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.

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.

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.

Clinicians' Attitudes Toward Telepsychology in Addiction and Mental Health Services, and Prediction of Postpandemic Telepsychology Uptake: Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic has resulted in unprecedented uptake of telepsychology services; however, clinicians have mixed attitudes toward virtual technologies. OBJECTIVE: This study (1) explored clinicians' experiences of and intentions to use video, telephone, and in-person services, and (2) tested the utility of the unified theory of acceptance and use of technology (UTAUT) to predict clinicians' intentions to offer telepsychology after the COVID-19 pandemic. METHODS: Clinician satisfaction and therapeutic alliance were compared across in-person, video, and telephone services, while technology attitudes and intention to use after the pandemic were compared across video and telephone services among 118 addiction and mental health clinicians during the COVID-19 pandemic. RESULTS: Clinicians reported more positive experiences with in-person services than both virtual technologies; further, clinicians reported greater positive experiences, attitudes, and intentions to use video services than telephone services across measures. Based on the UTAUT, performance expectancy positively predicted concurrent intentions to use video services (ß=0.46; P<.001) and telephone services (ß=0.35; P<.001) after the pandemic. Social influence (ß=0.24; P=.004) and facilitating conditions (ß=0.19; P=.03) additionally predicted the intention to use telephone services. CONCLUSIONS: Clinicians rated in-person services more positively than virtual technologies, with video services perceived more positively than telephone services. Performance expectancy was the primary facilitator of the uptake of both virtual modalities.

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: 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.

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.

Prevalence, Demographic, and Clinical Correlates of Likely PTSD in Subscribers of Text4Hope during the COVID-19 Pandemic.

BACKGROUND: During the COVID-19 pandemic, people may experience increased risk of adverse mental health, particularly post-traumatic stress disorder (PTSD). METHODS: A survey measured stress, anxiety, depression, and PTSD symptoms in Text4Hope subscribers using the Perceived Stress Scale, Generalized Anxiety Disorder 7-Item Scale, Patient Health Questionnaire-9, and PTSD Checklist for DSM-5 Part 3, respectively. A Chi-square test and multivariate logistic regression were employed. RESULTS: Most respondents were 41-60 years old (49.5%), Caucasian (83.3%), with post-secondary education (92.1%), employed (70.3%), married/cohabiting/partnered (64.9%), and homeowners (71.7%). Likely PTSD was reported in 46.8% of the respondents. Those who were afraid to contract the coronavirus had a history of depression before the pandemic, and those who received counselling during the pandemic exhibited a high prevalence of likely PTSD (OR (1.7 to 2.2)). Significant lower odds of likely PTSD were observed among subscribers who received absolute support from family/friends. CONCLUSIONS: This paper presents findings on the prevalence of likely PTSD and identified vulnerable groups during the COVID-19 pandemic. Our results support the proposal that public health advice should incorporate mental health wellness campaigns aiming to reduce the psychological impact of pandemics.

Text4Hope: Receiving Daily Supportive Text Messages for 3 Months During the COVID-19 Pandemic Reduces Stress, Anxiety, and Depression.

BACKGROUND: This study reports on the changes in stress, anxiety, and depressive symptoms of subscribers after 3 months using Text4Hope, a supportive text messaging program designed to provide support during the pandemic. METHODS: Standardized self-report measures were used to evaluate perceived stress (measured with the Perceived Stress Scale-10 [PSS-10]), anxiety (measured with the General Anxiety Disorder Scale 7 [GAD-7]), and depressive symptoms (measured with the Patient Health Questionnaire [PHQ-9]), at baseline and 3rd month (n = 373). RESULTS: After 3 months of using Text4Hope, subscribers' self-reports revealed significant (p< 0.001) mean score reductions compared with baseline on: the GAD-7 by 22.7%, PHQ-9 by 10.3%, and PSS-10 scores by 5.7%. Reductions in inferred prevalence rates for moderate to high symptoms were also observed, with anxiety demonstrating the largest reduction (15.7%). CONCLUSIONS: Observed Text4Hope-related reductions in psychological distress during COVID-19 indicate that Text4Hope is an effective, convenient, and accessible means of implementing a population-level psychological intervention.

Mental Health Outreach via Supportive Text Messages during the COVID-19 Pandemic: Improved Mental Health and Reduced Suicidal Ideation after Six Weeks in Subscribers of Text4Hope Compared to a Control Population.

Background: In March 2020, Alberta Health Services launched Text4Hope, a free mental health text-message service. The service aimed to alleviate pandemic-associated stress, generalized anxiety disorder (GAD), major depressive disorder (MDD), and suicidal propensity. The effectiveness of Text4Hope was evaluated by comparing psychiatric parameters between two subscriber groups. Methods: A comparative cross-sectional study with two arms: Text4Hope subscribers who received daily texts for six weeks, the intervention group (IG); and new Text4Hope subscribers who were yet to receive messages, the control group (CG). Logistic regression models were used in the analysis. Results: Participants in the IG had lower prevalence rates for moderate/high stress (78.8% vs. 88.0%), likely GAD (31.4% vs. 46.5%), and likely MDD (36.8% vs. 52.1%), respectively, compared to respondents in the CG. After controlling for demographic variables, the IG remained less likely to self-report symptoms of moderate/high stress (OR = 0.56; 95% CI = 0.41-0.75), likely GAD (OR = 0.55; 95% CI = 0.44-0.68), and likely MDD (OR = 0.50; 95% CI = 0.47-0.73). The mean Composite Mental Health score, the sum of mean scores on the PSS, GAD-7, and PHQ-9 was 20.9% higher in the CG. Conclusions: Text4Hope is an effective population-level intervention that helps reduce stress, anxiety, depression, and suicidal thoughts during the COVID-19 pandemic. Similar texting services should be implemented during global crises.

COVID-19 pandemic: demographic and clinical correlates of disturbed sleep among 6,041 Canadians.

OBJECTIVES: Psychological burdens of the COVID-19 pandemic are likely to impact sleep negatively. We investigate prevalence and correlates of disturbed sleep among subscribers to Text4Hope a daily supportive text message program launched in Alberta to support residents to deal with stress, anxiety, and depression. METHODS: A survey link was sent to Text4Hope subscribers to assess demographic and clinical variables, including disturbed sleep, stress, anxiety, and depression using the third question on the Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale, Generalised Anxiety Disorder 7-item scale, and PHQ-9, respectively. Data were analysed using univariate and logistic regression analyses. RESULTS: Overall, 6041 out of 32,805 Text4Hope subscribers completed the survey (18.4% response rate). Prevalence of disturbed sleep was 77.8%. Subscribers aged 41-60 years were twice as likely to present with sleep disturbance compared to individuals ≤25 years (OR 1.89, 95% CI: 1.27-2.81). Individuals with moderate/high anxiety and stress symptoms and those with passive death wish/suicidal ideation had higher probability for sleep disturbance [(OR 4.05, 95% CI: 3.33-4.93), (OR 2.42, 95% CI: 1.99-2.94), and (OR 2.39, 95% CI: 1.69-3.38)], respectively. CONCLUSION: As the pandemic continues, more Canadians are likely to develop sleep problems, an important consideration for planning mental health services.KEY POINTSThis is the first study to examine the prevalence rates and demographic and clinical correlates of disturbed sleep in a large sample (n = 6041) of Canadians during the COVID-19 pandemic.Prevalence of disturbed sleep was high at 77.8%.Individuals aged 41-60 years were twice as likely to present with sleep disturbance compared to individuals ≤25 years (OR 1.89, 95% CI: 1.27-2.81).Individuals with moderate/high anxiety symptoms, moderate/high stress symptoms, and suicidal ideation/thoughts of self-harm had higher likelihood of developing sleep disturbance, compared to individuals lacking these symptoms [(OR 4.05, 95% CI: 3.33-4.93) and (OR 2.42, 95% CI: 1.98-2.94)], respectively.As the pandemic continues, with fear of multiple waves, more Canadians are likely to develop sleep problems, an important consideration for planning the provision of mental health services.

COVID-19 Pandemic: Demographic Predictors of Self-Isolation or Self-Quarantine and Impact of Isolation and Quarantine on Perceived Stress, Anxiety, and Depression.

Introduction: With the sudden onset and global dispersal of the SARS-CoV-2 virus, many nations including Canada attempted to reduce spread of the resultant COVID-19 syndrome with self-isolation and quarantine, while seeking a cure or vaccine for this disease. Understanding impacts of self-isolation and self-quarantine on stress, anxiety, and depression will help us to mitigate these issues through appropriate development of mental health services. Methods: The sample was drawn from individuals who self-subscribed to Text4Hope, a service that delivers text messages based on a cognitive behavioral therapy framework. Text4Hope was developed to support Albertans during the COVID-19 pandemic. Subscribers were asked for demographic information and if they had to self-isolate or self-quarantine during the pandemic via a survey link. Mental health was assessed using the validated instruments: Perceived Stress Scale (PSS), Generalized Anxiety Disorder-7 item scale (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). Descriptive statistics and Chi-Square test results were derived using Statistical Package for Social Sciences (SPSS) version-26. Results: 6,041 of 32,805 Text4Hope subscribers (18.4%) completed the survey. Of these respondents, 19.2% had self-isolated or self-quarantined in Alberta as of March 31, 2020 during the COVID-19 pandemic. Post-hoc analysis using adjusted residuals suggested that individuals aged 60 years of age or older, and retirees had a higher likelihood of self-isolation or self-quarantine, compared to respondents with other age or employment characteristics. One-week prevalence rates for self-reported measures of moderate to high stress, likely Generalized Anxiety Disorder (GAD), and likely Major Depressive Disorder (MDD) were 84.9, 46.7, and 41.4%, respectively. Respondents who had to self-isolate or self-quarantine during the COVID-19 pandemic were significantly more likely to present with moderate to high stress, significant anxiety symptomatology, and significant depressive symptomatology. Conclusions: Older age and employment status were significantly associated with the likelihood of self-isolation or self-quarantine. We found elevated self-reported levels of anxiety and depression associated with self-reported COVID-19 pandemic-related self-isolation and self-quarantine activity. These findings have mental health implications both during and after the pandemic and demonstrate the need for greater focus on psychological complications of self-isolation and self-quarantine, and development of optimal ways to manage these pandemic consequences.

COVID-19 pandemic: demographic and clinical correlates of passive death wish and thoughts of self-harm among Canadians.

BACKGROUND: Suicidal ideation can be triggered or exacerbated by psychosocial stressors including natural disasters and pandemics. AIMS: This study investigated prevalence rates and demographic and clinical correlates of self-reported passive death wishes and thoughts of self-harm among Canadians subscribing to Text4Hope; a daily supportive text message program. METHODS: A survey link was sent out to Text4Hope subscribers. Demographic information was captured and clinical data collected using the Perceived Stress Scale (PSS), Generalized Anxiety Disorder-7-item (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9). Data were analysed with descriptive analysis, the chi-square test, and logistic regression. RESULTS: Responders showed an increase in prevalence rates for passive death wish and thoughts of self-harm compared to baseline Canadian statistics on suicidality. Responders aged ⩽25years, Indigenous, had less than high school education, unemployed, single, living with family, with increased anxiety, disordered sleep, and recent concerns about germs and contamination were at greatest risk. CONCLUSIONS: Our results indicate that suicidal thoughts may have increased in the general population as a result of COVID-19 and signals an urgent need for public education on appropriate health seeking methods and increased access to mental and social support especially during the COVID-19 pandemic and its immediate aftermath.

COVID-19 Pandemic and Mental Health: Prevalence and Correlates of New-Onset Obsessive-Compulsive Symptoms in a Canadian Province.

Background: This cross-sectional online survey investigates the prevalence of obsessive-compulsive disorder (OCD) symptoms at an early stage of the COVID-19 pandemic in Canada. Methods: OCD symptoms, moderate/high stress, likely generalized anxiety disorder (GAD) and likely major depressive disorder (MDD) were assessed with the Brief Obsessive-Compulsive Scale (BOCS), Perceived Stress Scale (PSS), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale, respectively. Results: Out of 32,805 individuals subscribed to Text4Hope, 6041 completed an online survey; the response rate was 18.4%. Overall, 60.3% of respondents reported onset of OCD symptoms and 53.8% had compulsions to wash hands during the COVID-19 pandemic. Respondents who showed OCD symptoms only since the start of COVID-19 were significantly more likely to have moderate/high stress (z = 6.4, p < 0.001), likely GAD (z = 6.0, p < 0.001), and likely MDD (z = 2.7, p < 0.01). Similarly, respondents who engaged in compulsive hand washing were significantly more likely to have moderate/high stress (z = 4.6, p < 0.001) and likely GAD (z = 4.6 p < 0.001), but not likely MDD (z = 1.4, p = 0.16). Conclusion: The prevalence of OCD symptoms increased during the COVID-19 pandemic, at a rate significantly higher than pre-pandemic rates reported for the sample population. Presenting with OCD symptoms increased the likelihood of presenting with elevated stress, likely GAD, and likely MDD.

Changes in Stress, Anxiety, and Depression Levels of Subscribers to a Daily Supportive Text Message Program (Text4Hope) During the COVID-19 Pandemic: Cross-Sectional Survey Study.

BACKGROUND: In addition to the obvious physical medical impact of COVID-19, the disease poses evident threats to people's mental health, psychological safety, and well-being. Provision of support for these challenges is complicated by the high number of people requiring support and the need to maintain physical distancing. Text4Hope, a daily supportive SMS text messaging program, was launched in Canada to mitigate the negative mental health impacts of the pandemic among Canadians. OBJECTIVE: This paper describes the changes in the stress, anxiety, and depression levels of subscribers to the Text4Hope program after 6 weeks of exposure to daily supportive SMS text messages. METHODS: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of Text4Hope subscribers. Perceived stress, anxiety, and depression were measured with the 10-Item Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder-7 (GAD-7) scale, and the Patient Health Questionnaire-9 (PHQ-9) scale at baseline and sixth week time points. Moderate or high perceived stress, likely generalized anxiety disorder, and likely major depressive disorder were assessed using cutoff scores of ≥14 for the PSS-10, ≥10 for the GAD-7, and ≥10 for the PHQ-9, respectively. At 6 weeks into the program, 766 participants had completed the questionnaires at both time points. RESULTS: At the 6-week time point, there were statistically significant reductions in mean scores on the PSS-10 and GAD-7 scales but not on the PHQ-9 scale. Effect sizes were small overall. There were statistically significant reductions in the prevalence rates of moderate or high stress and likely generalized anxiety disorder but not likely major depressive disorder for the group that completed both the baseline and 6-week assessments. The largest reductions in mean scores and prevalence rates were for anxiety (18.7% and 13.5%, respectively). CONCLUSIONS: Text4Hope is a convenient, cost-effective, and accessible means of implementing a population-level psychological intervention. This service demonstrated significant reductions in anxiety and stress levels during the COVID-19 pandemic and could be used as a population-level mental health intervention during natural disasters and other emergencies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/19292.

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

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