JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic has largely affected mental health status and psychological well-being. Especially individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help to cope with these stressors. The internet and digital applications provide a platform to add to regular treatment and to conduct research on this topic.

Objective:

Making use of internet-based assessments, this study investigated individuals from the general population and individuals 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 common digital applications were compared. Furthermore, we investigated whether partaking in internet-delivered digital trainings prior to and during the rehabilitation stay, as well as the perceived usefulness of digital trainings are associated with improved mental health after rehabilitation.

Methods:

A large-scale online cross-section study was conducted among the general population (n=1812) in Germany from May 2020 to April 2021. In addition, a longitudinal study was conducted making use of the internet among psychosomatic rehabilitation patients at two measurement timepoints, before (n=1719) and after (n=738) medical rehabilitation, between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and corona-related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariances, exploratory factor analysis, and hierarchical regression analyses were performed.

Results:

Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F(4,2028)=183.74, P<.001, ηp2=.27) compared to the general population. Rehabilitation patients perceived greater satisfaction in communication with healthcare professionals (F(1,837)=31.67, P<.001, ηp2=.04), had lower financial worries (F(1,837)=38.96, P<.001, ηp2=.04), but higher household-related worries (F(1,837)=5.34, P=.02, ηp2=.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower post rehabilitation (F(1,712)=23.21, P<.001, ηp2=.04) than prior to the rehabilitation. Psychosomatic patients reported a greater intention to use common apps and digital trainings (F(3,2021)=51.41, P<.001, ηp2=.07) than the general population. With regard to digital trainings offered prior and during the rehabilitation stay, the perceived usefulness of digital rehabilitation goal trainings was associated with decreased symptoms of depression (ß=-.14, P<.001), anxiety (ß=-.12, P<.001), loneliness (ß=-.18, P<.001) and stress post rehabilitation (ß=-.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F(1,725)=4.82, P=.03, ηp2=.01) and anxiety (F(1,725)=6.22, P=.01, ηp2=.01) from pre to post-rehabilitation.

Conclusions:

This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the potentials of rehabilitation treatment. Digital rehabilitation components are promising tools that can prepare patients for their rehabilitation stay, integrated well with face-to-face therapy during rehabilitation and support care after rehabilitation.