BACKGROUND The death toll of COVID-19 topped 170,000 in Europe by the end of May 2020. Covid-19 has caused an immense psychological burden on the population, especially doctors and nurses were faced with a high infection risk and increased workload. OBJECTIVE To compare the mental health of medical professionals with non-medical professionals in different European countries during COVID-19, assuming that medical professionals, particularly those exposed to COVID-19 at work, would have higher scores in depression, anxiety and stress, as well as to determine their main stressors and most frequently used coping strategies during the crisis. METHODS A cross-sectional online survey was conducted during peak COVID-19 months in eight European countries. The questionnaire included demographic data and whether the participants were exposed to COVID-19 at work or not. Mental health was assessed via the Depression-Anxiety-Stress Scales (DASS-21). A 12-item checklist on preferred coping strategies and another 23-item questionnaire on major stressors was filled by the medical professionals. RESULTS The sample (N=609) consisted of 189 doctors, 165 nurses and 255 non-medical professionals. Participants from France and the UK were more often assigned to the group with severe/extremely severe depression, anxiety and stress on DASS-21. Non-medical professionals had significantly higher scores for depression and anxiety. No significant link was reported between direct contact with COVID-19 patients at work and anxiety, depression or stress among medical professionals. ´Uncertainty about when the epidemic will be under control´ was the most stressful aspect among healthcare professionals while ´taking protective measures´” was the most frequently used coping strategy among all participants. CONCLUSIONS COVID-19 poses a major challenge to the mental health of the participants as a considerable proportion of them showed high values for depression, anxiety and stress. Even though the medical professionals showed less mental stress than the non-medical professionals, sufficient help should be offered to all occupational groups with an emphasis on effective coping strategies.

BACKGROUND The development of e-mental health applications for patients with depression has shown technological advances to a certain extent. Many feasibility studies reveal the acceptance of patients and evidence for positive treatment outcomes. However, few studies ask for the user experience regarding the personalized help of specific treatment components in self-management apps. OBJECTIVE The aim of the present study is to ask for the user experience and acceptance of patients with depression and healthy adults, who tested the app SELFPASS. The results serve as a source for evidence-based recommendations for developers and clinicians regarding the graphical and conceptual design of a self-management app for patients with depression with and without anxiety symptoms. METHODS The sample consisted of N=110 participants, of which 41 (37.3%) were adult patients and 69 (62.7%) healthy adults. They tested the app SELFPASS over a period of 5 days and filled out a self-developed evaluation questionnaire. Quantitative measures asked with 5-point Likert scaled items (range: -2 to +2) for the perceived quality of the program and its components, its practicality (both referred to as user experience), and its acceptance. Student t tests and Pearson correlations were calculated for comparisons of groups and associations between the measures. Open text fields were analyzed by applying a qualitative structuring content analysis regarding suggestions for usability, therapeutic content and personalization. RESULTS The perceived quality of the total program (PQTP) was rated with M=0.96 (SD=0.82), the practicality (P) was M=0.84 (SD=0.08), and the acceptance (A) was M=0.25 (SD=1.04). Patients rated PQTP and A higher than healthy adults, while there was no difference in P. Acceptance was associated with increased depression scores (r=.33, P=.01), higher scores of PQTP (r=0.48, P<.001) and of P (r=0.45, P<.001). Feedback of both groups regarding the usability, the therapeutic content and personalization revealed a strong wish for guidance and insights into mood progress, opportunities for choice of interventions and features of customization for an individualized treatment. CONCLUSIONS Patients with depression accepted the app SELFPASS more than healthy adults and gave higher ratings in quality. User experience of all users reveals a strong need for features of guidance, choice and personalization, that clinicians and developers of future apps should pay special attention to. CLINICALTRIAL Trial Registration: DRKS (DRKS00015614).

BACKGROUND COVID-19 has resulted in considerable mental health burden in the Chinese general population and health care workers at the beginning and peak of the pandemic. However, little is known about potentially vulnerable groups during the final stage of the lockdown. OBJECTIVE The aim of this survey study was to assess the mental health burden of different professions in China in order to find vulnerable groups, possible influencing factors, and the successful ways of coping during the last four weeks of the lockdown in Hubei province. METHODS A cross-sectional online survey asked participants about current residence, daily working hours, exposure to COVID-19 at work and media preferences. We used Depression-Anxiety-Stress Scales (DASS-21) for the assessment of mental health. Further assessments included perceived stress (CPSS-14), coping strategies for all participants and specific stressors for health care workers. We follow the reporting guidelines of the STROBE statements for observational studies. RESULTS The sample (N=687) consisted of 158 doctors, 221 nurses, 24 other medical staff, 43 students, 60 teachers/government staff, 135 economy staff, 26 workers/farmers and 20 others. We found 17.9% cases of increased depression, 30.3% anxiety and 13.7% stress. Other medical staff and students were vulnerable to depression while doctors, nurses and students were vulnerable to anxiety. Other medical staff, students and economy staff were vulnerable to stress. Coping strategies were reduced to three factors: active, mental and emotional. Being female and emotional coping were independently associated with depression, anxiety or stress. Applying active coping strategies showed lower odds for anxiety while mental coping strategies showed lower odds for depression, anxiety and stress. Age, being inside a lockdown area, exposure to COVID-19 at work and having a high workload (8-12h per day) was not associated with any symptoms. WeChat was the preferred way of staying informed in all groups. CONCLUSIONS By the end of the lockdown a considerable part of the Chinese population showed increased levels of depression and anxiety. Students and other medical staff were the most affected, while economy staff were highly stressed. Doctors and nurses need support regarding potential anxiety disorders. Future work should focus on longitudinal results of the pandemic and develop targeted preventive measures. CLINICALTRIAL not applicable

BACKGROUND E-mental-health applications targeting at depression and anxiety have gained increased attention in mental health care. Daily self-assessment is an essential part of e-mental-health apps. The app SELFPASS (Self-administered-Psycho-TherApy-SystemS) is a self-management app to manage depressive and anxious symptoms. A self-developed item pool with 40 depression items and 12 anxiety items is included to provide symptom specific suggestions for interventions. However, the psychometric properties of the item pool have not yet been tested. OBJECTIVE The aim of this study is to investigate the validity and reliability of the SELFPASS item pool that has been developed for an internet-based daily self-assessment of depressive and anxious symptoms. METHODS An online link with the SELFPASS item pool and validated mood assessment scales were distributed to healthy subjects and patients who had received a diagnosis of a depressive disorder within the last year. Two scores were derived from the SELFPASS item pool: SELFPASS depression (SP-D) and SELFPASS anxiety (SP-A). The reliability was examined using Cronbach’s α. The construct validity was assessed via Pearson correlations with the Patients Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder Scale-7 (GAD-7) and the WHO-5-Wellbeing-Scale (WHO-5). A logistic regression was performed as an indicator for concurrent criterion validity of SP-D and SP-A. A factor analysis provides information about the underlying factor structure of the item pool. Item-scale-correlations were calculated in order to determine item quality. RESULTS A total of n=284 participants were included, with n=192 (67.6%) healthy subjects and n=92 (32.4%) patients. Cronbach’s α was α=0.94 for SP-D and α=0.88 for SP-A. We found significant positive correlations of SP-D and PHQ-9 (r=0.87, P<.001), SP-A and GAD-7 (r=0.80, P<.001), and negative correlations of SP-D and WHO-5 (r=-0.80, P<.001) and SP A and WHO-5 (r=-.69, P<.001). Increasing scores of SP-D and SP-A led to increased odds of belonging to the patient group (SP-D: OR=1.03 (1.01 – 1.05), P<.001; SP-A: 1.05 (1.05 – 1.01), P=.01). The item pool showed two factors with one that consisted of mood-related items and another factor with somatic-related items. CONCLUSIONS The SELFPASS item pool showed good psychometric properties in terms of reliability, construct and criterion validity. However, the underlying factor structure could not be reduced to the two diagnostic categories depression and anxiety, but to a more mood related and a rather somatic factor. Few items should be replaced for future use.