Abstract
ObjectiveDue to the wide impact of the COVID-19 pandemic on mental health, the need for scalable interventions that can effectively reduce psychological distress has been recognized. Expressive writing (EW) can be beneficial for different conditions, including depression, suicidal ideation, and coping with trauma. Therefore, we aim to assess the applicability and effectiveness of an online format of EW in the reduction of psychological distress in context of the COVID-19 pandemic.MethodsIn this parallel-group, randomized controlled trial, participants (n = 120) were randomly allocated to (1) the intervention group-who completed five EW sessions over the 2 week period-or (2) the control group-who received treatment as usual (TAU). Participants were assessed for primary and secondary outcome measures at baseline, post-treatment, and follow-up-1-month after the treatment. The primary outcome was severity of psychological distress assessed at post-treatment, operationalized as Depression Anxiety Stress Scale (DASS) summary score. Secondary outcomes were severity of depression, anxiety, and stress (DASS subscale scores), well-being (WHO-5), subjective perception of quality of life (SQOL), and subjective evaluation of difficulties coping with pandemic, which were also assessed at post-treatment. Per protocol, analysis was conducted with available cases only.ResultsA less favorable outcome was found in the intervention group on psychological distress, and symptoms of stress, after controlling for baseline scores. Increased stress was recorded in the treatment group, with no effect in the control group. There was no significant difference between the groups on depression, anxiety, well-being, and subjective quality of life. No group effect for any of the outcomes measures was recorded at follow-up. Additional analysis revealed moderation effects of age and gender with older and male participants scoring higher on distress measures.ConclusionEngaging in EW during the pandemic was found to elevate stress; thus, when applied in the context of the COVID-19 pandemic, it may be harmful. Hence, EW or similar self-guided interventions should not be applied without prior evidence on their effects in the context of a pandemic and similar stressful and unpredictable circumstances.Clinical Trial RegistrationThis study is approved by the Institutional Ethics Committee (Protocol number #2020-20), and a trial has been registered at ISRCTN registry https://www.isrctn.com/ISRCTN17898730.
Highlights
The current COVID-19 pandemic brought numerous physical and mental health risks, which have been shown to lead to moderate to severe depression, anxiety, and traumatic stressrelated difficulties in the general population (Wang et al, 2020)
There was no significant difference between the groups on depression, anxiety, well-being, and subjective quality of life
This study aims to assess the effectiveness of Expressive writing (EW) interventions in the reduction of psychological distress in the general population during the COVID-19 pandemic by conducting a randomized controlled trial (RCT)
Summary
The current COVID-19 pandemic brought numerous physical and mental health risks, which have been shown to lead to moderate to severe depression, anxiety, and traumatic stressrelated difficulties in the general population (Wang et al, 2020). In addition to the pandemic itself, various measures for the prevention and spread of COVID-19 have both short- and long-term negative impacts on mental health and well-being (Brooks et al, 2020). The negative social and economic impacts of the pandemic are expected, which represent additional risk factors for mental health. These multifactorial and complex effects should be expected to persist for a long period of time after the pandemic is over. To prevent and mitigate the negative effects of the COVID-19 pandemic, it was recognized that the development and implementation of mental health programs, including assessment, support, and treatment should be prioritized (Xiang et al, 2020)
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