PDF(Pubmed)
Abstract：
BACKGROUND: The COVID-19 pandemic involved a prolonged period of collective trauma and stress during which substantial increases in mental health concerns, like depression and anxiety, were observed across the population. In this context, CHAMindWell was developed as a web-based intervention to improve resilience and reduce symptom severity among a public health care system\'s patient population.
OBJECTIVE: This program evaluation was conducted to explore participants\' engagement with and outcomes from CHAMindWell by retrospectively examining demographic information and mental health symptom severity scores throughout program participation.
METHODS: We examined participants\' symptom severity scores from repeated, web-based symptom screenings through Computerized Adaptive Testing for Mental Health (CAT-MH) surveys, and categorized participants into symptom severity-based tiers (tier 1=asymptomatic to mild; tier 2=moderate; and tier 3=severe). Participants were provided tier-based mindfulness resources, treatment recommendations, and referrals. Logistic regressions were conducted to evaluate associations between demographic variables and survey completion. The McNemar exact test and paired sample t tests were performed to evaluate changes in the numbers of participants in tier 1 versus tier 2 or 3 and changes in depression, anxiety, and posttraumatic stress disorder severity scores between baseline and follow-up.
RESULTS: The program enrolled 903 participants (664/903, 73.5% female; 556/903, 61.6% White; 113/903, 12.5% Black; 84/903, 9.3% Asian; 7/903, 0.8% Native; 36/903, 4% other; and 227/903, 25.1% Hispanic) between December 16, 2020, and March 17, 2022. Of those, 623 (69%) completed a baseline CAT-MH survey, and 196 completed at least one follow-up survey 3 to 6 months after baseline. White racial identity was associated with completing baseline CAT-MH (odds ratio [OR] 1.80, 95% CI 1.14-2.84; P=.01). Participants\' odds of having symptom severity below the clinical threshold (ie, tier 1) were significantly greater at follow-up (OR 2.60, 95% CI 1.40-5.08; P=.001), and significant reductions were observed across symptom domains over time.
CONCLUSIONS: CHAMindWell is associated with reduced severity of mental health symptoms. Future work should aim to address program engagement inequities and attrition and compare the impacts of CHAMindWell to a control condition to better characterize its effects.
OBJECTIVE: This program evaluation was conducted to explore participants\' engagement with and outcomes from CHAMindWell by retrospectively examining demographic information and mental health symptom severity scores throughout program participation.
METHODS: We examined participants\' symptom severity scores from repeated, web-based symptom screenings through Computerized Adaptive Testing for Mental Health (CAT-MH) surveys, and categorized participants into symptom severity-based tiers (tier 1=asymptomatic to mild; tier 2=moderate; and tier 3=severe). Participants were provided tier-based mindfulness resources, treatment recommendations, and referrals. Logistic regressions were conducted to evaluate associations between demographic variables and survey completion. The McNemar exact test and paired sample t tests were performed to evaluate changes in the numbers of participants in tier 1 versus tier 2 or 3 and changes in depression, anxiety, and posttraumatic stress disorder severity scores between baseline and follow-up.
RESULTS: The program enrolled 903 participants (664/903, 73.5% female; 556/903, 61.6% White; 113/903, 12.5% Black; 84/903, 9.3% Asian; 7/903, 0.8% Native; 36/903, 4% other; and 227/903, 25.1% Hispanic) between December 16, 2020, and March 17, 2022. Of those, 623 (69%) completed a baseline CAT-MH survey, and 196 completed at least one follow-up survey 3 to 6 months after baseline. White racial identity was associated with completing baseline CAT-MH (odds ratio [OR] 1.80, 95% CI 1.14-2.84; P=.01). Participants\' odds of having symptom severity below the clinical threshold (ie, tier 1) were significantly greater at follow-up (OR 2.60, 95% CI 1.40-5.08; P=.001), and significant reductions were observed across symptom domains over time.
CONCLUSIONS: CHAMindWell is associated with reduced severity of mental health symptoms. Future work should aim to address program engagement inequities and attrition and compare the impacts of CHAMindWell to a control condition to better characterize its effects.
摘要：
背景：COVID-19大流行涉及长期的集体创伤和压力，在此期间精神健康问题大幅增加，比如抑郁和焦虑，在整个人口中观察到。在这种情况下，CHAMindWell是一种基于网络的干预措施，旨在提高公共卫生保健系统患者人群的弹性并降低症状严重程度。
目的：本项目评估旨在通过回顾性检查整个项目参与过程中的人口统计学信息和心理健康症状严重程度评分来探索参与者对CHAMindWell的参与和结果。
方法：我们检查了参与者的症状严重程度评分，通过计算机自适应心理健康测试（CAT-MH）调查进行基于网络的症状筛查，并将参与者分为基于症状严重程度的等级(1级=无症状至轻度;2级=中度;3级=重度).参与者被提供了基于层级的正念资源，治疗建议,和转介。进行Logistic回归以评估人口统计学变量与调查完成之间的关联。进行McNemar精确检验和配对样本t检验，以评估第1级与第2级或第3级参与者人数的变化以及抑郁的变化，焦虑,基线和随访之间的创伤后应激障碍严重程度评分。
结果：该计划在2020年12月16日至2022年3月17日期间招募了903名参与者（664/903，73.5％女性；556/903，61.6％白人；113/903，12.5％黑人；84/903，9.3％亚洲；7/903，0.8％本地；36/903，4％其他；227/903，25.1％西班牙裔）。其中,623（69%）完成了基线CAT-MH调查，196人在基线后3~6个月完成了至少一项随访调查.白人种族认同与完成基线CAT-MH相关（比值比[OR]1.80，95％CI1.14-2.84；P=0.01）。参与者出现症状严重程度低于临床阈值的几率(即，第1层)在随访时显著更大(OR2.60，95%CI1.40-5.08；P=.001)，随着时间的推移，在症状领域观察到显著减少。
结论：CHAMindWell与精神健康症状严重程度降低相关。未来的工作应旨在解决计划参与不平等和减员问题，并将CHAMindWell的影响与控制条件进行比较，以更好地表征其影响。
目的：本项目评估旨在通过回顾性检查整个项目参与过程中的人口统计学信息和心理健康症状严重程度评分来探索参与者对CHAMindWell的参与和结果。
方法：我们检查了参与者的症状严重程度评分，通过计算机自适应心理健康测试（CAT-MH）调查进行基于网络的症状筛查，并将参与者分为基于症状严重程度的等级(1级=无症状至轻度;2级=中度;3级=重度).参与者被提供了基于层级的正念资源，治疗建议,和转介。进行Logistic回归以评估人口统计学变量与调查完成之间的关联。进行McNemar精确检验和配对样本t检验，以评估第1级与第2级或第3级参与者人数的变化以及抑郁的变化，焦虑,基线和随访之间的创伤后应激障碍严重程度评分。
结果：该计划在2020年12月16日至2022年3月17日期间招募了903名参与者（664/903，73.5％女性；556/903，61.6％白人；113/903，12.5％黑人；84/903，9.3％亚洲；7/903，0.8％本地；36/903，4％其他；227/903，25.1％西班牙裔）。其中,623（69%）完成了基线CAT-MH调查，196人在基线后3~6个月完成了至少一项随访调查.白人种族认同与完成基线CAT-MH相关（比值比[OR]1.80，95％CI1.14-2.84；P=0.01）。参与者出现症状严重程度低于临床阈值的几率(即，第1层)在随访时显著更大(OR2.60，95%CI1.40-5.08；P=.001)，随着时间的推移，在症状领域观察到显著减少。
结论：CHAMindWell与精神健康症状严重程度降低相关。未来的工作应旨在解决计划参与不平等和减员问题，并将CHAMindWell的影响与控制条件进行比较，以更好地表征其影响。
