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

Modifying Text Messages from a Faith-Based Physical Activity Intervention with Latino Adults in Response to the COVID-19 Pandemic

BACKGROUND

Text messages are useful for health promotion and can be modified during public health emergencies.

PURPOSE

Describe how we developed and implemented a physical activity (PA) text messaging component within a faith-based intervention, modified the text message content in response to the COVID-19 pandemic and evaluated participants' perceptions of the modified text messages.

RESEARCH DESIGN AND STUDY SAMPLE

PA promotion text messages were delivered to predominately Spanish-speaking, churchgoing Latino adults (n = 284) in Los Angeles, California. In 2020, we modified the messages to disseminate COVID-19-related information and support and share virtual PA resources.

DATA COLLECTION AND ANALYSIS

We analyzed quantitative and qualitative survey data to gauge participants' experiences with the text messages.

RESULTS

COVID-19 related text messages were a feasible, acceptable addition to a PA intervention for a sample of Latinos.

CONCLUSIONS

Throughout the pandemic, the messages enabled continued communication and support for PA and protection from COVID-19 in a population at high-risk of health inequities.

Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study

BACKGROUND

Cancer is the leading cause of death in Canada, and living with cancer generates psychological demands, including depression and anxiety among cancer survivors and caregivers. Text4Hope-Cancer Care SMS text messaging-based service was provided to people with cancer and caregivers during the COVID-19 pandemic to support their mental health.

OBJECTIVE

The aim of this study is to examine the clinical effectiveness of and satisfaction with Text4Hope-Cancer Care in addressing mental health conditions among people living with cancer and caregivers.

METHODS

The study was conducted in Alberta, Canada. People who were diagnosed or receiving cancer treatment and caregivers self-subscribed to receive 3-months daily supportive cognitive behavioral therapy-based SMS text messages and a web-based survey was sent at designated time points to collect clinical and nonclinical data. The Hospital Anxiety and Depression scale (HADS) was used to examine changes in anxiety and depression symptoms after receiving the service. Satisfaction with the service was assessed using a survey with a Likert scale. Descriptive and inferential statistics were used, and test significance was considered with P≤.05.

RESULTS

Overall, 107 individuals subscribed to the service, and 93 completed the program (completion rate 93/107, 86.9%). A significant improvement in the anxiety symptoms (HADS-Anxiety [HADS-A] subscale) was reported after 3 months of Text4Hope-Cancer Care (t11=2.62; P=.02), with medium effect size (Hedges g=0.7), but not depression symptoms (HADS-Depression [HADS-D] subscale). Subscribers expressed high satisfaction and agreed that the service has helped them to cope with mental health symptoms and improve their quality of life. Most subscribers read the SMS text messages more than once (30/30, 100%); took time to reflect or took a beneficial action after reading the messages (27/30, 90%); and highly agreed (27/30, >80%) with the value of the received supportive SMS text messages as being relevant, succinct, affirmative, and positive. All subscribers recommended SMS text messaging for stress, anxiety, and depression and for cancer care support (30/30, 100%).

CONCLUSIONS

Text4Hope-Cancer Care was well-perceived and effectively addressed anxiety symptoms among people living with cancer and caregivers during the peak of the COVID-19 pandemic. This study provides evidence-based support and insight for policy and stakeholders to implement similar convenient, economic, and accessible mental health services that support vulnerable populations during crises.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/20240.

Changes in mental health services in response to the COVID-19 pandemic in high-income countries: a rapid review

BACKGROUND

Severe deterioration in mental health and disrupted care provision during the COVID-19 increased unmet needs for mental health. This review aimed to identify changes in mental health services for patients in response to the pandemic and understand the impact of the changes on patients and providers.

METHODS

Following the Cochrane guidance for rapid reviews, Cochrane CENTRAL, MEDLINE, Embase and PsycInfo were searched for empirical studies that investigated models of care, services, initiatives or programmes developed/evolved for patients receiving mental health care during COVID-19, published in English and undertaken in high-income countries. Thematic analysis was conducted to describe the changes and an effect direction plot was used to show impact on outcomes.

RESULTS

33 of 6969 records identified were included reporting on patients' experiences (n = 24), care providers' experiences (n = 7) and mixed of both (n = 2). Changes reported included technology-based care delivery, accessibility, flexibility, remote diagnostics and evaluation, privacy, safety and operating hours of service provision. These changes had impacts on: (1) care access; (2) satisfaction with telehealth; (3) comparability of telehealth with face-to-face care; (4) treatment effectiveness; (5) continuity of care; (6) relationships between patients and care providers; (7) remote detection and diagnostics in patients; (8) privacy; (9) treatment length and (10) work-life balance.

CONCLUSIONS

A shift to telecommunication technologies had a significant impact on patients and care providers' experiences of mental health care. Improvements to care access, flexibility, remote forms of care delivery and lengths of operating service hours emerged as crucial changes, which supported accessibility to mental health services, increased attendance and reduced dropouts from care. The relationships between patients and care providers were influenced by service changes and were vastly depending on technological literacy and context of patients and availability and care access ranging from regular contact to a loss of in-person contact. The review also identified an increase in care inequality and a feeling of being disconnected among marginalised groups including homeless people, veterans and ethic minority groups. Telehealth in mental care could be a viable alternative to face-to-face service delivery with effective treatment outcomes. Further research is needed to better understand the impact of the changes identified particularly on underserved populations.

The effectiveness of CBT-based daily supportive text messages in improving female mental health during COVID-19 pandemic: results from the Text4Hope program

Introduction

The COVID-19 pandemic has significantly exacerbated gender disparities in mental health, particularly impacting women. To address this, Alberta, Canada, launched Text4Hope, a Cognitive Behaviour Therapy-based text messaging intervention, to provide support and resources for psychological challenges during the pandemic. This study aimed to assess the effectiveness of Text4Hope in reducing stress, anxiety, depression, sleeping disturbances, and suicidal ideation among female subscribers during the COVID-19 pandemic.

Methods

The study employed both an uncontrolled longitudinal design and a controlled cohort design. The uncontrolled longitudinal study analyzed a one-year dataset (n = 9,545) of clinical outcomes, comparing mean differences in mental health symptoms from baseline to 6 weeks after subscription. The controlled cohort design compared two groups, with (n = 1,763) and without (n = 567) intervention exposure during the same period. Data were collected through self-administered online surveys completed at baseline and six weeks after subscription. Sociodemographic information and validated scales (e.g., 10-item Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire (PHQ-9)) were used to assess mental health outcomes.

Results

The results from the longitudinal study indicated a significant reduction in anxiety prevalence and anxiety symptoms, with a 19.63% decrease in GAD-7 mean score and a 32.02% decrease in likely anxiety from baseline to six weeks. Depressive symptoms and perceived stress also showed a significant reduction (p < 0.001), albeit to a lesser extent. In the controlled cohort study, the intervention group had significantly (p < 0.001) lower PHQ-9 [19.5 (SD 7.05)], GAD-7 [7.5 (SD 5.27)], and CMH [35.53 (SD 18.45)] scores. Additionally, the study found substantial differences (p < 0.001) in suicidal ideation (26.1 vs. 15.7) between groups but no significant differences in sleep disruption.

Discussion

These findings suggest that Text4Hope could be an effective intervention for reducing stress, depression, suicidal ideation, and particularly anxiety symptoms among women during public emergencies. The study provides valuable insights into the potential benefits of text messaging interventions in supporting mental health during crisis situations.

Effectiveness and implementation of a text messaging intervention to reduce depression and anxiety symptoms among Latinx and Non-Latinx white users during the COVID-19 pandemic

Text messaging interventions are increasingly used to help people manage depression and anxiety. However, little is known about the effectiveness and implementation of these interventions among U.S. Latinxs, who often face barriers to using mental health tools. The StayWell at Home (StayWell) intervention, a 60-day text messaging program based on cognitive behavioral therapy (CBT), was developed to help adults cope with depressive and anxiety symptoms during the COVID-19 pandemic. StayWell users (n = 398) received daily mood inquiries and automated skills-based text messages delivering CBT-informed coping strategies from an investigator-generated message bank. We conduct a Hybrid Type 1 mixed-methods study to compare the effectiveness and implementation of StayWell for Latinx and Non-Latinx White (NLW) adults using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Effectiveness was measured using the PHQ-8 depression and GAD-7 anxiety scales, assessed before starting and after completing StayWell. Guided by RE-AIM, we conducted a thematic text analysis of responses to an open-ended question about user experiences to help contextualize quantitative findings. Approximately 65.8% (n = 262) of StayWell users completed pre-and-post surveys. On average, depressive (-1.48, p = 0.001) and anxiety (-1.38, p = 0.001) symptoms decreased from pre-to-post StayWell. Compared to NLW users (n = 192), Latinx users (n = 70) reported an additional -1.45 point (p < 0.05) decline in depressive symptoms, adjusting for demographics. Although Latinxs reported StayWell as relatively less useable (76.8 vs. 83.9, p = 0.001) than NLWs, they were more interested in continuing the program (7.5 vs. 6.2 out of 10, p = 0.001) and recommending it to a family member/friend (7.8 vs. 7.0 out of 10, p = 0.01). Based on the thematic analysis, both Latinx and NLW users enjoyed responding to mood inquiries and sought bi-directional, personalized text messages and texts with links to more information to resources. Only NLW users stated that StayWell provided no new information than they already knew from therapy or other sources. In contrast, Latinx users suggested that engagement with a behavioral provider through text or support groups would be beneficial, highlighting this group's unmet need for behavioral health care. mHealth interventions like StayWell are well-positioned to address population-level disparities by serving those with the greatest unmet needs if they are culturally adapted and actively disseminated to marginalized groups. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04473599.

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 Usability, Feasibility, Acceptability, and Efficacy of Digital Mental Health Services in the COVID-19 Pandemic: Scoping Review, Systematic Review, and Meta-analysis

BACKGROUND

After the rapid spread of the novel SARS-CoV-2, the short-term and long-term mental health impacts of the pandemic on the public, in particular on susceptible individuals, have been reported worldwide. Although digital mental health services expand accessibility while removing many barriers to in-person therapy, their usability, feasibility, acceptability, and efficacy require continued monitoring during the initial phase of the pandemic and its aftermath.

OBJECTIVE

In this study, we aimed to understand what mental health services are offered, whether they are practical or acceptable, and to what extent digital mental health services are effective in response to the COVID-19 pandemic across high-income and low- and middle-income countries.

METHODS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guideline. We implemented searches in PubMed (MEDLINE), Embase, PsycINFO, and Cochrane databases for studies that were published between December 2019 and November 2021 and that involved the use of digital mental health services. Two review authors screened, assessed, and extracted studies independently. The protocol was registered on the International Prospective Register of Systematic Reviews.

RESULTS

This review identified 7506 articles through database searching. In total, 65 (0.9%) studies from 18 countries with 67,884 participants were eligible for the scoping review. Of the 65 studies, 16 (24.6%) were included in the meta-analysis. A total of 15 (23.1%) studies measured the usability; 31 (47.7%) studies evaluated the feasibility; 29 (44.6%) studies assessed the acceptability; and 51 (78.5%) studies assessed the efficacy. Web-based programs (21/65, 32.3%), videoconferencing platforms (16/65, 24.6%), smartphone apps (14/65, 21.5%), and SMS text messaging (5/65, 7.7%) were the main techniques. Psychotherapy (44/65, 67.7%) followed by psychoeducation (6/65, 9.2%) and psychological support (5/65, 7.7%) were commonly used. The results of the meta-analysis showed that digital mental health interventions were associated with a small reduction in depressive symptoms (standardized mean difference=-0.49; 95% CI -0.74 to -0.24; P<.001) and a moderate reduction in anxiety symptoms (standardized mean difference=-0.66; 95% CI -1.23 to -1.0; P=.02) significantly.

CONCLUSIONS

The findings suggest that digital mental health interventions may be practical and helpful for the general population, at-risk individuals, and patients with preexisting mental disorders across high-income and middle-income countries. An expanded research agenda is needed to apply different strategies for addressing diverse psychological needs and develop integrated mental health services in the post-COVID-19 era.

TRIAL REGISTRATION

PROSPERO CRD42022307695; https://tinyurl.com/2jcuwjym.

Augmenting Mental Health Support for Patients Accessing Different Degrees of Formal Psychiatric Care through a Supportive Text Messaging Program: Protocol for a Randomized Controlled Trial

Patients feel more vulnerable when accessing community mental health programs for the first time or after being discharged from psychiatric inpatient units. Long wait times for follow-up appointments, shortage of mental health professionals, lack of service integration, and scarcity of tailored support can weaken their connection to the health care system. As a result, patients can present low adherence, dissatisfaction with treatment, and recurrent hospitalizations. Finding solutions to avoid unnecessary high-cost services and providing tailored and cost-effective mental health interventions may reduce the health system burden and augment patient support. We propose implementing an add-on, supportive text messaging service (Text4Support), developed using cognitive-behavioural therapy (CBT) principles to augment mental health support for patients attending to or being discharged from psychiatric care in Nova Scotia, Canada. This randomized controlled trial aims to investigate the effectiveness of Text4Support in improving mental health outcomes and overall mental well-being compared with usual care. We also will examine the intervention's impact on health services utilization and patient satisfaction. The results from this study will provide evidence on stepped and technology-based mental health care, which will contribute to generating new knowledge about mental health innovations in various clinical contexts, which is not only helpful for the local context but to other jurisdictions in Canada and abroad that are seeking to improve their health care.

Text Messages for Depression, Anxiety and Alcohol Abuse Therapy-Are Construction Guidelines Needed?

Despite the effectiveness of text messaging therapy in improving mental health conditions, limited attention has been paid to how the text messages are constructed. Thus, this study questions whether there is a need to develop a model of text message construction for mental health therapy. In this backdrop, this study reviews how a text message for mental health therapy is constructed, specifically focused on the process and guidelines. This study also aims to identify the research gap regarding the guideline of text message construction for mental health therapy and to identify mental health professionals' practices in text messaging therapy. In addition, the opinions of mental health professionals on the need to develop a text message construction guideline were also gathered. The findings from the literature review confirmed that there are still limited guidelines explaining the process of constructing text messages for mental health therapy. Meanwhile, results from the online survey found that mental health professionals expressed a high need to explore and develop a model of text message construction for mental health therapy. With this research gap addressed, this study proposes further research into the development of a text message construction model for mental health therapy.

Can ResilienceNHope, an evidence-based text and email messaging innovative suite of programs help to close the psychological treatment and mental health literacy gaps in college students?

There is a high prevalence of stress, anxiety, depression, and substance use disorders in college students globally. Financial stressors, course workload, peer pressure, and other personal, family, and societal stressors contribute to the high incidence of mental disorders among college students. Despite the high prevalence of mental disorders in college students, barriers such as lack of mental health literacy, stigma of mental health, inadequate numbers of mental health counselors and clinical psychologists supporting students in colleges in both low- and high-income countries, and financial and geographical barriers often hinder college students from accessing the needed mental supports. There is increasing evidence on the effectiveness and feasibility of mobile technology in health promotion and closing psychological treatment gaps. College students are well adapted to the use of mobile technology, particularly text and email messaging daily, which presents a unique opportunity for an innovative way to offer support for their mental health. In this article, we provide a perspective on the ResilienceNHope program, an evidence-based text and email messaging innovation, to close the psychological treatment gap and improve the mental health literacy of college students.

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.

Readmission of Patients to Acute Psychiatric Hospitals: Influential Factors and Interventions to Reduce Psychiatric Readmission Rates

Background: Appropriate and adequate treatment of psychiatric conditions in the community or at first presentation to the hospital may prevent rehospitalization. Information about hospital readmission factors may help to reduce readmission rates. This scoping review sought to examine the readmission of patients to acute psychiatric hospitals to determine predictors and interventions to reduce psychiatric readmission rates. Method: A scoping review was conducted in eleven bibliographic databases to identify the relevant peer-reviewed studies. Two reviewers independently assessed full-text articles, and a screening process was undertaken to identify studies for inclusion in the review. PRISMA checklist was adopted, and with the Covidence software, 75 articles were eligible for review. Data extraction was conducted, collated, summarized, and findings reported. Result: 75 articles were analyzed. The review shows that learning disabilities, developmental delays, alcohol, drug, and substance abuse, were crucial factors that increased the risk of readmission. Greater access to mental health services in residential treatment and improved crisis intervention in congregate care settings were indicated as factors that reduce the risk of readmission. Conclusion: High rates of readmission may adversely impact healthcare spending. This study suggests a need for focused health policies to address readmission factors and improve community-based care.

Stress, Burnout, Anxiety and Depression among Teachers: A Scoping Review

BACKGROUND

Worldwide, stress and burnout continue to be a problem among teachers, leading to anxiety and depression. Burnout may adversely affect teachers' health and is a risk factor for poor physical and mental well-being. Determining the prevalence and correlates of stress, burnout, anxiety, and depression among teachers is essential for addressing this public health concern.

OBJECTIVE

To determine the extent of the current literature on the prevalence and correlates of stress, burnout, anxiety, and depression among teachers.

METHOD

This scoping review was performed using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Relevant search terms were used to determine the prevalence and correlates of teachers' stress, burnout, anxiety, and depression. Articles were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Data Base), APA PsycINFO, CINAHL Plus (Cumulative Index of Nursing and Allied Health Literature), Scopus Elsevier and ERIC (Education Resources Information Center). The articles were extracted, reviewed, collated, and thematically analyzed, and the results were summarized and reported.

RESULTS

When only clinically meaningful (moderate to severe) psychological conditions among teachers were considered, the prevalence of burnout ranged from 25.12% to 74%, stress ranged from 8.3% to 87.1%, anxiety ranged from 38% to 41.2% and depression ranged from 4% to 77%. The correlates of stress, burnout, anxiety, and depression identified in this review include socio-demographic factors such as sex, age, marital status, and school (organizational) and work-related factors including the years of teaching, class size, job satisfaction, and the subject taught.

CONCLUSION

Teaching is challenging and yet one of the most rewarding professions, but several factors correlate with stress, burnout, anxiety, and depression among teachers. Highlighting these factors is the first step in recognizing the magnitude of the issues encountered by those in the teaching profession. Implementation of a school-based awareness and intervention program is crucial to resolve the early signs of teacher stress and burnout to avoid future deterioration.

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.

Prevalence and Predictors of Generalized Anxiety Disorder Symptoms in Residents of Fort McMurray Five Years after the Devastating Wildfires

Background: Natural disasters adversely impact individuals living in places where they occur, resulting in emotional distress. The wildfire that occurred in Fort McMurray (FMM), Alberta in 2016 is no different. Objective: This study aims to identify the prevalence and predictors of Generalized Anxiety Disorder (GAD) symptoms in residents of FMM five years after the devastating wildfires. Methods: Data for the study were collected through a cross-sectional survey conducted online from the 24th of April to the 2nd of June 2021. A validated instrument, the GAD-7 scale, was used to collect information on anxiety. Results: This study involved 186 residents of FMM, of which the majority were females (85.5%), employed (94.1%), working at school boards (50.0%), and were either married, cohabiting, or partnered (71.0%). The prevalence of likely GAD among the study sample was 42.5%. Unemployed respondents were seventeen times more likely to develop GAD symptoms (OR = 16.62; 95% C.I. 1.23–223.67) while respondents who would like to receive mental health counseling were five times more likely to experience GAD symptoms (OR = 5.35; 95% C.I. 2.03–14.15). Respondents who suffered a loss of property because of the wildfire were two times more likely to develop GAD symptoms (OR = 2.36; 95% C.I. 1.01–22.62). Conclusion: Policymakers may mitigate GAD symptoms, particularly after natural disasters, by making long-term mental health counseling available and a key component of post-disaster management, and by investing in the social capital of the people to build resilience and support to deal with the post-disaster mental health effects.

Five Years after the Fort McMurray Wildfire: Prevalence and Correlates of Low Resilience

Background: The Fort McMurray wildfire of 3 May 2016 was one of the most devastating natural disasters in Canadian history. Although resilience plays a crucial role in the daily functioning of individuals by acting as a protective shield that lessens the impact of disasters on their mental well-being, to date little is known about the long-term impact of wildfires on resilience and associated predictors of low resilience. Objectives: The objective of the study was to assess the prevalence and predictors of resilience among residents of Fort McMurray five years after the wildfires. Method: This was a quantitative cross-sectional study. A self-administered online survey which included standardized rating scales for resilience (BRS), anxiety (GAD-7), depression (PHQ-9), and post-traumatic stress disorder (PTSD)(PCL-C) was used to determine the prevalence of resilience as well as its demographic, clinical, and wildfire-related predictors. The data were collected between 24 April and 2 June 2021 and analyzed using the Statistical Package for Social Sciences (SPSS) version 25 using univariate analysis with a chi-squared test and binary logistic regression analysis. Results: A total of 186 residents completed the survey out of 249 who accessed the online survey, producing a response rate of 74.7%. Most of the respondents were females (85.5%, 159), above 40 years of age (81.6%, 80), employed (94.1%, 175), and in a relationship (71%, 132). Two variables—having had PTSD symptoms (OR = 2.85; 95% CI: 1.06–7.63), and age—were significant predictors of low resilience in our study. The prevalence of low resilience in our sample was 37.4%. Conclusions: Our results suggest that age and the presence of PTSD symptoms were the independent significant risk factors associated with low resilience five years after the Fort McMurray wildfire disaster. Further research is needed to enhance understanding of the pathways to resilience post-disaster to identify the robust predictors and provide appropriate interventions to the most vulnerable individuals and communities.

Clinical Outcomes in Routine Evaluation Measures for Patients Discharged from Acute Psychiatric Care: Four-Arm Peer and Text Messaging Support Controlled Observational Study

Background: Peer support workers (PSW) and text messaging services (TxM) are supportive health services that are frequently examined in the field of mental health. Both interventions have positive outcomes, with TxM demonstrating clinical and economic effectiveness and PSW showing its utility within the recovery-oriented model. Objective: To evaluate the effectiveness of PSW and TxM in reducing psychological distress of recently discharged patients receiving psychiatric care. Methods: This is a prospective, rater-blinded, pilot-controlled observational study consisting of 181 patients discharged from acute psychiatric care. Patients were randomized into one of four conditions: daily supportive text messages only, peer support only, peer support plus daily text messages, or treatment as usual. Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM), a standardized measure of mental distress, was administered at four time points: baseline, six weeks, three months, and six months. MANCOVA was used to assess the impact of the interventions on participants’ scores on four CORE-OM subscales across the three follow-up time points. Recovery, clinical change, and reliable change in CORE-OM all-item analysis were examined across the four groups, and the prevalence of risk symptoms was measured. Results: A total of 63 patients completed assessments at each time point. The interaction between PSW and TxM was predictive of differences in scores on the CORE-OM functioning subscale with a medium effect size (F1,63 = 4.19; p = 0.045; ηp2 = 0.07). The PSW + TxM group consistently achieved higher rates of recovery and clinical and reliable improvement compared to the other study groups. Additionally, the text message group and the PSW + TxM group significantly reduced the prevalence of risk of self/other harm symptoms after six months of intervention, with 27.59% (χ2(1) = 4.42, p = 0.04) and 50% (χ2(1) = 9.03, p < 0.01) prevalence reduction, respectively. Conclusions: The combination of peer support and supportive text messaging is an impactful intervention with positive clinical outcomes for acute care patients. Adding the two interventions into routine psychiatric care for patients after discharge is highly recommended.

Burnout and Associated Psychological Problems among Teachers in Alberta and Nova Scotia, and the impact of a Supportive Text Messaging Program (Wellness4Teachers)- Protocol for a Cross-Sectional and Program Evaluation Study (Preprint)

Background

Stress, burnout, anxiety, and depression continue to be a problem among teachers worldwide. It is not presently known what the prevalence and correlates for these psychological problems are among teachers in Alberta and Nova Scotia. It is also not known if a supportive text message program (Wellness4Teachers) would be effective in reducing stress, burnout, anxiety, or depression symptoms among teachers.

Objective

The goal of this study is to evaluate the prevalence and correlates of stress, burnout, symptoms of anxiety, depression, and low resilience among elementary and high school teachers in Alberta and Nova Scotia, Canada. It also aims to determine if daily supportive text messages can help reduce the prevalence of these psychological problems in teachers.

Methods

This is a cross-sessional mixed methods study with data to be collected from subscribers of Wellness4Teachers using a web-based survey at baseline (onset of text messaging), 6 weeks, the program’s midpoint (3 months), and end point (6 months). Teachers can subscribe to the Wellness4Teachers program by texting the keyword “TeachWell” to the program phone number. Outcome measures will be assessed using standardized rating scales and key informant interviews. Data will be analyzed with descriptive and inferential statistics using SPSS and thematic analysis using NVivo.

Results

The results of this study are expected 24 months after program launch. It is expected that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Alberta and Nova Scotia would be comparable to those reported in other jurisdictions. It is also expected that factors such as gender, number of years teaching, grade of teaching, and school type (elementary vs high school) will have an association with burnout and other psychological disorders among teachers. Furthermore, it is expected that Wellness4Teachers will reduce the prevalence and severity of psychological problems in teachers, and subscriber satisfaction will be high.

Conclusions

The Wellness4Teachers project will provide key information regarding prevalence and correlates of common mental health conditions in teachers in Alberta and Nova Scotia, as well as the impact of daily supportive text messages on these mental health parameters. Information from this study will be useful for informing policy and decision-making concerning psychological interventions for schoolteachers.

Reducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program

Background

Individuals discharged from inpatient psychiatry units have the highest readmission rates of all hospitalized patients. These readmissions are often due to unmet need for mental health care compounded by limited human resources. Reducing the need for hospital admissions by providing alternative effective care will mitigate the strain on the healthcare system and for people with mental illnesses and their relatives. We propose implementation and evaluation of an innovative program which augments Mental Health Peer Support with an evidence-based supportive text messaging program developed using the principles of cognitive behavioral therapy.

Methods

A pragmatic stepped-wedge cluster-randomized trial, where daily supportive text messages (Text4Support) and mental health peer support are the interventions, will be employed. We anticipate recruiting 10,000 participants at the point of their discharge from 9 acute care psychiatry sites and day hospitals across four cities in Alberta. The primary outcome measure will be the number of psychiatric readmissions within 30 days of discharge. We will also evaluate implementation outcomes such as reach, acceptability, fidelity, and sustainability. Our study will be guided by the Consolidated Framework for Implementation Research, and the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Data will be extracted from administrative data, surveys, and qualitative methods. Quantitative data will be analysed using machine learning. Qualitative interviews will be transcribed and analyzed thematically using both inductive and deductive approaches.

Conclusions

To our knowledge, this will be the first large-scale clinical trial to assess the impact of a daily supportive text message program with and without mental health peer support for individuals discharged from acute psychiatric care. We anticipate that the interventions will generate significant cost-savings by reducing readmissions, while improving access to quality community mental healthcare and reducing demand for acute care. It is envisaged that the results will shed light on the effectiveness, as well as contextual barriers and facilitators to implementation of automated supportive text message and mental health peer support interventions to reduce the psychological treatment and support gap for patients who have been discharged from acute psychiatric care.

Trial registration

clinicaltrials.gov, NCT05133726. Registered 24 November 2021

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07510-8.

The Text4HealthyAging Program: An Evidence-Based Text Messaging Innovation to Support Healthy Urban Aging in Canada and Australia

Age-friendly cities are crucial to achieve the WHO goal of healthy aging. Such cities promote opportunities for health, participation, and security, thus enhancing quality of life as people age. Older people commonly experience psychosocial challenges such as anxiety, depression, substance abuse, loss of autonomy, grief, fear, and loneliness. Australian and Canadian cities continue to seek innovation to improve healthy urban aging and create more age-friendly environments for older adults. There is increasing evidence on the effectiveness and feasibility of mobile technology in health promotion and closing psychological treatment gaps. Older adults have been demonstrated to engage frequently with mobile devices, particularly text messaging. In this article, we conceptualize the Text4HealthyAging, an evidence-based text messaging innovation to support healthy urban aging in Canadian and Australian cities.

Current directions in digital interventions for mood and anxiety disorders

PURPOSE OF REVIEW

The purpose of this review is to provide an overview of the current scope of digital interventions for anxiety and mood disorders, with a focus on smartphone apps, for clinicians and mental healthcare providers.

RECENT FINDINGS

Of the 11 randomized controlled trials analyzed, 7 showed evidence that guided digital interventions (those supported by humans) were effective in improving anxiety and mood symptoms, and 3 showed evidence that unguided (those not supported by humans) interventions were effective. Psychoeducation was the most popular feature of both guided and unguided interventions. Attrition was highest (50%) in the unguided app-based intervention and lowest in the guided interventions. Many studies lacked active control groups and comparison was often made to a nondigital or waitlist control condition.

SUMMARY

Guided digital interventions continue to show promising results and can be used to enhance clinical care with minimal resources although more direct comparisons to existing treatments are necessary to understand their actual efficacy. Unguided self-help apps and chatbots remain promising, but more work is necessary to understand the real-world engagement and efficacy of these interventions.

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.

Bereavement during the COVID-19 Pandemic: Impact on Coping Strategies and Mental Health

The COVID-19 coronavirus has caused 5.4 million deaths worldwide, including over 800,000 deaths in the United States (as of December 2021). In addition to these staggering statistics, an even greater number of individuals have died from other causes during the COVID-19 pandemic. As a result, a large portion of the global population has faced bereavement during the COVID-19 pandemic and resulting quarantine. The often rapid and unexpected nature of COVID-19 deaths and the presence of pandemic-related stressors and living restrictions make it more difficult for individuals bereaved during the pandemic to implement effective strategies for coping with the loss compared to non-pandemic periods. Quarantine-related constraints (e.g., social distancing, availability of and access to resources) impede coping strategies that have been found to be adaptive after a loss, such as supportive (e.g., seeking emotional and instrumental support) and active (e.g., problem-focused and cognitive reframing) coping, and they augment avoidant strategies (e.g., substance use, denial, and isolation) that have been found to be maladaptive. Poorer mental health outcomes (including prolonged grief disorder; PGD) have been associated with less healthy coping. This article reviews research findings regarding bereavement during the COVID-19 pandemic, discusses the effects of pandemic-related stressors on bereavement coping strategies, and proposes how different types of coping during the pandemic may account for the poorer mental health outcomes described in recent reports. Interventions for promoting adaptive coping strategies and minimizing maladaptive coping strategies are also outlined.

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.

Prevalence and Determinants of Generalized Anxiety Disorder Symptoms in Residents of Fort McMurray 12 Months Following the 2020 Flooding

BACKGROUND

The flood in Fort McMurray (FMM) which occurred between April 26 and May 2, 2020, is known to have displaced an estimated population of 1,500 people, and destroyed or damaged about 1,230 buildings. In all, it is estimated to have caused about $228 million in losses.

OBJECTIVE

This study aims to identify the prevalence and determinants of likely Generalized Anxiety disorder (GAD) in among respondents 12-months after the 2020 flooding.

METHODS

Data for the study were collected through a cross-sectional survey sent through REDCap and hosted online from the 24th of April to the 2nd of June 2021. The self-administered questionnaire was emailed to respondents using community, government, school, and occupational platforms. Demographic, flooding-related variables, and clinical data were collected. A validated instrument, the GAD-7 was used to collect information on likely GAD. Consent was implied by completing the survey forms, and the University of Alberta Health Research Ethics Committee approved the study.

RESULTS

Of the 249 residents surveyed, 74.7% (186) respondents completed the online survey, 81.6% (80) were above 40 years, 71% (132) were in a relationship, 85.5% (159) were females, and 94.1% (175) were employed. The prevalence of likely GAD was 42.5% in our study. Predictors of likely GAD among respondents included positive employment status (OR = 30.70; 95% C.I. 2.183-423.093), prior diagnosis of depression (OR = 3.30; 95% C.I. 1.157-9.43), and the perceived need to have mental health counseling (OR = 6.28; 95% C.I. 2.553-15.45).

CONCLUSION

This study showed that there was an increased magnitude of moderate to high anxiety symptoms among respondents following the natural disaster particularly the flood in 2020. The predictors of likely GAD include positive employment status, history of depression diagnosis, and the need to have mental health counseling. Policymakers may mitigate the rise of anxiety after flooding in vulnerable areas by addressing these and other factors.

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.

A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study

BACKGROUND

Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19-related depression and anxiety symptoms among people who speak English and Spanish in the United States.

OBJECTIVE

This paper describes the changes in StayWell participants' anxiety and depression levels after 60 days of exposure to skills-based SMS text messages.

METHODS

We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later.

RESULTS

The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of -1.72 (95% CI -2.35 to -1.09) in PHQ-8 scores and -0.48 (95% CI -0.71 to -0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively.

CONCLUSIONS

StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/23592.

Prevalence of Major Depressive Disorder and Correlates of Thoughts of Death, Suicidal Behaviour, and Death by Suicide in the Geriatric Population-A General Review of Literature

Background: There has been an increase in deaths by suicide in old age in the last decade. Depression and suicide in the elderly, 60 years and above, is a major global public health concern. Determining the prevalence of depression, and correlates of death by suicide in the geriatric population, is an important first step toward addressing this public health concern. This literature review aims to determine the prevalence of major depressive disorders and the correlates of death by suicide in the geriatric population. Methods: This general review of the literature was performed using relevant search terms to determine both the prevalence of depression and the correlates of death by suicide among the geriatric population. Databases such as MEDLINE, PsycINFO, CINAHL, and PubMed were searched. Relevant and current articles were extracted, reviewed, and analyzed. The elderly population was defined as individuals 60 years and above. Only full texts articles in English were reviewed. Findings: The prevalence estimates of major depressive disorder in the elderly ranged from 5.37 to 56%. Adults aged 60 years and older have a high risk of depression that exposes them to suicide. Moreover, elderly women are more likely to experience depression than elderly men, but successful suicide is more common in men. Depression and other mental health conditions (schizophrenia, anxiety disorders) and perceived stress were found to be predictors of suicide in the elderly. Other predictors included physical illnesses such as malignancies, financial constraints, cuckoldry, and sexual dysfunction, and also social factors like living alone triggers depressive symptoms and increases suicidal risk in the elderly. Hanging was found to be the most common method of death by suicide for both sexes. While elderly women preferred poisoning, elderly men in Western countries preferred firearms. Differences in gender, the aging process and social issues were also contributing factors to methods used for suicide. Conclusions: Depression and debilitating physical illnesses were identified as significant contributors to suicide risk in the elderly population, and emphasis should be placed on identifying these factors early and treating them. Recognizing and addressing factors that predict suicide in the elderly will help to improve the mental wellbeing of the elderly.

Anxiety, Depression and Posttraumatic Stress Disorder after Terrorist Attacks: A General Review of the Literature

Terrorism, though not well-defined, is a violent act that has been shown to have longstanding effects on the mental health of those who witness it. The aim of this general literature review is to explore the effect that terrorism has on posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and anxiety disorders, as well as the bio-psycho-social determinants that mediate its impact. This paper describes the prevalence, risk factors, protective factors, common presentations and interventions identified for PTSD, depression and anxiety disorders occurring following terrorist attacks. We conducted a literature search in MEDLINE using a number of keywords detailed below. After applying inclusion and exclusion criteria, we kept 80 articles, which we summarized in tabular form. A majority of articles found detailed the impact of terrorism on PTSD, and took place in a Western, mainly American setting. The main factors that impacted the presentation of mental illness include gender, ethnicity, social supports, socioeconomic status, level of preparedness, level of exposure, pre-existing trauma and mental illness, and subsequent life stressors. The main intervention detailed in this article as showing evidence post-terrorism is trauma-focused cognitive-behavioural therapy. This study highlights the importance of this topic, and in particular, its implications for public health policy and practice.

The Impact of Wildfires on Mental Health: A Scoping Review

One of the many consequences of climate change is an increase in the frequency, severity, and, thus, impact of wildfires across the globe. The destruction and loss of one's home, belongings, and surrounding community, and the threat to personal safety and the safety of loved ones can have significant consequences on survivors' mental health, which persist for years after. The objective of this scoping review was to identify primary studies examining the impact of wildfires on mental health and to summarize findings for PTSD, depression, anxiety, and substance use. Literature searches on Pubmed and Embase were conducted in February and April of 2021, respectively, with no date restrictions. A total of 254 studies were found in the two database searches, with 60 studies meeting the inclusion criteria. Three other studies were identified and included based on relevant in-text citations during data abstraction. The results show an increased rate of PTSD, depression, and generalized anxiety at several times of follow-up post-wildfire, from the subacute phase, to years after. An increased rate of mental health disorders post-wildfire has been found in both the adult and pediatric population, with a number of associated risk factors, the most significant being characteristics of the wildfire trauma itself. Several new terms have arisen in the literature secondary to an increased awareness and understanding of the impact of natural disasters on mental health, including ecological grief, solastalgia, and eco-anxiety. There are a number of patient factors and systemic changes that have been identified post-wildfire that can contribute to resilience and recovery.

Social and Mental Health Impact of Nuclear Disaster in Survivors: A Narrative Review

This narrative review synthesizes the literature on the psychological consequences of the Three Mile Island nuclear accident of 1979, the Chernobyl nuclear disaster of 1986, and the Fukushima nuclear disaster of 2011. A search was conducted on OVID for studies in English from 1966 to 2020. Fifty-nine studies were included. Living through a nuclear disaster is associated with higher levels of PTSD, depression, and anxiety. Decontamination workers, those living in closest proximity to the reactor, and evacuees experience higher rates of mental health problems after a nuclear disaster. Those with greater psychological resilience and social supports experience lower rates of psychological distress. Individual-level interventions, such as mindfulness training, behavioral activation, and cognitive reappraisal training, have shown modest benefits on improving psychological wellbeing. At the population level, many of the measures in place aimed at reducing exposure to radiation actually increase individuals’ anxiety. Technology-based supports have been studied in other types of natural disasters and it may be beneficial to look at mobile-based interventions for future nuclear disasters.

Prevalence and Correlates of Likely Major Depressive Disorder among the Adult Population in Ghana during the COVID-19 Pandemic

Background: Emerging research suggests that the novel coronavirus disease (COVID-19) pandemic and associated public health restrictions have caused psychological distress in many contexts. In order for public health authorities and policy makers to effectively address the psychological distress associated with the pandemic, it is important to determine the prevalence and correlates of mental disorders, including depression. Objectives: We aimed to determine the prevalence, and demographic, social, clinical and other COVID-19 related correlates of major depressive disorder symptoms among the general population in Ghana during the COVID-19 pandemic. Method: The study was a cross-sectional survey using online data collection methods. The survey assessed demographic, social and clinical variables as well as COVID-19 related variables. Major depressive disorder symptoms were assessed using the Patient Health Questionnaire-9. The survey link was distributed primarily through WhatsApp-based platforms. Data were analyzed using descriptive and inferential statistics. Results: The overall prevalence of likely MDD symptoms among the sample population was 12.3%. Variables such as employment, loss of jobs during the pandemic and rate of exposure to COVID-related news were independently and significantly associated with the likelihood that respondents had likely MDD. Variables such as gender, relationship, housing status and having a family member or friend who was sick from COVID-19 were not independently significantly associated with the likelihood that respondents had likely MDD, when all other factors in the model were controlled. Conclusion: This study has identified the prevalence and correlates of depression symptoms in Ghana during the COVID-19 pandemic. There is the urgent need for mental health policy makers and the government of Ghana to have policies in place to alleviate the potential threat to the mental health of the population.

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.

An E-Mental Health Solution to Prevent and Manage Post-Traumatic Stress Injuries among First Responders in Alberta: Protocol for the Implementation and Evaluation of Text4PTSI and Text4Wellbeing (Preprint)

Background

First responders are confronted with traumatic events in their work that has a substantial toll on their psychological health and may contribute to or result in posttraumatic stress injuries (PTSIs) for many responders. Persons with a PTSI usually seek management therapies. Evidence indicates that digital delivery of these therapies is an innovative, efficient, and effective way to improve PTSI symptoms as an adjunct to in-person delivery.

Objective

This project aims to implement and provide accessible, convenient, and economical SMS text messaging services, known as Text4PTSI and Text4Wellbeing, to first responders in Alberta, Canada; to prevent and improve the symptoms of PTSI among first responders; and to improve their overall quality of life. We will evaluate posttraumatic symptoms and the impact of Text4PTSI and Text4Wellbeing on stress, anxiety, and depression in relation to the correspondents’ demographic backgrounds.

Methods

First responders who subscribe to Text4PTSI or Text4Wellbeing receive daily supportive and psychoeducational SMS text messages for 6 months. The SMS text messages are preprogrammed into an online software program that delivers messages to subscribers. Baseline and follow-up data are collected through online questionnaires using validated scales at enrollment, 6 weeks, 12 weeks, and 24 weeks (end point). In-depth interviews will be conducted to assess satisfaction with the text-based intervention.

Results

We hypothesize that participants who enroll in this program will have improved PTSI symptoms; increased or improved quality of life; and significant reduction in associated stress, depression, and anxiety symptoms, among other psychological concerns. Improvement will be determined in comparison to established baseline parameters.

Conclusions

This research will be beneficial for practitioners and will inform policy-making and decision-making regarding psychological interventions for PTSI. Lessons from this study will inform the scale-up of the intervention, a cost-effective, zero contact therapeutic option to manage PTSI.

International Registered Report Identifier (IRRID)

PRR1-10.2196/30680

The Role of Social Determinants in Mental Health and Resilience After Disasters: Implications for Public Health Policy and Practice

In this general literature review, we will explore the impacts and contribution of social determinants to mental health and resiliency following both natural and man-made disasters. Natural disasters, such as wildfires, earthquakes, tsunamis, and hurricanes, as well as man-made disasters, such as civil wars, have been known to inflict significant damage to the mental health of the victims. In this paper, we mainly explore some most studied vulnerability and protective social determinant factors such as gender, age, ethnicity, socials support and socioeconomic status for the mental health and resiliency in survivors of such disasters. Several other possible factors such as previous trauma, childhood abuse, family psychiatric history, and subsequent life stress that were explored by some studies were also discussed. We conducted a literature search in major scientific databases, using keywords such as: mental health, social determinants, disasters, wildfires, earthquakes, terrorist attacks, and resilience. We discuss the implications for public health policy and practice.