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.

项目总结 新型冠状病毒病(新冠肺炎)的大流行给人们的身体、精神和 经济健康危机(关等人，2019；Pfefferbaum等人，2020；姚等人，2020；周等人，2020；) 值得注意的是，大流行对黑人、拉丁裔和美国印第安人产生了不成比例的负面影响 (BLAI)社区(Karaca-Mandic等人，2020年)。BLAI人群经历了更高的慢性健康比率 与非拉丁裔白人(NLW)人口相比，这会增加他们患严重疾病的风险 他们签约新冠肺炎。他们也不太可能有保险和/或更少地获得医疗保健(CDC， 2020年)，并且更有可能在增加他们接触新冠肺炎风险的情况下工作和生活(例如， 基本工人)。随后，在接触新冠肺炎的比率方面出现了明显的健康差距。 BLAI相对于NLW个人的住院和死亡(CDC，2020；CDC，2020)。同样， 新出现的数据表明，与新冠肺炎相关的心理健康差距更大 种族/少数民族群体相对于非低收入群体的经历(CDC，2020；Fitzpatrick等人，2020；Fitzpatrick 等人，2020年)。例如，为减缓病毒传播而采取的措施(例如，社交距离、商业、 和学校关闭)对BLAI人群的心理健康产生了不成比例的负面影响 由于多代人健康的社会决定因素(即基本工作和更多的老年人和儿童保育 责任)，这对遵守建议的能力构成了挑战(Hooper等人，2020年)。这些因素， 再加上获得行为健康治疗的机会较少(SAMHSA，2020)，可能会导致 BLAI(Chowkwanyun，2020)之间的心理健康差异，部分原因是他们患新冠肺炎的风险增加 暴露和更糟糕的结果以及获得行为保健的机会减少(相对于NLW 种群)。目前的项目解决了在获得行为保健方面的健康差距问题。 新冠肺炎通过对我们既定的、经过验证的、低成本的移动设备的改编进行评估，跻身BLAI 针对焦虑和/或升高的BLAI患者持续的心理健康问题的应用程序(APP 抑郁症状。使用精准医学的方法，缓解每个人的焦虑敏感 (EASE)APP针对焦虑敏感性，这是一种与病因学有关的跨诊断个体差异因素， 焦虑和抑郁症状的维持和发展(Taylor等人，2020年)。此外，还可以轻松 包括新冠肺炎症状监测、暴露管理技能，以及新冠肺炎上的心理教育- 相关压力以及压力对感染易感性和疾病进展的影响。参与者(N= 200名黑人、200名拉丁裔、200名美国印第安人、200名NLW)将被随机分配到我们的临床级别应用程序中 (EASE)或积极的护理标准控制数字正念干预(基于正念的控制 治疗焦虑和抑郁。 基于正念的控制应用程序，将作为这一提议的比较器/控制条件，是一个 现成的循证指导冥想和正念应用程序旨在促进健康和 健康的生活，减少压力和焦虑。本研究将包括一项基线评估、一项3- 1个月的干预期，3个月的持续评估期(可获得干预材料)，3- 和6个月的基线后评估，以及通过电话或在线平台(如Zoom)进行定性访谈 在为期6个月的评估中。参与者将完成两个预定的基于智能手机的日常生态 在干预期间和持续评估期间进行的瞬时评估(EMA)将指导 即时、个性化行为保健的即时方法(EASE组)；所有评估都将 远程完成。此外，家长研究将评估实验干预的有效性 跨种族/民族。 A.1.干预效果：比较EASE与新冠肺炎特异性元素的效果(干预组， N=400)建立了经经验验证的护理标准数字干预，该数字干预具有新冠肺炎特定的 对照组(n=400)。H1：那些被指派放松的人将显示出更大的焦虑和 抑郁症状，以及日常责任(例如，工作)中功能障碍的更大程度减少 表现、家庭维护、社会互动和关系)相对于对照组。 H2：在不同种族/民族之间，缓解的效果将是相似的。 A.2.行动机制和主持人：确定干预效果的潜在机制。H3： 对研究结果的干预效果将通过降低焦虑敏感度和改变 新冠肺炎带来的压力和恐惧。H4：感觉到的歧视(干预结果更差)、社会支持 (较好的干预结果)和社会经济地位(SES；较低的SES与较差的结果相关) 将被视为缓解效果的潜在缓和因素。 A.3.探索性目标：(A)确定通过以下方式提高EASE的有效性、覆盖面和采用率的机会 定性访谈。(B)利用每天的急诊检查，对疗程(例如，治疗)有详细的了解 收到、症状持续时间)和后遗症(例如，失业、被驱逐、失业救济金减少) 新冠肺炎大流行和新冠肺炎影响的健康行为(即体力活动、疼痛体验、 在那些感染和没有感染病毒的人中)。