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

PROJECT SUMMARY The novel coronavirus disease (COVID-19) pandemic has created a significant physical, mental, and economic health crisis (Guan et al., 2019; Pfefferbaum et al., 2020; Yao et al., 2020; Zhou et al., 2020;) Notably, the pandemic has disproportionately and negatively impacted Black, Latinx, and American Indian (BLAI) communities (Karaca-Mandic et al., 2020). BLAI populations experience higher rates of chronic health conditions compared to non-Latino White (NLW) populations, which increases their risk for serious illness if they contract COVID-19. They also are less likely to be insured and/or have less access to healthcare (CDC, 2020) and are more likely to work and live in situations that increase their risk for COVID-19 exposure (e.g., essential workers). Subsequently, clear health disparities have emerged in rates of COVID-19 exposure, hospitalization, and death among BLAI relative to NLW individuals (CDC, 2020; CDC, 2020). Similarly, emerging data indicates that there are greater mental health disparities associated with COVID-19 that are experienced by racial/ethnic minority groups relative to NLWs (CDC, 2020; Fitzpatrick et al., 2020; Fitzpatrick et al., 2020). For example, measures taken to slow the spread of the virus (e.g., social distancing, business, and school closures) have disproportionate negative impacts on the mental health of BLAI populations because of multigenerational social determinants of health (i.e., essential jobs and greater elder and childcare responsibilities), which challenge the ability to follow recommendations (Hooper et al., 2020). These factors, coupled with less access to behavioral health treatment (SAMHSA, 2020), are likely to result in increased mental health disparities among BLAI (Chowkwanyun, 2020) in part, due to their increased risk for COVID-19 exposure and worse outcomes as well as decreased access to behavioral health care (relative to NLW populations). The current project addresses health disparities in access to behavioral health care during COVID-19 among BLAI via the evaluation of an adaptation of our established, validated, low-cost, mobile application ('app') that will target ongoing mental health concerns among BLAI with elevated anxiety and/or depressive symptoms. Using 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 (Taylor et al., 2020). In addition, 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, 200 NLW) will be randomized to either our clinical grade app (EASE) or to an active standard-of-care control digital mindfulness intervention (Mindfulness-Based Control App) for anxiety and depression. Mindfulness-Based Control App, which will serve as the comparator/control condition for this proposal, is a readily available, evidence-based guided meditation and mindfulness app designed to promote wellness and healthy living and to reduce stress and anxiety. The present study will include a baseline assessment, a 3- month intervention period, a 3-month continued assessment period (with access to intervention materials), 3- and 6-month post-baseline assessments, and a qualitative interview via phone or online platform (e.g., Zoom) at the 6-month assessment. Participants will complete two scheduled daily smartphone-based 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 (EASE group); all assessments will be completed remotely. Further, the parent study will evaluate the effectiveness of the experimental intervention across race/ethnic group. A.1. Intervention Effects: Compare the effect of EASE with COVID-19 specific elements (Intervention group, n=400) to an established empirically validated standard-of-care digital intervention with COVID-19 specific elements (Control group, n=400). H1: Those assigned to EASE will show greater reductions in anxiety and depression symptoms, and greater reductions in functional impairment in daily responsibilities (e.g., work performance, household maintenance, and social interactions, and relationships) relative to the control group. H2: Effectiveness of EASE will be similar across racial/ethnic groups. A.2. Mechanisms of Action and Moderators: Identify mechanisms underlying intervention effects. H3: Intervention effects on study outcomes will be mediated by reductions in anxiety sensitivity and changes in COVID-19 related stress and fear. H4: Perceived discrimination (worse intervention outcomes), social support (better intervention outcomes), and socioeconomic status (SES; lower SES associated with worse outcomes) will be examined as potential moderators of the EASE effects. A.3. Exploratory Aims: (a) Identify opportunities to improve the efficacy, reach, and adoption of EASE through qualitative interviews. (b) Utilize daily EMAs to obtain a granular understanding of the course (e.g., treatments received, duration of symptoms) and sequelae (e.g., job loss, eviction, reduction of unemployment benefits) of the COVID-19 pandemic and health behaviors affected by COVID-19 (i.e., physical activity, pain experience, sleep) among those who do and do not contract the virus.