A review has found that self-guided, internet-based mental health interventions may be both effective and scalable for reducing COVID-19-related anxiety and depressive symptoms.
The national lockdowns imposed in most countries across the world because of the COVID-19 pandemic have led to concerns over the mental health of many individuals. The challenge for mental health services for those affected by COVID-19 include several facets such as loneliness, boredom, depression, stress and anxiety. Moreover, for an intervention to be of wider value, it has to be scalable. Although previous reviews have synthetised the available data on mental health interventions in COVID-19, none have included randomised, controlled trials. As a result, a team from the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada, sought to conduct a systematic review of mental health interventions, including the results provided in both randomised and non-randomised clinical trials. Eligible studies were those designed to address COVID-19 mental health issues or mental health symptoms occurring as a result of infection with the virus. Trials were excluded where the intervention targeted non-mental health outcomes, e.g., exercise, even if the study also reported mental health outcomes. The team defined eligible outcomes as those which considered general mental health, mental health quality of life, anxiety and depressive symptoms or other emotional states. For included trials, the authors calculated between-group standardised mean differences (SMDs).
The researchers identified nine eligible trials. Three were well-conducted, randomised studies that tested interventions specifically for COVID-19 mental challenges and six trials of standard interventions such as individual or group therapy and considered outcomes such as mindfulness recording and which had been minimally adapted for COVID-19. Two of the well-designed trials used lay-delivered or peer-support interventions and the third, used an online cognitive behavioural therapy to address dysfunctional COVID-19 worry in the general population. In the online study, which included 670 participants, self-guided, internet-based cognitive behavioural interventions were used to target dysfunctional COVID-19 worries such as anxiety and depression. The study found that,COVID-19 anxiety reduced by an SMD of 0.74 and depressive symptoms by 0.38. In the trial of lay-delivered telephone support with 240 participants, only one measure of loneliness was reduced (SMD = 0.48). Among the six non-randomised trials, the SMD for anxiety was between 0.78 and 1.14.
The authors noted that the interventions delivered in the three randomised trials were easily scalable and appeared to reduce COVID-19 related anxiety and depressive symptoms and improved mental health function by an SMD of 0.46. In fact, the observed SMD changes were broadly in line with those seen after the use of antidepressants and cognitive behavioural therapy for depression. They concluded that self-guided online interventions that target the challenges posed by COVID-19, can help support the mental health impact of the pandemic. However, the lack of studies among children and adolescents was a concern that should be address in future research.
Bonardi O et al. Effects of COVID-19 Mental Health Interventions among Community-based Children, Adolescents, and Adults: A Living Systematic Review of Randomised Controlled Trials. MedRxiv 2021