A Mobile Phone-Based Intervention to Reduce Mental Health Problems in Health Care Workers During the COVID-19 Pandemic (PsyCovidApp): Randomized Controlled Trial

被引:109
作者
Antonia Fiol-DeRoque, Maria [1 ,2 ]
Jesus Serrano-Ripoll, Maria [1 ,2 ,3 ]
Jimenez, Rafael [1 ,3 ]
Zamanillo-Campos, Rocio [1 ,2 ,4 ]
Maria Yanez-Juan, Aina [1 ,5 ]
Bennasar-Veny, Miquel [1 ,6 ]
Leiva, Alfonso [1 ,2 ,7 ]
Gervilla, Elena [1 ,3 ]
Esther Garcia-Buades, M. [3 ]
Garcia-Toro, Mauro [1 ]
Alonso-Coello, Pablo [8 ,9 ]
Pastor-Moreno, Guadalupe [8 ,10 ]
Ruiz-Perez, Isabel [8 ,10 ]
Sitges, Carolina [1 ,3 ,11 ]
Garcia-Campayo, Javier [7 ,12 ]
Llobera-Canaves, Joan [1 ,2 ,7 ]
Ricci-Cabello, Ignacio [1 ,2 ,8 ]
机构
[1] Hlth Res Inst Balearic Isl, Palma De Mallorca, Spain
[2] Balearic Isl Hlth Serv, Primary Care Res Unit Mallorca, Palma De Mallorca, Spain
[3] Univ Balearic Isl UIB, Dept Psychol, Palma De Mallorca, Spain
[4] Valencian Int Univ VIU, Dept Hlth, Valencia, Spain
[5] Univ Balearic Isl, Res Grp Global Hlth & Human Dev, Palma De Mallorca, Spain
[6] Univ Balearic Isl, Dept Nursing & Physiotherapy, Palma De Mallorca, Spain
[7] Primary Care Prevent & Hlth Promot Res Network, Madrid, Spain
[8] CIBER Epidemiol & Salud Publ, Madrid, Spain
[9] Iberoamer Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Biomed Res Inst St Pau, Barcelona, Spain
[10] Andalusian Sch Publ Hlth, Granada, Spain
[11] Res Inst Hlth Sci, Dept Psychol, Palma De Mallorca, Spain
[12] Miguel Servet Univ Hosp, Aragon Inst Hlth Res, Zaragoza, Spain
关键词
COVID-19; randomized controlled trial; mental health; health care workers; mHealth; app; INSOMNIA SEVERITY INDEX; ANXIETY STRESS SCALES; PSYCHOMETRIC PROPERTIES; SPANISH VERSION; DEPRESSION; SYMPTOMS; EFFICACY; METAANALYSIS; VALIDATION; VALIDITY;
D O I
10.2196/27039
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to health care workers, who are facing heavy workloads under psychologically difficult situations. Mental mobile Health (mHealth) interventions are now being widely deployed due to their attractive implementation features, despite the lack of evidence about their efficacy in this specific population and context. Objective: The aim of this trial is to evaluate the effectiveness of a psychoeducational, mindfulness-based mHealth intervention to reduce mental health problems in health care workers during the COVID-19 pandemic. Methods: We conducted a blinded, parallel-group, controlled trial in Spain. Health care workers providing face-to-face health care to patients with COVID-19 were randomly assigned (1:1) to receive the PsyCovidApp intervention (an app targeting emotional skills, healthy lifestyle behavior, burnout, and social support) or a control app (general recommendations about mental health care) for 2 weeks. The participants were blinded to their group allocation. Data were collected telephonically at baseline and after 2 weeks by trained health psychologists. The primary outcome was a composite of depression, anxiety, and stress (overall score on the Depression Anxiety Stress Scale-21 [DASS-21]). Secondary outcomes were insomnia (Insomnia Severity Index), burnout (Maslach Burnout Inventory Human Services Survey), posttraumatic stress (Davidson Trauma Scale), self-efficacy (General Self-Efficacy Scale), and DASS-21 individual scale scores. Differences between groups were analyzed using general linear modeling according to an intention-to-treat protocol. Additionally, we measured the usability of the PsyCovidApp (System Usability Scale). The outcome data collectors and trial statisticians were unaware of the treatment allocation. Results: Between May 14 and July 25, 2020, 482 health care workers were recruited and randomly assigned to PsyCovidApp (n=248) or the control app (n=234). At 2 weeks, complete outcome data were available for 436/482 participants (90.5%). No significant differences were observed between the groups at 2 weeks in the primary outcome (standardized mean difference -0.04; 95% CI -0.11 to 0.04; P=.15) or in the other outcomes. In our prespecified subgroup analyses, we observed significant improvements among health care workers consuming psychotropic medications (n=79) in the primary outcome (-0.29; 95% CI -0.48 to -0.09; P=.004), and in posttraumatic stress, insomnia, anxiety, and stress. Similarly, among health care workers receiving psychotherapy (n=43), we observed improvements in the primary outcome (-0.25; 95% CI -0.49 to -0.02; P=.02), and in insomnia, anxiety, and stress. The mean usability score of PsyCovidApp was high (87.21/100, SD 12.65). After the trial, 208/221 participants in the intervention group (94.1%) asked to regain access to PsyCovidApp, indicating high acceptability. Conclusions: In health care workers assisting patients with COVID-19 in Spain, PsyCovidApp, compared with a control app, reduced mental health problems at 2 weeks only among health care workers receiving psychotherapy or psychotropic medications. Trial Registration: ClinicalTrials.gov NCT04393818; https://clinicaltrials.gov/ct2/show/NCT04393818. (JMIR Mhealth Uhealth 2021;9(5):e27039) doi: 10.2196/27039
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