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COVID-19: Closing the Psychological Treatment Gap during the Pandemic, a Protocol for Implementation and Evaluation of Text4Hope (a Supportive Text Message Program).

BACKGROUND
Coronavirus disease 2019 (COVID-19) has spread globally with far-reaching, significant and unprecedented impacts on health and way of life. Threats to mental health, psychological safety and well being are now emerging, increasing the impact of this virus on world health. Providing support for these challenges is difficult because of very high numbers of people requiring support in the context of a need to maintain physical distancing. This protocol describes use of text messaging (Text4Hope) as a convenient, cost-effective, and accessible population-level mental health intervention. This program is evidence-based, with prior research supporting good outcomes and high user satisfaction.


OBJECTIVE
The project goal is to implement a program of daily supportive text messaging (Text4Hope) to reduce distress related to the COVID-19 crisis initially amongst Canadians. Prevalence of stress, anxiety and depressive symptoms, demographic correlates of the same, and the outcomes of the Text4Hope intervention in mitigating distress will be evaluated.


METHODS
Self-administered, anonymous, online questionnaires will be used to assess stress (Perceived Stress Scale), anxiety (GAD-7), and depressive symptoms (PHQ-9). Data will be collected at baseline (onset of text messaging), at program midpoint (6-weeks), and end (12-weeks).


RESULTS
Data analysis will include parametric and non-parametric techniques, focusing on primary outcomes (i.e., stress, anxiety, depressive symptoms) and metrics of use, including number of subscribers and user satisfaction. Given the large size of the data set, machine learning and data-mining methods will also be used.


CONCLUSIONS
This COVID-19 project will provide key information regarding prevalence rates of stress, anxiety, and depressive symptoms during the pandemic, demographic correlates of distress, and outcome data related to this scalable population-level intervention. Information from this study will be valuable for practitioners, as useful for informing policy and decision-making regarding psychological interventions during the pandemic.


CLINICALTRIAL