Wells Kenneth, Thames April Denise, Young Alexander S, Zhang Lily, Heilemann MarySue V, Romero Daniela Flores, Oliva Adrian, Jones Felica, Tang Lingqi, Brymer Melissa, Elliott Thomas, Arevian Armen
Research Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States.
JMIR Form Res. 2022 Dec 7;6(12):e42031. doi: 10.2196/42031.
The COVID-19 pandemic increased disparities for communities burdened by structural barriers such as reduced affordable housing, with mental health consequences. Limited data are available on digital resources for public mental health prevention during the COVID-19 pandemic.
The study aim was to evaluate engagement in and impact of free digital resources on the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website during COVID-19 in California.
A pilot evaluation of T4W/Juntos was performed, with partner agencies inviting providers, clients, and partners to visit the website and complete surveys at baseline (September 20, 2021, to April 4, 2022) and at 4-6-week follow-up (October 22, 2021, to May 17, 2022). Website use was assessed by three engagement items (ease of use, satisfaction, relevance), comfort in use, and use of six resource categories. Primary outcomes at follow-up were depression and anxiety (scores≥3 on Patient Health Questionnaire-2 item [PHQ2] and Generalized Anxiety Disorder-2 item [GAD2] scales). Secondary outcomes were post-pre differences in PHQ2 and GAD2 scores, and use of behavioral health hotlines and services the month before follow-up.
Of 366 eligible participants, 315 (86.1%) completed baseline and 193 (61.3%) completed follow-up surveys. Of baseline participants, 72.6% identified as female, and 21.3% identified as lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+). In terms of ethnicity, 44.0% identified as Hispanic, 17.8% as African American, 26.9% as non-Hispanic white, and 11.4% as other ethnicity. Overall, 32.7% had moderate anxiety or depression (GAD2/PHQ2≥3) at baseline. Predictors of baseline website engagement included being Hispanic versus other race/ethnicity (β=.27, 95% CI .10-.44; P=.002) and number of COVID-19-related behavior changes (β=.09, 95% CI .05-.13; P<.001). Predictors of comfort using the website were preferring English for website use (odds ratio [OR] 5.57, 95% CI 2.22-13.96; P<.001) and COVID-19-related behavior changes (OR 1.37, 95% CI 1.12-1.66; P=.002); receiving overnight behavioral health treatment in the prior 6 months (OR 0.15, 95% CI 0.03-0.69, P=.015) was associated with less comfort in website use. The main predictor of depression at follow-up (PHQ2≥3) was baseline depression (OR 6.24, 95% CI 2.77-14.09; P<.001). Engagement in T4W/Juntos was associated with lower likelihood of depression (OR 0.54, 95% CI 0.34-0.86; P=.01). Website use the month before follow-up was associated with a post-pre reduction in PHQ2 score (β=-.62, 95% CI -1.04 to -0.20; P=.004). The main predictor of GAD2≥3 at follow-up was baseline GAD2≥3 (OR 13.65, 95% CI 6.06-30.72; P<.001). Greater baseline website engagement predicted reduced hotline use (OR 0.36, 95% CI 0.18-0.71; P=.004).
Ethnicity/language and COVID-19-related behavior changes were associated with website engagement; engagement and use predicted reduced follow-up depression and behavioral hotline use. Findings are based on participants recommended by community agencies with moderate follow-up rates; however, significance was similar when weighting for nonresponse. This study may inform research and policy on digital mental health prevention resources.
新冠疫情加剧了因经济适用房减少等结构性障碍而负担沉重的社区的不平等现象，并对心理健康产生了影响。关于新冠疫情期间用于公共心理健康预防的数字资源的数据有限。
本研究旨在评估加利福尼亚州新冠疫情期间“共同促进健康/携手共筑福祉”（T4W/Juntos）网站上免费数字资源的参与度及其影响。
对T4W/Juntos进行了一项试点评估，合作机构邀请提供者、客户和合作伙伴访问该网站，并在基线期（2021年9月20日至2022年4月4日）和4-6周随访期（2021年10月22日至2022年5月17日）完成调查。通过三个参与度项目（易用性、满意度、相关性）、使用舒适度以及六个资源类别的使用情况来评估网站使用情况。随访期的主要结局是抑郁和焦虑（患者健康问卷-2项[PHQ2]和广泛性焦虑障碍-2项[GAD2]量表得分≥3）。次要结局是PHQ2和GAD2得分的前后差异，以及随访前一个月行为健康热线和服务的使用情况。
在366名符合条件的参与者中，315名（86.1%）完成了基线调查，193名（61.3%）完成了随访调查。在基线参与者中，72.6%为女性，21.3%为女同性恋、男同性恋、双性恋、跨性别、酷儿/疑问者及其他（LGBTQ+）群体。在种族方面，44.0%为西班牙裔，17.8%为非裔美国人，26.9%为非西班牙裔白人，11.4%为其他种族。总体而言，32.7%的参与者在基线期有中度焦虑或抑郁（GAD2/PHQ2≥3）。基线期网站参与度的预测因素包括西班牙裔与其他种族/族裔相比（β = 0.27，95%可信区间0.10 - 0.44；P = 0.002）以及与新冠疫情相关的行为变化数量（β = 0.09，95%可信区间0.05 - 0.13；P < 0.001）。使用网站舒适度的预测因素是更喜欢使用英语访问网站（优势比[OR] 5.57，95%可信区间2.22 - 13.96；P < 0.001）以及与新冠疫情相关的行为变化（OR 1.37，95%可信区间1.12 - 1.66；P = 0.002）；在过去6个月内接受过夜行为健康治疗（OR 0.15，95%可信区间0.03 - 0.69，P = 0.015）与网站使用舒适度较低相关。随访期抑郁（PHQ2≥3）的主要预测因素是基线期抑郁（OR 6.24，95%可信区间2.77 - 14.09；P < 0.001）。参与T4W/Juntos与抑郁可能性降低相关（OR 0.54，95%可信区间0.34 - 0.86；P = 0.01）。随访前一个月的网站使用与PHQ2得分的前后降低相关（β = -0.62，95%可信区间 -1.04至 -0.20；P = 0.004）。随访期GAD2≥3的主要预测因素是基线期GAD2≥3（OR 13.65，95%可信区间6.06 - 30.72；P < 0.001）。基线期更高的网站参与度预测热线使用减少（OR 0.36，95%可信区间0.18 - 0.71；P = 0.004）。
种族/语言以及与新冠疫情相关的行为变化与网站参与度相关；参与度和使用情况预测随访期抑郁和行为热线使用减少。研究结果基于社区机构推荐的参与者，随访率适中；然而，在对无应答进行加权时，显著性相似。本研究可能为数字心理健康预防资源的研究和政策提供参考。
