Mobile Health to Monitor Risk for COVID-19 and Improve Mental Health during the Pandemic

移动医疗可监测 COVID-19 风险并改善大流行期间的心理健康

• 批准号: 10663119
• 负责人: Michael S. Businelle
• 金额: $ 2.56万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-05 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10663119
• 关键词: Address; Adoption; American Indians; Anxiety; Black race; Businesses; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 risk; COVID-19 stress; Cellular Phone; Cessation of life; Child Care; Chronic; Clinical; Communities; Contracts; Control Groups; Coupled; Data; Diagnostic; Disease Progression; Ecological momentary assessment; Effectiveness; Elements; Essential worker; Ethnic Population; Etiology; Evaluation; Fright; Health; Health behavior; Healthcare; Hospitalization; Household; Individual; Individual Differences; Infection; Intervention; Interview; Job loss; Latino; Latinx; Long-Term Care for Elderly; Maintenance; Measures; Mediating; Meditation; Mental Depression; Mental Health; Monitor; Occupations; Outcome; Outcome Study; Pain; Parents; Participant; Performance at work; Physical activity; Population; Predisposition; Psyche structure; Public Health; Randomized; Recommendation; Research; Risk; SARS-CoV-2 exposure; Schedule; Sleep; Social Distance; Social Interaction; Social support; Socioeconomic Status; Stress; Symptoms; Telephone; Testing; Time; Unemployment; United States Substance Abuse and Mental Health Services Administration; Virus; Work; access disparities; anxiety sensitivity; anxiety symptoms; behavioral health; cost; depressive symptoms; design; digital; digital intervention; effectiveness evaluation; ethnic minority population; evidence base; experience; functional disability; group intervention; health care availability; health disparity; health economics; improved; intervention effect; low socioeconomic status; mHealth; mindfulness; mindfulness intervention; mobile application; novel coronavirus; pandemic disease; perceived discrimination; precision medicine; psychoeducation; psychoeducational; racial minority population; racial population; school closure; skills; social health determinants; standard of care; stress reduction

PROJECT SUMMARY The novel coronavirus disease (COVID-19) pandemic has created a significant physical, mental, and economic health crisis (Guan et al., 2019; Pfefferbaum et al., 2020; Yao et al., 2020; Zhou et al., 2020;) Notably, the pandemic has disproportionately and negatively impacted Black, Latinx, and American Indian (BLAI) communities (Karaca-Mandic et al., 2020). BLAI populations experience higher rates of chronic health conditions compared to non-Latino White (NLW) populations, which increases their risk for serious illness if they contract COVID-19. They also are less likely to be insured and/or have less access to healthcare (CDC, 2020) and are more likely to work and live in situations that increase their risk for COVID-19 exposure (e.g., essential workers). Subsequently, clear health disparities have emerged in rates of COVID-19 exposure, hospitalization, and death among BLAI relative to NLW individuals (CDC, 2020; CDC, 2020). Similarly, emerging data indicates that there are greater mental health disparities associated with COVID-19 that are experienced by racial/ethnic minority groups relative to NLWs (CDC, 2020; Fitzpatrick et al., 2020; Fitzpatrick et al., 2020). For example, measures taken to slow the spread of the virus (e.g., social distancing, business, and school closures) have disproportionate negative impacts on the mental health of BLAI populations because of multigenerational social determinants of health (i.e., essential jobs and greater elder and childcare responsibilities), which challenge the ability to follow recommendations (Hooper et al., 2020). These factors, coupled with less access to behavioral health treatment (SAMHSA, 2020), are likely to result in increased mental health disparities among BLAI (Chowkwanyun, 2020) in part, due to their increased risk for COVID-19 exposure and worse outcomes as well as decreased access to behavioral health care (relative to NLW populations). The current project addresses health disparities in access to behavioral health care during COVID-19 among BLAI via the evaluation of an adaptation of our established, validated, low-cost, mobile application (‘app’) that will target ongoing mental health concerns among BLAI with elevated anxiety and/or depressive symptoms. Using a precision medicine approach, the Easing Anxiety Sensitivity for Everyone (EASE) app targets anxiety sensitivity, a transdiagnostic individual difference factor implicated in the etiology, maintenance, and progression of anxiety and depressive symptoms (Taylor et al., 2020). In addition, EASE includes COVID-19 symptom monitoring, exposure management skills, and psychoeducation on COVID-19- related stress and the impact of stress on susceptibility to infection and disease progression. Participants (N = 800; 200 Black, 200 Latinx, 200 American Indian, 200 NLW) will be randomized to either our clinical grade app (EASE) or to an active standard-of-care control digital mindfulness intervention (Mindfulness-Based Control App) for anxiety and depression. Mindfulness-Based Control App, which will serve as the comparator/control condition for this proposal, is a readily available, evidence-based guided meditation and mindfulness app designed to promote wellness and healthy living and to reduce stress and anxiety. The present study will include a baseline assessment, a 3- month intervention period, a 3-month continued assessment period (with access to intervention materials), 3- and 6-month post-baseline assessments, and a qualitative interview via phone or online platform (e.g., Zoom) at the 6-month assessment. Participants will complete two scheduled daily smartphone-based ecological momentary assessments (EMAs) during the intervention and continued assessment periods that will guide a just-in-time approach to immediate, personalized behavioral health care (EASE group); all assessments will be completed remotely. Further, the parent study will evaluate the effectiveness of the experimental intervention across race/ethnic group. A.1. Intervention Effects: Compare the effect of EASE with COVID-19 specific elements (Intervention group, n=400) to an established empirically validated standard-of-care digital intervention with COVID-19 specific elements (Control group, n=400). H1: Those assigned to EASE will show greater reductions in anxiety and depression symptoms, and greater reductions in functional impairment in daily responsibilities (e.g., work performance, household maintenance, and social interactions, and relationships) relative to the control group. H2: Effectiveness of EASE will be similar across racial/ethnic groups. A.2. Mechanisms of Action and Moderators: Identify mechanisms underlying intervention effects. H3: Intervention effects on study outcomes will be mediated by reductions in anxiety sensitivity and changes in COVID-19 related stress and fear. H4: Perceived discrimination (worse intervention outcomes), social support (better intervention outcomes), and socioeconomic status (SES; lower SES associated with worse outcomes) will be examined as potential moderators of the EASE effects. A.3. Exploratory Aims: (a) Identify opportunities to improve the efficacy, reach, and adoption of EASE through qualitative interviews. (b) Utilize daily EMAs to obtain a granular understanding of the course (e.g., treatments received, duration of symptoms) and sequelae (e.g., job loss, eviction, reduction of unemployment benefits) of the COVID-19 pandemic and health behaviors affected by COVID-19 (i.e., physical activity, pain experience, sleep) among those who do and do not contract the virus.

项目摘要 新型冠状病毒病（Covid-19）大流行创造了重要的身体，精神和 经济健康危机（Guan等，2019; Pfeferbaum等，2020; Yao等，2020; Zhou等，2020;）;） 值得注意的是，大流行对黑人，拉丁和美洲印第安人的影响不大和负面影响 （Blai）社区（Karaca-Mandic等人，2020年）。 与非拉丁裔白人（NLW）受欢迎的条件相比，这会增加严重的风险 他们签约了19年。 2020年），更有可能工作和生活在增加其Covid-19风险风险的网站上（例如， 基本工人）。 相对于NLW个人的住院和死亡（CDC，2020； CDC，2020年）。 新兴的数据表明，与Covid-19相关的心理心理心理健康纪律越来越大。 相对于NLW，由种族/族裔少数群体实验（CDC，2020； Fitzpatrick等，2020； Fitzpatrick 等，2020）。 和学校关闭）对泡沫人群的心理健康产生不利影响的影响 由于健康的多代社会决定因素（即基本工作以及更大的长者和育儿者 责任），挑战遵循建议的能力（Hooper等人，2020年）。 再加上较少获得行为健康terth沟槽的机会（Samhsa，2020年） Blai（Chokwanyun，2020年）之间的心理健康差异部分是因为它们对Covid-19的风险增加了 暴露和更糟糕的结果为-semign，是行为医疗保健（相对于NLW 人口）。 通过评估我们已建立的，经过验证，低成本，移动的改编 应用程序（“应用”）将针对焦虑症升高和或或或或或或或或或或或以或或或或或或或或或或或以或或或或或或或以或或或或以或或或以或或或以或或或以或或或为目标的心理健康问题 抑郁症状。 （轻松）应用靶向焦虑敏感性，这是一个涉及病因学的经诊断的个体差异因素， 维护和焦虑和抑郁症状的进展（Taylor等人，2020年） 包括-19症状监测，暴露管理技能以及COVID-19-的心理教育 相关压力和压力OND疾病的影响（n = n = n = n = 800; 200个黑色，200个拉丁裔，200 nlw）将被随机分配给我们的临床级应用 （轻松）或积极的护理标准控制数字正念干预 应用程序）焦虑和抑郁。 基于正念的控制应用程序将作为该提案的比较器/控制条件，是一个 可预订的，基于明显的有指导性冥想和正念应用程序，旨在促进健康和 健康的生活并减轻压力和焦虑。 月干预期，一个3个月的评估期（使用干预材料），3-- 和6个月后评估，以及通过电话或在线平台进行定性访谈（例如Zoom） 在6个月的评估中。 暂时评估（EMAS）在间隔和构成评估期内将指导 即时，个性化行为保健的及时方法（轻松组）； 远程完成。 跨种族/族裔。 A.1。 n = 400）与凭经验验证的验证标准数字干预措施，以covid-19的特定 元素（控制组，n = 400）。 深度症状和日常责任的功能性降低的较高的修复（例如，工作 相对于对照组的绩效，家庭维护和社交互动以及关系）。 H2：在种族/族裔群体之间，轻松的有效性将相似。 A.2。 对研究结果的干预影响将由焦虑敏感性和变化的变化介导 Covid-19相关的压力和恐惧。 （更好的干预结果）和社会经济状况（与结果较差相关的SES） 将被检查为轻松效率的潜在主持人。 A.3。 定性访谈。 接受，症状持续时间）和后遗症（例如，失业，驱逐，减少失业福利） COVID-19 COVID-19的大流行和健康行为受到COVID-19的影响（即体育锻炼，疼痛经验， 睡觉）在做病毒和不感染病毒之中。