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

摘要 在黑人中接触新冠肺炎、住院和死亡率方面已经出现了明显的健康差异， 拉丁裔和美国印第安人(BLAI)个人，相对于非拉丁裔白人(NLW)个人，以及BLAI 人群受到行为健康可获得性降低和负面心理加剧的不成比例的影响 大流行造成的健康后果。目前的项目直接与PAR-20的目标相一致- 243.它解决了在新冠肺炎期间BLAI通过一个 调整已建立的、初步验证的、低成本的移动应用程序(APP)，该应用程序的目标是持续进行 焦虑和/或抑郁症状升高的BLAI患者的心理健康问题。利用精确度 医学方法，缓解每个人的焦虑敏感(EASE)应用程序针对焦虑敏感，a 跨诊断个体差异因素在焦虑的病因、维持和进展中的作用 和抑郁症状。易用性包括新冠肺炎症状监测、暴露管理技能和 新冠肺炎相关应激心理教育及应激对感染易感性的影响 疾病的发展。参与者(N=800；200黑人、200拉丁裔、200美国印第安人和200 NLW)将是 随机进行缓解或主动标准护理控制数字干预(Headspace应用程序)，用于 焦虑和抑郁。本研究将包括基线评估、3个月干预期、 3个月持续评估期(可获得干预材料)，以及3个月和6个月后 基准评估，包括通过电话或在线平台(例如，Zoom)在6- 一个月的随访。参与者将完成两个预定的每日生态瞬时评估(EMA) 在干预和持续评估期间，这将指导采取及时的方法， 个性化的行为保健。评估将远程完成。目的1.比较两种药物的治疗效果 轻松使用新冠肺炎的特定元素(n=400)，以建立经经验验证的护理标准 使用新冠肺炎特定元素的数字干预(n=400)。为了评价实验的疗效 对每个种族/民族群体的干预。目的2.确定EASE的治疗机制，包括 理论驱动的中介变量(即焦虑敏感性、新冠肺炎相关压力的后续变化和 恐惧)和调解人(即感受到的种族歧视、社会支持和社会经济地位)。总的来说， 目前的提案有可能通过减少焦虑和 被确定为最有可能长期恶化的易受伤害人群中的抑郁症状 负面的健康后遗症。

ABSTRACT Clear health disparities have emerged in rates of COVID-19 exposure, hospitalization, and death among Black, Latinx, and American Indian (BLAI) individuals, relative to Non-Latino White (NLW) individuals, and BLAI populations are disproportionately affected by lower behavioral health access and heightened negative mental health outcomes as a result of the pandemic. The current project directly aligns with the objectives of PAR-20- 243 as it addresses health disparities in access to behavioral health care during COVID-19 among BLAI via an adaptation of the established, initially validated, low-cost, mobile application (‘app’) that will target ongoing mental health concerns among BLAI with elevated anxiety and/or depressive symptoms. Utilizing 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. 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, and 200 NLW) will be randomized to either EASE or to an active standard-of-care control digital intervention (Headspace app) for anxiety and depression. The present study will include a baseline assessment, a 3-month intervention period, a 3-month continued assessment period (with access to intervention materials), and 3- and 6-month post- baseline assessments that includes a qualitative interview via phone or online platform (e.g., Zoom) at the 6- month follow-up. Participants will complete two scheduled daily 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. Assessments will be completed remotely. Aim 1. To compare the effect of EASE with COVID-19 specific elements (n = 400) to an established empirically validated standard-of-care digital intervention with COVID-19 specific elements (n = 400). To evaluate the efficacy of the experimental intervention across each race/ethnic group. Aim 2. To identify the therapeutic mechanisms of EASE, including theoretically driven mediators (i.e., anxiety sensitivity, subsequent changes in COVID-19 related stress and fear) and moderators (i.e., perceived racial discrimination, social support, and socioeconomic status). Overall, the current proposal has the potential to significantly impact public health and safety by decreasing anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae.