Evolution of Mental Health Online Strategies from the Early Stage of the COVID-19 Pandemic to the Pre-Vaccination Period

Abstract

Background: The COVID-19 outbreak and its consequent quarantines, containment measures and social distancing imposed by authorities worldwide has caused an increase of psychological responses such as depression, abuse use, insomnia, post-traumatic stress symptoms, anger, anxiety, grief or confusion. This situation has fostered the implementation of new strategies like remote therapy to maintain the continuity of mental health (MH) care. Several international organizations (World Health Organization, the United Nations and the American Psychiatric Association) are focused on addressing the recovery from the COVID-19 pandemic, ensuring availability of emergency MH services, strengthening social cohesion, reducing the isolation, and promoting psychological support, as well as protecting human rights. This research aims to assess the evolution of online MH strategies and recommendations to cope with psychological impact of COVID-19 since early stages of the pandemic to pre-vaccination period. Methods: A sample of 24 online documents was analysed to assess their structural evolution from April 2020 to June 2021. Each document was analysed separately by two researchers. The questionnaire, developed by Almeda et al. (2021), was used to assess the content of these documents. This instrument consists of 39 items organized in seven domains (D) D1) Symptoms, D2) Mental disorders, D3) COVID-19 general information, D4) MH strategies and MH topics, D5) MH strategies and MH-related topics, D6) MH recommendations and MH topics and D7) MH recommendations and MH-related topics. To assess the structural evolution of the document in the selected periods, a T-Student for related samples was used. Results: Statistically significant differences with a negligible effect size were found in D1+D2 domains (t(23) = 3, p = 0.006, d = 0.18). An increasing concern on bereavement, sleeping problems and loneliness symptoms has been highlighted together with a greater interest on schizophrenia, bipolar disorder, chronic pain and obsessivecompulsive disorder. Statistically significant differences with negligible size effect were also found when the questions related to COVID-19 have been analysed (D3-D7;t(23) = 2.24, p = 0.035, d = 0.19). All COVID-19 information items have increased (D3) as also happened in most of the MH strategies and MH-related topics (80%;D5). In D7, D4 and D6 domains, a small increase in the information provided is highlighted. From an international point of view, England, Australia, New Zealand and Mexico are the countries with the highest rate of improvement in their strategies, followed by Ireland and Spain with small improvements. Finally, the information in the online documents of the rest of the countries remains stable. Conclusions: Online MH strategies and recommendations have improved during the pandemic period only in specific countries, especially in Mexico. Due to the high rate of mortality, bereavement has played a key role in the set of symptoms included. Globally speaking, the analysed countries are making efforts to address MH remotely, as it is evidenced in their online strategies.