daily supportive text messages for six weeks resulted in significantly lower odds of both likely GAD and experiencing thoughts of self-harm or death wish while controlling for sociodemographic characteristics. CONCLUSIONS: The Text4Hope service is an effective tool for mental health support for young adult subscribers. Young adults receiving the service exhibited a reduction in psychological symptoms, including thoughts of self-harm or death wish. This population-level intervention program can be used to effectively support young adult mental health and in suicide prevention programs.

Prevalence and correlates of cannabis abuse among residents in the community of Fort McMurray, a city in Northern Alberta which had endured multiple natural disasters.

Background: Cannabis is one of the widely used drugs for relaxation and may be abuse among users. Researchers have given attention to cannabis use among the general population while vulnerable populations who have experience multiple traumas may be at risk of cannabis abuse. Other factors may influence cannabis abuse among people exposed to traumas. Objective: The study aims to determine the prevalence and correlates of self-reported cannabis abuse among residents of Fort McMurray, a city in Northern Alberta, Canada. Methods: A cross-sectional survey was conducted using an online questionnaire. Sociodemographic data, trauma exposure, and clinical characteristics were collected to identify the possible risk factor of cannabis abuse. Data were analyzed with SPSS version 25 using a chi-square test and binary logistic regression analysis. Correlation analysis was also performed to ascertain likely cannabis abuse and the association with other mental health conditions. Results: Overall, participants who completed the survey were one hundred and eighty-sixed out of the two hundred and forty-nine residents who accessed the online survey, giving a response rate of 74.7%. The prevalence of self-reported cannabis abuse among participants was 14%. Most of the participants were females (159, 85.5%), more than 40 years of age (98, 52.7%), employed (175, 94.1%), owned their house (145, 78.0%), and 103 (60.6%) reported being exposed to at least a trauma (COVID-19, flooding, or wildfire). Regarding regression analysis results, participants living in a rented accommodation were nearly four times more likely to abuse cannabis (OR = 3.86; 95% CI: 1.34-11.14) than those owning their houses. Similarly, male participants were more than 6-folds more likely to abuse cannabis than the female gender (OR= 6.25; 95% CI: 1.89-20), and participants in a relationship were six times more likely to abuse cannabis than participants not in a relationship (OR = 6.33; 95% CI: 1.67-24.39). The study also found significant association of depressive symptoms (X 2 = 4.561; p = 0.033) and anxiety symptoms (X 2 = 4.700; p = 0.030) with likely cannabis abuse. Conclusion: Demographic factors significantly predicted likely cannabis abuse in the Fort McMurray population, and cannabis abuse significantly correlated with presence of moderate to high anxiety and depression symptoms. It is essential to mobilized resources to support vulnerable communities and manage cannabis abuse.

Self-Reported Alcohol Abuse and the Desire to Receive Mental Health Counselling Predict Suicidal Thoughts/Thoughts of Self-Harm among Female Residents of Fort McMurray.

Suicidal ideation and thoughts of self-harm continue to be challenging public health problems. It is presently unknown what the prevalence and correlates of suicidal thoughts and self-harm are in female residents of Fort McMurray, a city that has endured wildfires, flooding, and the COVID-19 pandemic in the last five years. This study aimed to determine the prevalence and correlates of suicidal ideation and thoughts of self-harm among female residents of Fort McMurray. A cross-sectional study using an online survey questionnaire was used to collect sociodemographic and clinical information from the residents of Fort McMurray between 24 April and 2 June 2021. Suicidal ideation and thoughts of self-harm among females were assessed using the ninth question of the Patient Health Questionnaire-9, a validated screening tool used to assess depression symptoms. Likely generalized anxiety disorder (GAD), major depressive disorder (MDD), post-traumatic stress disorder (PTSD) and low resilience were measured using standardized rating scales. Data were analyzed with SPSS version 25 using chi-squared tests and multivariate logistic regression analysis. Among Fort McMurray residents, 249 accessed the online survey, while 186 ultimately completed it, yielding a survey completion rate of 74.7%. Of these, 159 (85%) were females. After controlling for other variables in the regression model, respondents who expressed a desire to receive mental health counselling were more than seven times more likely to report suicidal ideation and thoughts of self-harm compared to the respondents who did not desire to receive mental health counselling (OR: 7.29; 95% CI: 1.19-44.58). Similarly, respondents who reported having abused alcohol in the past year were nearly four times more likely to report suicidal ideation or thoughts of self-harm compared to the respondents who said they had not abused alcohol in the past year (OR: 3.91; 95% CI: 1.05-14.57). A high prevalence of suicidal thoughts and thoughts of self-harm were reported among female residents of Fort McMurray. Timely access to adequate mental health support should be offered to female residents of communities impacted by multiple natural disasters, particularly residents who self-report alcohol abuse or desire to receive mental health counselling.

Naturalistic randomized controlled trial demonstrating effectiveness of Text4Hope in supporting male population mental health during the COVID-19 pandemic

Background Mental illness is not uncommon among males. It is estimated that males are more likely to die by suicide, become dependent on alcohol, report frequent drug use, and be dissatisfied with their life, compared to women. In this study, we assessed the potential to offer support to this population using Text4Hope, a texting mental health service. Methods The study was a naturalistic randomized controlled trial comparing two populations of Text4Hope male subscribers;an intervention group (IG, Text4Hope subscribers who received once-daily supportive text messages for 6 weeks) and a control group (CG, Text4Hope subscribers who joined the program in the same time frame but were yet to receive text messages). Inferential statistics were used to compare the severity and the prevalence of the likely stress, anxiety, and depression, between the two groups, using the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder 7-item (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9), and defined the Composite Mental Health (CMH) score as the sum of these three. T-test, Chi-squared association, and binary logistic regression analyses were applied. Results There were 286 male subscribers to Text4Hope. The majority were above 40 years, white, employed, had postsecondary education, were in a relationship, and owned a home. Mean scores of PSS-10, GAD-7, and PHQ-9 scales and the CMH were significantly higher for the CG compared to the IG, 11.4, 28.8, 25.8, and 18.7%, respectively. Similarly, a statistically significantly lower prevalence in IG, compared to the CG, on likely MDD (58.15 vs. 37.4%) and likely GAD (50 vs. 30.8%), with a small effect size. The IG was a significant predictor for lower odds of both likely MDD and likely GAD while controlling for sociodemographic characteristics. Conclusions The Text4Hope service is an effective tool for mental health support for male subscribers during the COVID-19 pandemic. Compared to the males who didn't receive the service, those who received it were in better mental health conditions. Further effort is still needed to encourage males to participate in such online services that can help them receive adequate support, particularly during crisis times.

Prevalence and correlates of cannabis abuse among residents in the community of Fort McMurray, a city in Northern Alberta which had endured multiple natural disasters

Background Cannabis is one of the widely used drugs for relaxation and may be abuse among users. Researchers have given attention to cannabis use among the general population while vulnerable populations who have experience multiple traumas may be at risk of cannabis abuse. Other factors may influence cannabis abuse among people exposed to traumas. Objective The study aims to determine the prevalence and correlates of self-reported cannabis abuse among residents of Fort McMurray, a city in Northern Alberta, Canada. Methods A cross-sectional survey was conducted using an online questionnaire. Sociodemographic data, trauma exposure, and clinical characteristics were collected to identify the possible risk factor of cannabis abuse. Data were analyzed with SPSS version 25 using a chi-square test and binary logistic regression analysis. Correlation analysis was also performed to ascertain likely cannabis abuse and the association with other mental health conditions. Results Overall, participants who completed the survey were one hundred and eighty-sixed out of the two hundred and forty-nine residents who accessed the online survey, giving a response rate of 74.7%. The prevalence of self-reported cannabis abuse among participants was 14%. Most of the participants were females (159, 85.5%), more than 40 years of age (98, 52.7%), employed (175, 94.1%), owned their house (145, 78.0%), and 103 (60.6%) reported being exposed to at least a trauma (COVID-19, flooding, or wildfire). Regarding regression analysis results, participants living in a rented accommodation were nearly four times more likely to abuse cannabis (OR = 3.86;95% CI: 1.34–11.14) than those owning their houses. Similarly, male participants were more than 6-folds more likely to abuse cannabis than the female gender (OR= 6.25;95% CI: 1.89–20), and participants in a relationship were six times more likely to abuse cannabis than participants not in a relationship (OR = 6.33;95% CI: 1.67–24.39). The study also found significant association of depressive symptoms (X2 = 4.561;p = 0.033) and anxiety symptoms (X2 = 4.700;p = 0.030) with likely cannabis abuse. Conclusion Demographic factors significantly predicted likely cannabis abuse in the Fort McMurray population, and cannabis abuse significantly correlated with presence of moderate to high anxiety and depression symptoms. It is essential to mobilized resources to support vulnerable communities and manage cannabis abuse.

Text Messages in the Field of Mental Health: Rapid Review of the Reviews.

Background: While mental health problems constitute a worldwide concern contributing to the global rates of morbidity and mortality, conventional mental healthcare services do not meet the current needs. Text messages (TM) represent a live model that incorporates technology into health services, spanning a large number of health conditions and playing different roles that may support the current healthcare system. Objective: To examine the TM services in the field of mental health, regarding their effectiveness, feasibility, acceptability, and economic evaluation in different contexts of mental health diagnoses and during critical times, when provided to individuals with mental health symptoms/disorders. Methods: This rapid review was conducted through an online search in PubMed, Embase, PsycINFO, and Medline databases. The review targeted the review studies which examined online or mobile addiction and mental health services, utilizing TM services. The search was run from the inception up to September 30, 2021. Results: Sixty review articles met the inclusion criteria and were included in this review. All reviews were published over the last decade. The results showed that people of a young age were fairly represented, and most reviews were run over substance use disorders (SUD), including Alcohol. Most reviews examined the effectiveness outcomes of the texting service, while to a lesser extent the acceptability and feasibility, among others. Texting services were reported as effective in psychotic disorders and SUD. However, the results related to depression and anxiety were mixed. Most reviews reported a considerably high risk of bias among their included studies. High satisfaction and acceptability of the texting services were reported for patients with various mental health conditions, including those with severe mental illness. Conclusions: This rapid review highlighted the applications, usability, benefits, and satisfaction with the TM in the field of mental health. For a higher quality of evidence, future studies should consider TM interventions in the contexts with mixed results or a dearth of literature, and during critical times, such as the COVID-19 pandemic. Policy- and decision-makers, therefore, need to further support text-based services with guided investments in interventions that were evidenced to be accepted, economic and feasible.

Evaluating the Prevalence and Predictors of Moderate to Severe Depression in Fort McMurray, Canada during the COVID-19 Pandemic.

BACKGROUND: The Coronavirus disease (COVID-19) pandemic has produced adverse health consequences, including mental health consequences. Studies indicate that residents of Fort McMurray, a community which has experienced trauma from flooding and wildfires in the past, may be more vulnerable to the mental health effects of the pandemic. OBJECTIVE: This study aimed to examine the prevalence and predictors of likely Major Depressive Disorder (MDD) among residents of Fort McMurray during the COVID-19 pandemic. METHODS: A cross-sectional approach was adopted utilizing an online survey questionnaire to gather sociodemographic data, COVID-19 related data, and clinical information, including likely MDD using the Patient Health Questionnaire (PHQ-9) scale, from the residents of Fort McMurray between the period of 24 April to 2 June 2021. RESULTS: Overall, 186 individuals completed the survey out of 249 residents who accessed the online survey, yielding a completion rate of 74.7%. The prevalence of likely MDD among respondents was 45%. Respondents willing to receive mental health counselling were five times more likely to experience MDD during the COVID-19 pandemic (OR = 5.48; 95% CI: 1.95-15.40). Respondents with a history of depression were nearly five folds more likely to report MDD during the era of the pandemic than residents without a history of depression (OR = 4.64; 95% CI: 1.49-14.44). Similarly, respondents with a history of taking hypnotics (sleeping tablets) were nearly six-fold more likely to express MDD than respondents with no history of receiving sleeping tablets (OR = 5.72; 95% CI: 1.08-30.30). Finally, respondents who reported receiving only partial support from the employer had three times higher odds of having likely MDD than those who received absolute support from the employer (OR = 3.50; 95% CI: 1.24-9.82). CONCLUSION: In addition to the effect of the pandemic and other measures taken to curb the psychopathological impact of the pandemic, policymakers need to implement policies to manage individuals with preexisting mental health conditions and provide strong employer support.

Cumulative trauma from multiple natural disasters increases mental health burden on residents of Fort McMurray.

Background: Fort McMurray, a city in northern Alberta, Canada, has experienced multiple traumatic events in the last five years, including the 2016 wildfire, the 2020 floods, and the COVID-19 pandemic. Traumatic events often lead to increased mental health burdens in affected communities. Objective: To assess if the number of traumatic events experienced by residents of Fort McMurray correlates with the prevalence and severity of mental health issues experienced. Methodology: A cross-sectional study using an online survey questionnaire was used to gather demographic, trauma (wildfire, flooding, and COVID-19), and clinical information from the resident of Fort McMurray between April 24 to June 2 2021. Likely Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD) and low resilience were measured using standardised rating scales. Data were analyzed with SPSS version 26 using Chi-Square tests and multivariate regression analysis. Results: Respondents who experienced COVID-19 and either flood or wildfire traumas (N = 101) were eleven times more likely to have GAD symptoms (OR: 11.39; 95% CI: 1.43-91.04), four times more likely to have likely MDD, (OR: 3.85; 95% CI: .995-14.90), ten times more likely to have likely PTSD (OR: 10.47; 95% CI: 1.28-85.67), and low resilience (OR: 10.56; 95% CI: 1.21-92.17). Respondents who experienced COVID-19, flooding, and wildfire traumas (N = 47) were eighteen times more likely to express GAD symptoms (OR: 18.30; 95% CI: 2.20-152.45) and more than eleven times likely to have likely PTSD (OR: 11.41; 95% CI: 1.34-97.37) in comparison to the respondents who experienced COVID-19 only trauma (N = 19). Conclusion: Measures to reduce climate change and associated natural disasters could reduce the impact of cumulative trauma and associated mental health burden in vulnerable populations. It is essential that more mental health resources are mobilised to support communities impacted by multiple natural disasters. HIGHLIGHTS: The number of traumatic disasters experienced in residents of Fort McMurray five years after the 2016 wildfires, a year after the 2020 flooding, and during the COVID-19 pandemic correlates with the prevalence and severity of the mental health conditions reported in this study.

Antecedentes: Fort McMurray es una ciudad en el norte de Alberta, Canadá, que ha experimentado múltiples eventos traumáticos en los últimos cinco años, incluyendo el incendio forestal del 2016, las inundaciones del 2020 y la pandemia por la COVID-19. Los eventos traumáticos con frecuencia conducen a una mayor carga de salud mental en las comunidades afectadas. Objetivo: Evaluar si el número de eventos traumáticos experimentados por los residentes de Fort McMurray se correlacionan con la prevalencia y la severidad de los problemas de salud mental experimentados. Métodos: Se realizó un estudio transversal utilizando un cuestionario en línea para recolectar información demográfica relacionada con el trauma (incendio forestal, inundación y COVID-19) y con la información clínica de los residentes de Fort McMurray entre el 24 de abril y el 2 de junio del 2021. Se midió la probabilidad del trastorno de ansiedad generalizada (TAG), del trastorno depresivo mayor (TDM), del trastorno de estrés postraumático (TEPT) y de una baja resiliencia utilizando escalas de medición estandarizadas. Los datos fueron analizados con el programa SPSS versión 26 utilizando las pruebas de Chi cuadrado y el análisis multivariado de regresión. Resultados: Los encuestados que experimentaron la COVID-19 y los traumas por las inundaciones o los incendios forestales (N=101) tenían once veces más probabilidad de tener síntomas de TAG (OR: 11.39; 95% CI: 1.43­91.04), cuatro veces más probabilidad de tener un TDM (OR: 3.85; 95% CI:.995­14.90), diez veces más probabilidad de tener TEPT (OR: 10.47; 95% CI: 1.28­85.67) y una baja resiliencia. Los encuestados que experimentaron traumas tanto por la COVID 19, por las inundaciones y por los incendios forestales (N=47) tenían dieciocho veces más probabilidad de expresar síntomas de TAG (OR: 18.30; 95% CI: 2.20­152.45) y más de once veces la probabilidad de tener TEPT (OR: 11.41; 95% CI: 1.34­97.37) en comparación con los encuestados que experimentaron a la COVID-19 como su única experiencia traumática (N=19). Conclusiones: Las medidas para reducir el cambio climático y los desastres naturales asociados podrían reducir el impacto acumulativo de las experiencias traumáticas y la carga de salud mental asociada en poblaciones vulnerables. Es esencial que se movilicen más recursos de salud mental para brindar apoyo a las comunidades afectadas por múltiples desastres naturales.

Isolation, Economic Precarity, and Previous Mental Health Issues as Predictors of PTSD Status in Females Living in Fort McMurray During COVID-19.

Objectives: The COVID-19 pandemic represents an instance of collective trauma across the globe; as such, it is unique to our lifetimes. COVID-19 has made clear systemic disparities in terms of access to healthcare and economic precarity. Our objective was to examine the mental health repercussions of COVID-19 on adult females living in Fort McMurray, Canada in light of their unique circumstances and challenges. Method: To investigate this issue, we analyzed responses gathered from an anonymous cross-section of online survey questionnaire responses gathered from females living in the Fort McMurray area (n = 159) during the COVID-19 pandemic (April 24-June 2, 2021). This included relevant demographic, mental health history, and post-traumatic stress disorder (PTSD), as well as COVID-19 data. Chi-squared analysis was used to determine outcome relevance, and binary logistic regression was employed to generate a model of susceptibility to PTSD. Results: 159 females completed the survey. The prevalence of putative PTSD in our sample was 40.8%. A regression analysis revealed 4 variables with significant, unique contributions to PTSD. These were: a diagnosis of depression; a diagnosis of anxiety; job loss due to COVID-19; and lack of support from family and friends. Specifically, women with a previous diagnosis of either depression or anxiety were ~4-5 times more likely to present with PTSD symptomatology in the wake of COVID-19 (OR = 3.846; 95% CI: 1.13-13.13 for depression; OR = 5.190; 95% CI: 1.42-19.00 for anxiety). Women who reported having lost their jobs as a result of the pandemic were ~5 times more likely to show evidence of probable PTSD (OR = 5.182; 95% CI: 1.08-24.85). Receiving inadequate support from family and friends made the individual approximately four times as likely to develop probable PTSD (OR = 4.258; 95% CI: 1.24-14.65), while controlling for the other variables in the regression model. Conclusions: Overall, these results support our hypothesis that volatility in factors such as social support, economic stability, and mental health work together to increase the probability of women developing PTSD in response to a collective trauma such as COVID-19.

One Year after the Flood: Prevalence and Correlates of Post-Traumatic Stress Disorder among Residents in Fort McMurray.

BACKGROUND: The 2020 Fort McMurray (FMM) and area flood caused more than $228 million in insured damage, affected over 1200 structures, and more than 13,000 people were evacuated. OBJECTIVE: This study sought to determine the prevalence of post-traumatic stress disorder (PTSD)-like symptoms and the risk predictors among the population of FMM one year after the 2020 flooding. METHODS: An online quantitative cross-sectional survey was distributed to residents of FMM via REDCap between 24 April to 2 June 2021 to collect sociodemographic, clinical, and flood-related information. The PTSD checklist for DSM-5 (PCL-C) was used to assess likely PTSD among respondents. RESULTS: 186 of 249 respondents completed all essential self-assessment questionnaires in the analysis, yielding a response rate of 74.7%. The prevalence of likely PTSD was 39.6% (65). Respondents with a history of depression were more likely to develop PTSD symptoms (OR = 5.71; 95% CI: 1.68-19.36). Similarly, responders with limited and no family support after the disaster were more prone to report PTSD symptoms ((OR = 2.87; 95% CI: 1.02-8.05) and (OR = 2.87; 95% CI: 1.06-7.74), respectively). CONCLUSIONS: Our research indicated that history of depression and the need for mental health counseling significantly increased the risk of developing PTSD symptoms following flooding; family support is protective. Further studies are needed to explore the relations between the need to receive counseling and presenting with likely PTSD symptoms.

The Mental Health Impact of the COVID-19 Pandemic Among Physicians, Nurses, and Other Health Care Providers in Alberta: Cross-sectional Survey.

BACKGROUND: During the COVID-19 pandemic, threats to mental health, psychological safety, and well-being are evident, particularly among the first responders and the health care staff. OBJECTIVE: This study aims to examine the prevalence and potential predictors of the likely stress, generalized anxiety disorder, and major depressive disorder among health care workers (HCWs). METHODS: A cross-sectional survey was used through a survey link sent to gather demographic information and responses on several self-report scales, including the Perceived Stress Scale, the Generalized Anxiety Disorder 7-item scale, and the Patient Health Questionnaire-9 among HCWs enrolled in the Text4Hope program. RESULTS: The result from this study suggests that during the COVID-19 pandemic, HCWs reported a high likelihood of moderate-to-high perceived stress (n=840, 81.2%), moderate-to-severe anxiety (n=369, 38.6%), and depression (n=317, 32.7%) symptoms. Nurses and other HCWs were significantly more likely to report depressive symptoms compared to physicians (F(2, 159.47)=15.89, 95% CI -5.05 to -2.04). Younger age groups of HCWs (≤30 years) were more prone to report likely stress, anxiety, and depressive symptoms compared to HCWs 41-50 and >50 years old (odds ratio [OR] 1.82-3.03). Similarly, females and those who reported a lack of social support (separated/divorced and single) among HCWs had a higher likelihood to report likely stress and depressive symptoms, respectively (OR 1.8 and 1.6, respectively). CONCLUSIONS: This cross-sectional study explored a high level of mental health burdens during the COVID-19 pandemic among HCWs in Alberta. Levels of psychological symptoms were more noticeable in the female gender and the nursing profession.

Patients' Expectations and Experiences With a Mental Health-Focused Supportive Text Messaging Program: Mixed Methods Evaluation.

BACKGROUND: Web-based services are an economical and easily scalable means of support that uses existing technology. Text4Support is a supportive, complementary text messaging service that supports people with different mental health conditions after they are discharged from inpatient psychiatric care. OBJECTIVE: In this study, we aim to assess user satisfaction with the Text4Support service to gain a better understanding of subscribers' experiences. METHODS: This was a mixed methods study using secondary data from a pilot observational controlled trial. The trial included 181 patients discharged from acute psychiatric care and distributed into 4 randomized groups. Out of the 4 study groups in the initial study, 2 groups who received supportive text messages (89/181, 49.2% of patients), either alone or alongside a peer support worker, were included. Thematic and descriptive analyses were also performed. Differences in feedback based on sex at birth and primary diagnosis were determined using univariate analysis. The study was registered with ClinicalTrials.gov (trial registration number: NCT03404882). RESULTS: Out of 89 participants, 36 (40%) completed the follow-up survey. 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 the subscriber's sex at birth or primary diagnosis. The patients' initial expectations were either neutral or positive in relation to the expected nature or the impact of the text messages received on their mental well-being. In addition, the subscribers were satisfied with the frequency of the messages, which were received once daily for 6 consecutive months. The participants recommended more personalized messages or mutual interaction with health care personnel. CONCLUSIONS: Text4Support was generally well perceived by patients after hospital discharge, regardless of their sex at birth or mental health diagnosis. Further personalization and interactive platforms were recommended by participants that may need to be considered when designing similar future services.

COVID-19 Pandemic in a Vulnerable Population: Prevalence and Correlates of Anxiety.

BACKGROUND: The COVID-19 pandemic has produced negative mental health outcomes. These effects were more prominent in vulnerable communities that experienced prior similar disasters. The study aimed to examine the likelihood and correlates of anxiety symptoms among Fort McMurray (FMM) residents, during the COVID-19 pandemic. METHODS: A cross-sectional online survey questionnaire was applied between 24 April and 2 June 2021, at FMM, to gather sociodemographic, COVID-19, and clinical information, including generalized anxiety disorder (using GAD-7 scale). RESULTS: Overall, 186 individuals completed the survey (response rate 74.7%). Most of the respondents were females (159, 85.5%); above 40 years (98, 52.7%); employed (175, 94.1%); and in relationship (132, 71%). The prevalence of moderate-to-severe anxiety was (42.5%, 71) on GAD-7 self-reported scale. Subscribers who reported that they would like to receive mental health support; have received no family support since COVID-19 declaration; and have lost their job during the pandemic were all more likely to report moderate-to-severe anxiety (OR = 3.39; 95% CI: 1.29-8.88), (OR = 4.85; 95% CI: 1.56-15.03), and (OR = 4.40; 95% CI: 1.01-19.24), respectively. CONCLUSIONS: Anxiety levels were high among FMM residents, compared to levels before COVID-19. Clinical and social factors significantly predicted likely anxiety in the Fort McMurray population, during the COVID-19 pandemic. It is imperative that resources are mobilized to support vulnerable communities during the COVID-19 pandemic.

COVID-19 Pandemic: Influence of Gender Identity on Stress, Anxiety, and Depression Levels in Canada

Background: This cross-sectional study explored variation of the prevalence of perceived stress, depression and anxiety among different self-identified gender identity groups in the Canadian population during the early stages of the COVID-19 pandemic. Methods: Anxiety, depression, and stress were assessed using the Generalized Anxiety Disorder 7-item (GAD-7) scale, Patient Health Questionnaire-9 (PHQ-9), and Perceived Stress Scale (PSS) respectively. Data were analyzed using one-way analysis of variance. Results: There were 8267 respondents to the online survey;982 (12.0%) were male-identified, 7120 (86.9%) female-identified, and 92 (1.1%) identified as a diverse gender group. Prevalence rates for clinically meaningful anxiety (333 (41.7%), 2882 (47.6%), 47 (61.0%)), depression (330 (40.2%), 2736 (44.3%), 46 (59.7%)), and stress (702 (79.6%), 5711 (86.4%), 74 (90.2%)) were highest among respondents who self-identified as “other gender”followed by female-identified and then male-identified, respectively. There were statistically significant differences between gender groups for mean scores on GAD-7 (F (2, 6929) = 18.02, p = 0.00), PHQ-9 (F (2191.4) = 11.17, p < 0.001), and PSS (F (2204.6) = 21.13, p < 0.001). Conclusions: Gender identity differences exist in terms of the prevalence and severity of anxiety, depressive, and stress symptoms during the COVID-19 pandemic. This finding highlights the importance of incorporating self-identified gender identity in medical research, clinical practice, and policy.

Mental Health Impacts of Wildfire, Flooding and COVID-19 on Fort McMurray School Board Staff and Other Employees: A Comparative Study.

BACKGROUND: Fort McMurray, a city in northern Alberta, Canada, has experienced multiple traumas in the last five years, including the 2016 wildfire, the 2020 floods, and the COVID-19 pandemic. Eighteen months after the wildfire, major depressive disorder (MDD), generalized anxiety disorder (GAD), and Post Traumatic Stress Disorder (PTSD) symptoms were elevated among school board employees in the city. OBJECTIVE: This study aimed to compare employees of the school board and other employees of Fort McMurray in respect to the impact the 2016 wildfires, the 2019 COVID pandemic, and the 2020 floods had on their mental health. METHODOLOGY: A quantitative cross-sectional survey was conducted in Fort McMurray from 24 April to 2 June 2021. Online questionnaires were administered through REDCap and were designed to capture socio-demographic characteristics, clinical as well as wildfire, COVID-19, and flooding-related variables. Mental health outcome variables were captured using self-reported standardized assessment scales. Data were analysed with descriptive statistics, Chi-square/Fisher's Exact tests, and binary regression analysis. RESULTS: Of the 249 residents who accessed the online survey, 186 completed the survey, giving a response rate of 74.7%. Of these respondents, 93.5% (174) indicated their employment status and were included in the Chi-square analysis. Most of the respondents were female (86.2%, (150)), above 40 years (53.4%, (93)), and were in a relationship (71.3%, (124)). The prevalence values for MDD, GAD and PTSD among respondents were 42.4%, 41.0, and 36.8%, respectively. There was a statistically significant difference between employees of the school board and other employees with respect to likely PTSD prevalence (28% vs. 45%, respectively, p < 0.05), although with other factors controlled for, in a binary logistic regression model, employer type did not significantly predict likely PTSD. CONCLUSIONS: The study has established that likely PTSD symptoms were significantly higher in other employees compared to those of school board employees. Greater exposure to the traumatic events and a greater perceived lack of support from other employers might have contributed to the significantly higher prevalence of PTSD in other employees.

Gender Differences in Satisfaction With a Text Messaging Program (Text4Hope) and Anticipated Receptivity to Technology-Based Health Support During the COVID-19 Pandemic: Cross-sectional Survey Study.

BACKGROUND: In March 2020, Text4Hope-a community health service-was provided to Alberta residents. This free service aims to promote psychological resilience and alleviate pandemic-associated stress, anxiety, and depression symptoms during the COVID-19 pandemic. OBJECTIVE: This study aimed to evaluate the feedback, satisfaction, experience, and perceptions of Text4Hope subscribers and to examine any differences based on gender after subscribers received 6 weeks of daily supportive text messages. Additionally, this study examined subscribers' anticipated receptivity to technology-based medical services that could be offered during major crises, emergencies, or pandemics. METHODS: Individuals self-subscribed to Text4Hope to receive daily supportive text messages for 3 months. Subscribers were invited to complete a web-based survey at 6 weeks postintervention to provide service satisfaction-related information. Overall satisfaction was assessed on a scale of 0-10, and satisfaction scores were analyzed using a related-measures t test. Likert scale satisfaction responses were used to assess various aspects of the Text4Hope program. Gender differences were analyzed using one-way analysis of variance (ANOVA) and Chi-square analyses. RESULTS: A total of 2032 subscribers completed the baseline and 6-week surveys; 1788 (88%) were female, 219 (10.8%) were male, and 25 (1.2%) were other gender. The mean age of study participants was 44.58 years (SD 13.45 years). The mean overall satisfaction score was 8.55 (SD 1.78), suggesting high overall satisfaction with Text4Hope. The ANOVA analysis, which was conducted using the Welch test (n=1716), demonstrated that females had significantly higher mean satisfaction scores than males (8.65 vs 8.11, respectively; mean difference=0.546; 95% CI 0.19 to 0.91; P<.001) and nonsignificantly lower satisfaction scores than other gender respondents (mean difference=-0.938; 95% CI -0.37 to 2.25; P=.15). More than 70% of subscribers agreed that Text4Hope helped them cope with stress (1334/1731, 77.1%) and anxiety (1309/1728, 75.8%), feel connected to a support system (1400/1729, 81%), manage COVID-19-related issues (1279/1728, 74%), and improve mental well-being (1308/1731, 75.6%). Similarly, subscribers agreed that messages were positive, affirmative, and succinct. Messages were always or often read by 97.9% (1681/1716) of respondents, and more than 20% (401/1716, 23.4%) always or often returned to messages. The majority of subscribers (1471/1666, 88.3%) read the messages and either reflected upon them or took a positive action. Subscribers welcomed almost all technology-based services as part of their health care during crisis or emergency situations. Text4Hope was perceived to be effective by many female subscribers, who reported higher satisfaction and improved coping after receiving text messages for 6 weeks. CONCLUSIONS: Respondents affirmed the high quality of the text messages with their positive feedback. Technology-based services can provide remotely accessible and population-level interventions that align with the recommended physical distancing practices for pandemics. Text4Hope subscriber feedback revealed high satisfaction and acceptance at 6 weeks postintervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/19292.

Recovery Following Peer and Text Messaging Support After Discharge From Acute Psychiatric Care in Edmonton, Alberta: Controlled Observational Study.

BACKGROUND: Peer support is an emotional, social, and practical help provided by nonprofessionals to assist others in sustaining health behaviors. Peer support is valued in recovery-oriented models of mental health and is becoming increasingly implemented at the organizational level. Text messaging is a relatively low-cost, high-impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users. OBJECTIVE: This study aims to evaluate the effectiveness of an innovative peer support system plus a supportive text messaging program on the recovery of discharged patients from acute psychiatric care. METHODS: This prospective, rater blinded, controlled observational study included 181 patients who were discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages only, peer support only, or peer support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale [RAS]) was completed at baseline, 6 weeks, 3 months, and 6 months. Descriptive analysis, one-way analysis of variance, and repeated measures multivariate analysis of covariance were used to examine the changes in the RAS among the study groups and over the follow-up time points. RESULTS: A total of 65 patients completed the assessments at each time point. For the overall sample, higher scores were found for the peer support plus text message condition compared with the text message only and treatment as usual condition on several scales (ie, willingness to ask for help and personal confidence and hope) and total score on the RAS, after 6 months of intervention. CONCLUSIONS: Peer support plus supportive text messaging seems to result in improved recovery compared with other interventions. It may be advisable to incorporate the two interventions as part of routine practice for patients with psychiatric disorders upon hospital discharge.

COVID-19 Pandemic: Stress, Anxiety, and Depression Levels Highest amongst Indigenous Peoples in Alberta.

This study explores differences in stress, anxiety, and depression experienced by different ethnic groups during the COVID-19 pandemic. This was a cross-sectional online survey of subscribers of the COVID-19 Text4Hope text messaging program in Alberta. Stress, anxiety, and depression were measured among Caucasian, Indigenous, Asian, and other ethnic groups using the Perceived Stress Scale (PSS)-10, Generalized Anxiety Disorder (GAD)-7, and Patient Health Questionnaire (PHQ)-9 scales, respectively. The burden of depression and stress were significantly higher in Indigenous populations than in both Caucasian and Asian ethnic groups. The mean difference between Indigenous and Caucasian for PHQ-9 scores was 1.79, 95% CI of 0.74 to 2.84, p < 0.01 and for PSS-10 it was 1.92, 95% CI of 0.86 to 2.98, p < 0.01). The mean difference between Indigenous and Asian for PHQ-9 scores was 1.76, 95% CI of 0.34 to 3.19, p = 0.01 and for PSS-10 it was 2.02, 95% CI of 0.63 to 3.41, p < 0.01. However, Indigenous participant burden of anxiety was only significantly higher than Asian participants' (mean difference for GAD-7 was 1.91, 95% CI of 0.65 to 3.18, p < 0.01). Indigenous people in Alberta have higher burden of mental illnesses during the COVID-19 pandemic. These findings are helpful for service planning and delivery.