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

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.