Remote mental health care interventions during the COVID-19 pandemic: An umbrella review.

Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.

Impact of COVID-19 vaccination campaign on psychological status in cancer patients (pts)

Background: The health emergency caused by the SarS-Cov-2 pandemic has been strongly impacting on oncological patients’ (pts). The purpose of this study was to explore the emotional impact and perception of cancer pts who received the vaccine against COVID-19 at the University Hospital and Trust of Verona (Italy). Methods: After the first dose of COVID-19 vaccine an anonymously questionnaire was proposed to cancer pts (March-May 2021). The survey investigated anxiety and depression levels using the Hospital Anxiety and Depression Scale (HADS), psychological distress with the Distress Thermometer (DT). Additionally, four specific items regarding the awareness about: i) infection risks, ii) interference with chemotherapy treatment, and iii) adverse effects, were developed. Descriptive analyses were performed. Results: A total of 736 patients (mean age 63 yrs) completed the questionnaire. Breast (23%) and gastrointestinal (40%) were the most represented cancer sites. The majority of pts (65%) reported mild levels of distress (DT ≤4), while moderate (DT 5-7) and severe (DT ≥8) levels were identified in 26% and 9% of participants, respectively. A total of 11% and 8% of pts experienced clinically significant symptoms of anxiety and depression (HADS ≥11), whereas 15% were borderline (HADS score 8-10). Two thirds of pts (67%) thought that the vaccination may reduce the infection risks and 56% felt safer. Overall, 59% of pts did not believe that vaccine-related side effects may interfere with the oncological treatment and 49% considered the vaccination safe. Conclusions: Most cancer pts undergoing COVID-19 vaccination presented mild levels of anxiety, depression and distress. Oncological pts undergoing vaccination felt safe and judged the benefits of COVID-19 vaccination to overweight the potential side effects. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.