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

摘要 黑人的COVID-19暴露率、住院率和死亡率出现了明显的健康差异， 拉丁裔和美洲印第安人（BLAI）个体，相对于非拉丁裔白色（NLW）个体和BLAI 人口不成比例地受到较低的行为健康访问和较高的负面心理 这是由于大流行造成的健康后果。目前的项目直接符合PAR-20的目标， 243，因为它通过一个 对已建立的、经过初步验证的、低成本的移动的应用程序（“app”）进行调整， 精神健康问题的BLAI与焦虑和/或抑郁症状升高。利用精确的 EASE（Easing Anxiety Sensitivity for Everyone）应用程序针对焦虑敏感性， 跨诊断个体差异因素与焦虑的病因、维持和进展有关 和抑郁症状。EASE包括COVID-19症状监测、暴露管理技能和 关于COVID-19相关压力以及压力对感染易感性的影响的心理教育， 疾病进展。受试者（N = 800; 200名黑人、200名拉丁裔、200名美洲印第安人和200名NLW）将 随机分配至EASE或主动标准治疗对照数字干预（Headspace app）， 焦虑和抑郁。本研究将包括基线评估，3个月的干预期， 3-一个月的持续评估期（可获得干预材料），以及3个月和6个月后， 基线评估包括通过电话或在线平台进行的定性访谈（例如，放大）在6- 月随访。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， 个性化的行为健康护理。评估将远程完成。目标1。为了比较 将COVID-19特异性元素（n = 400）简化为经经验验证的既定标准治疗 具有COVID-19特定元素的数字干预（n = 400）。为了评估实验性的 对每个种族/族裔群体的干预。目标2.确定EASE的治疗机制，包括 理论上驱动的介体（即，焦虑敏感性，COVID-19相关压力的后续变化， 恐惧）和调节器（即，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， 被确定为最有可能发生恶化、长期 负面健康后遗症。

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.