Smartphone app helps healthcare workers deal with COVID-19’s mental toll

Mindfulness-based mobile health (mHealth) interventions could help ease the psychological burden of caring for patients with the novel coronavirus disease (COVID-19) among healthcare workers when used in conjunction with proven therapies, according to a recent study.

“[O]ur results suggest that although the mHealth interventions may not be effective as a standalone strategy, one possibility to benefit from apps could be to integrate them into a clinical setting and use them in conjunction with other evidence-based treatments,” the researchers said. “This is a relevant field that is still not well understood and should be further investigated.”

In the present blinded, parallel-group, controlled trial, 482 healthcare workers providing face-to-face care to COVID-19 patients were randomly assigned to either receive the PsyCovidApp intervention (n=248) or a control app (n=234). The primary outcome of interest was a composite of stress, anxiety, and depression; data were collected over the telephone at baseline and after the 2-week trial period.

At the time of enrolment, 90.2 percent of participants had been providing healthcare to COVID-19 patients for more than 4 weeks, while only 13.5 percent had been diagnosed with the infection. A third (33.4 percent) believed that they had been given inadequate means with which to protect themselves from the virus. [JMIR Mhealth Uhealth 2021;9:e27039]

A small minority of participants were either on psychotropic medications (16.4 percent) or were receiving psychotherapy (8.9 percent).

Concomitantly, mental health symptoms were prevalent in the participants: 42.7 percent had signs of depression, 51.9 percent of anxiety, 40.2 percent of post-traumatic stress, and 60.6 percent of stress. Burnout was also high among participants, with 58.5 percent and 34.2 percent presenting with emotional exhaustion and depersonalization, respectively.

After 2 weeks of intervention, scores for the composite outcome decreased overall in both the PsyCovidApp and control arms, with no significant difference between groups (standardized mean difference [SMD], –0.04, 95 percent confidence interval [CI], –0.11 to 0.04; p=0.15).

Similarly, the PsyCovidApp did not prove to be significantly superior to the control in terms of secondary outcome measures, such as participant trauma, burnout, insomnia, and self-efficacy, as well as app usability (p>0.05 for all).

However, subgroup analyses showed that the active intervention was significantly more effective than the control at improving the primary composite mental health outcome among healthcare workers taking psychotropic medications (SMD, –0.29, 95 percent CI, –0.48 to –0.09; p=0.004) or receiving psychotherapy (SMD, –0.25, 95 percent CI, –0.49 to –0.02; p=0.02).

In both participant subgroups, PsyCovidApp also significantly eased the burden of anxiety, insomnia, and stress, while also helping to combat post-traumatic stress in healthcare workers taking psychotropic medications.

“The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to frontline health care workers, who are facing high levels of workload under psychologically difficult situations with scarce resources and support,” the researchers said.

“PsyCovidApp may therefore improve mental health among healthcare workers who are already using other effective interventions, such as psychotherapy or pharmacological treatments,” they added.