Abstract
BackgroundThe COVID-19 pandemic has largely affected people’s mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic.ObjectiveMaking use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19–related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients’ rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation.MethodsA large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points—before (N=1719) and after (n=738) rehabilitation—between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19–related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed.ResultsPatients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F4,2028=183.74, P<.001, η2p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F1,837=31.67, P<.001, η2p=0.04), had lower financial worries (F1,837=38.96, P<.001, η2p=0.04), but had higher household-related worries (F1,837=5.34, P=.02, η2p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F1,712=23.21, P<.001, η2p=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (F3,2021=51.41, P<.001, η2p=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (β=–.14, P<.001), anxiety (β=–.12, P<.001), loneliness (β=–.18, P<.001), and stress postrehabilitation (β=–.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F1,725=4.82, P=.03, η2p=0.01) and anxiety (F1,725=6.22, P=.01, η2p=0.01) from pre- to postrehabilitation.ConclusionsThis study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare.Trial RegistrationClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735
Highlights
Mental Health and the COVID-19 PandemicThe COVID-19 pandemic has led to rapid changes in the lives of people all over the world, affecting both physical health as well as mental health and well-being [1]
With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (β=–.14, P
Concerning participants from the psychosomatic rehabilitation clinics, 1719 participants participated in the survey before their rehabilitation stay
Summary
The COVID-19 pandemic has led to rapid changes in the lives of people all over the world, affecting both physical health as well as mental health and well-being [1]. A study by Wang et al asked respondents to assess the psychological impact of the COVID-19 pandemic on their mental health. Recent studies from the United States highlighted the worldwide increase in depressive symptoms as well as in symptoms of anxiety, which occurred about three times more frequently during the COVID-19 pandemic than before. Research has indicated that pre-existing mental health conditions may worsen due to COVID-19 [7,8]. The COVID-19 pandemic has largely affected people’s mental health and psychological well-being. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic
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