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.

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.

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.

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.

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.

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.

Coronavirus Disease 2019 Pandemic: Health System and Community Response to a Text Message (Text4Hope) Program Supporting Mental Health in Alberta.

In an effort to support the mental health of Albertans during the coronavirus disease 2019 (COVID-19) pandemic, Alberta Health Services launched a supportive text message (Text4Mood) program on March 23, 2020. The program was simultaneously approved for funding by the 6 regional health foundations and launched within 1 week of conception. Residents of Alberta can subscribe to the program by texting "COVID19HOPE" to a sort code number. Each subscriber receives free daily supportive text messages, for 3 months, crafted by a team of clinical psychologists, psychiatrists, mental health therapist, and mental health service users. Within 1 week of the launch of Text4Hope, 32 805 subscribers had signed up to the program, and there have been expressions of interests from other jurisdictions to implement a similar program to support the mental health of those in quarantine, isolation, or lockdown.

COVID-19 Pandemic: Age-Related Differences in Measures of Stress, Anxiety and Depression in Canada.

BACKGROUND: The spread of COVID-19 along with strict public health measures have resulted in unintended adverse effects, including greater levels of distress, anxiety, and depression. This study examined relative presentations of these psychopathologies in different age groups in a Canadian cohort during the COVID-19 pandemic. METHODOLOGY: Participants were subscribers to the Text4Hope program, developed to support Albertans during the COVID-19 pandemic. A survey link was used to gather demographic information and responses on several self-report scales, such as Perceived Stress Scale (PSS), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9). RESULTS: There were 8267 individuals who completed the survey, giving a response rate of 19.4%. Overall, 909 (11.0%) respondents identified as ≤25 years, 2939 (35.6%) identified as (26-40) years, 3431 (41.5%) identified as (41-60) years, 762 (9.2%) identified as over 60 years, and 226 (2.7%) did not identify their age. Mean scores on the PSS, GAD-7, and PHQ-9 scales were highest among those aged ≤25 and lowest amongst those aged >60 years old. CONCLUSIONS: The finding that the prevalence rates and the mean scores for stress, anxiety, and depression on standardized scales to decrease from younger to older subscribers is an interesting observation with potential implications for planning to meet mental health service needs during COVID-19.

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

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